CAJ | 학술논문

目的探讨经阴道注水腹腔镜盆腔粘连松解术(THLPA)治疗不孕症的安全性和有效性.方法自2007年5月至2008年9月,对30例不孕患者进行THLPA,术中同时行输卵管染色通液术及宫腔镜检查与宫腔镜输卵管口插管通液术.盆腔粘连评分按照美国生育学会(AFS)1985年修订的子宫内膜异位症分期法(r-AFS)标准进行.按总分将盆腔粘连分为轻度粘连(24例,1～9分)、中度粘连(5例,10～19分)、重度粘连(1例,≥20分).记录手术时间与术后离院时间、盆腔粘连评分与粘连松解情况、输卵管通畅性、并发症及术后妊娠情况.结果 (1)THLPA:除7条输卵管近端周围的少量薄膜粘连未松解,5个卵巢的固有韧带处的少量薄膜粘连未松解外,其余所有盆腔薄膜粘连均被松解.全部患者中有4个卵巢存在致密粘连,未能松解.(2)输卵管通畅性:输卵管染色通液术中发现,35条输卵管近端阻塞,经宫腔镜输卵管口插管通液术治疗后,有21条(60%,21/35)输卵管被疏通,另有4条(11%,4/35)输卵管部分被疏通.(3)手术时间:轻度、中度和重度粘连患者的总手术时间分别为(32±6)、(52±6)和83 min,其中THLPA时间分别为(11±5)、(35±7)和62 min.(4)离院时间:全部患者的术后离院时间为120～175 min.无并发症发生.(5)妊娠率:术后随访(15.8±4.3)个月,妊娠率为45%(13/29),1例失访.结论 THLPA可行、有效、安全、不需住院,非常适用于经阴道注水腹腔镜检查中发现的薄膜粘连、特别是轻度盆腔粘连的治疗.
목적 탐토경음도주수복강경분강점련송해술(THLPA)치료불잉증적안전성화유효성.방법 자2007년5월지2008년9월,대30례불잉환자진행THLPA,술중동시행수란관염색통액술급궁강경검사여궁강경수란관구삽관통액술.분강점련평분안조미국생육학회(AFS)1985년수정적자궁내막이위증분기법(r-AFS)표준진행.안총분장분강점련분위경도점련(24례,1～9분)、중도점련(5례,10～19분)、중도점련(1례,≥20분).기록수술시간여술후리원시간、분강점련평분여점련송해정황、수란관통창성、병발증급술후임신정황.결과 (1)THLPA:제7조수란관근단주위적소량박막점련미송해,5개란소적고유인대처적소량박막점련미송해외,기여소유분강박막점련균피송해.전부환자중유4개란소존재치밀점련,미능송해.(2)수란관통창성:수란관염색통액술중발현,35조수란관근단조새,경궁강경수란관구삽관통액술치료후,유21조(60%,21/35)수란관피소통,령유4조(11%,4/35)수란관부분피소통.(3)수술시간:경도、중도화중도점련환자적총수술시간분별위(32±6)、(52±6)화83 min,기중THLPA시간분별위(11±5)、(35±7)화62 min.(4)리원시간:전부환자적술후리원시간위120～175 min.무병발증발생.(5)임신솔:술후수방(15.8±4.3)개월,임신솔위45%(13/29),1례실방.결론 THLPA가행、유효、안전、불수주원,비상괄용우경음도주수복강경검사중발현적박막점련、특별시경도분강점련적치료.
Objective To investigate the safety and efficacy of transvaginal hydrolaparoscopic pelvic adhesiolysis (THLPA) treatment in the infertile women.Methods From May 2007 to Sep.2008,30 infertile patients underwent THLPA.The dye-test,hysteroscopy,and dye-test using catheterization of tubal ostium by hysteroscopy were performed at the same time.Pelvic adhesions were scored according to the revised American Fertility Society classification of endometriosis (1985).The adhesions were graded as mild (score 1-9),moderate (10-19),and severe (≥20).Twenty-four cases were in mild adhesions,5 moderate adhesions,and 1 severe adhesion.The duration of the operation and discharge,pelvic adhesions score,tubal patency,complications,and pregnancy rate were investigated.Results (1) THPLA:the majority of pelvic adhesions in all patients were successfully performed adhesiolysis.Only a little filmy adhesions of proximal peritube of 7 tubes and proper ligament of 5 ovaries and cohesive adhesions of 4 ovaries did not underwent surgical lysis.(2) Tubal patency:35 tubes were of proximal occlusion by dye-test,of which 21 (60%,21/35) were unobstructed and 4 (11%,4/35) were partly unobstructed after the dye-test using catheterization of the tubal ostium by hysteroscopy.(3) The duration of operation:the overall operative time were (32±6) minutes in mild adhesion,(52± 6) minutes in moderate adhesion,and 83 minutes in severe adhesion.Of which the time of THLPA were (11±5) minutes in mild adhesion,(35±7)minutes in moderate adhesion,and 62 minutes in severe adhesion,respectively.(4)The duration of discharge:the postoperative discharge time was 120-175 minutes.No complications occurred.(5)The rate of pregnancy:in the (15.8±4.3) months' follow-up,the rate of pregnancy was 45% (13/29),which one patient lost follow-up.Conclusions THLPA is safe,efficacious and not being hospitalized management.When compared with laparoscopy,it is simpler,more economic,and less minimally invasive approach.The appropriate indication of THLPA is to treat filmy,especially mild pelvic adhesions.It could partly avoid transabdominal operative laparoscopy for the infertile women.