CAJ | 학술논문

目的探讨腹腔镜手术在输卵管阻塞性不孕合并子宫内膜异位症中的诊疗价值.方法 2006年5月至2010年5月我院行腹腔镜手术治疗输卵管阻塞患者381例,其中合并子宫内膜异位症119例,分析其诊疗结果,包括输卵管阻塞粘连分解伞端成形、子宫内膜异位症病灶清除电凝、内膜异位囊肿剥除术、术后妊娠等情况.结果因不孕行子宫输卵管碘油造影(HSG)或腹腔镜检查示输卵管阻塞(多为双侧)至少一侧位于远端(伞端)381例,行腹腔镜手术治疗,输卵管远端阻塞不伴子宫内膜异位症262例中临床妊娠82例,妊娠率31.3％;合并有子宫内膜异位症119例,占31.2％,妊娠29例,妊娠率24.4％,其中,输卵管粘连分级Ⅰ、Ⅱ级,子宫内膜异位症分期Ⅰ、Ⅱ期组(A组)42例,临床妊娠16例,占38.1％;输卵管粘连分级Ⅰ、Ⅱ级,子宫内膜异位症分期Ⅲ、Ⅳ期组(B组)26例,临床妊娠7例,占26.9％,输卵管粘连分级Ⅲ、Ⅳ级,子宫内膜异位症分期Ⅰ、Ⅱ期组(C组)28例,临床妊娠4例,占14.3％;输卵管粘连分级Ⅲ、Ⅳ级,子宫内膜异位症分期Ⅲ、Ⅳ期组(D组)23例,临床妊娠2例,占8.7％,A组的临床妊娠率明显高于B、C、D组,D组的临床妊娠率最低.结论腹腔镜手术是治疗输卵管阻塞性不孕合并子宫内膜异位症的最有效方法,不伴子宫内膜异位症的输卵管阻塞患者术后临床妊娠率明显高于合并子宫内膜异位症者,输卵管粘连轻子宫内膜异位症分期轻的患者术后临床妊娠率优于重者.
목적 탐토복강경수술재수란관조새성불잉합병자궁내막이위증중적진료개치.방법 2006년5월지2010년5월아원행복강경수술치료수란관조새환자381례,기중합병자궁내막이위증119례,분석기진료결과,포괄수란관조새점련분해산단성형、자궁내막이위증병조청제전응、내막이위낭종박제술、술후임신등정황.결과 인불잉행자궁수란관전유조영(HSG)혹복강경검사시수란관조새(다위쌍측)지소일측위우원단(산단)381례,행복강경수술치료,수란관원단조새불반자궁내막이위증262례중림상임신82례,임신솔31.3％;합병유자궁내막이위증119례,점31.2％,임신29례,임신솔24.4％,기중,수란관점련분급Ⅰ、Ⅱ급,자궁내막이위증분기Ⅰ、Ⅱ기조(A조)42례,림상임신16례,점38.1％;수란관점련분급Ⅰ、Ⅱ급,자궁내막이위증분기Ⅲ、Ⅳ기조(B조)26례,림상임신7례,점26.9％,수란관점련분급Ⅲ、Ⅳ급,자궁내막이위증분기Ⅰ、Ⅱ기조(C조)28례,림상임신4례,점14.3％;수란관점련분급Ⅲ、Ⅳ급,자궁내막이위증분기Ⅲ、Ⅳ기조(D조)23례,림상임신2례,점8.7％,A조적림상임신솔명현고우B、C、D조,D조적림상임신솔최저.결론 복강경수술시치료수란관조새성불잉합병자궁내막이위증적최유효방법,불반자궁내막이위증적수란관조새환자술후림상임신솔명현고우합병자궁내막이위증자,수란관점련경자궁내막이위증분기경적환자술후림상임신솔우우중자.
Objective To investigate the diagnosis and treatment value of laparoscopic surgery in tubal obstruction infertility patients with endometriosis.Methods Retrospective analysis was done in 381 cases underwent laparoscopic treatment for tubal obstruction from May 2005 to May 2010,,of which 119 cases were combined with endometriosis.The treatment results were analyzed,including the decomposition of the umbrella side tubal obstruction adhesions,lesions of endometriosis electrocoagulation,endometriosis cystectomy and pregnancy and so on.Results Hysterosalpingography(HSG)showed tubal occlusion in both side or one side in the distal end in 381 cases,and these patients were treated with laparoscopic surgery.There were 262 cases showed distal tubal occlusion not companied with endometriosis,of which 82 cases clinically pregnanced,accounting for 31.3％.Surgical treatment of endometriosis found in 119 cases,accounting for 31.2％ ; and 29 cases pregnaced,which accounted 24.4％.We found 42 cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,16 cases of clinical pregnancy,accounting for 38.1％ ;Twenty-six cases of tubal adhesions grade Ⅰ-Ⅱ and endometriosis stage Ⅰ-Ⅱ,7 cases of clinical pregnancy,accounting for 26.9％ ;Twenty-eitht cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅰ-Ⅱ,4 cases of clinical pregnancy,accounting for 14.3％ ;Twenty-three cases of tubal adhesions grade Ⅲ-Ⅳ and endometriosis stage Ⅲ-Ⅳ,2 cases of clinical pregnancy,accounting for 8.7％.The clinical pregnancy rate in the first group was significantly higher than the other groups,chnical pregnancy rate of the last group was the lowest.Conclusion Laparoscopic surgery is an effective treatment of tubal obstruction infertility combined with endometriosis.After laparoscopic surgery,the clinical pregnancy rate is significantly higher in Tubal obstruction without endometriosis than patients with endometriosis.After surgery,the clinical pregnancy rate in patients with the light stage tubal adhesions and endometriosis is better than those severely.