CAJ | 학술논문

目的评价输卵管妊娠保守手术后的不孕患者,经腹腔镜探查联合宫腔镜下输卵管口插管通液,不孕的因素及输卵管生育功能受损情况.方法 2008年12月至2010年10月在天津医科大学第二附属医院及中国人民武装警察部队后勤学院附属医院住院治疗,有输卵管妊娠保守手术史的不孕患者37例,采用腹腔镜观察盆腔粘连程度、输卵管形态、输卵管伞端等情况;并在腹腔镜监护下行宫腔镜下输卵管口插管通液,观察输卵管管腔是否通畅.结果 97.3％ (36/37)的患者存在输卵管不孕的因素,包括输卵管形态异常或周围粘连、伞端闭锁、管腔堵塞,至少有1个或多个因素合并存在.按每例患者2条输卵管计算,输卵管管腔堵塞79.7％(59/74),伞端闭锁54.1％(40/74),形态异常的发生率52.7％(39/74).盆腔粘连发生率平均89.2％,其中Ⅰ度21.6％,Ⅱ度32.4％,Ⅲ度35.1％,无Ⅳ度粘连.有妊娠史的一侧输卵管管腔堵塞75.7％、形态异常48.6％、伞端闭锁45.9％.无妊娠史的一侧输卵管,平均输卵管管腔堵塞86.5％、伞端闭锁62.2％,形态异常56.8％.患侧输卵管和对侧输卵管在输卵管形态、伞端形态、管腔堵塞方面相比较差异无统计学意义(P＞0.05).开腹保守治疗和腹腔镜保守治疗的患者在粘连程度、患侧及对侧输卵管形态、伞端形态、管腔堵塞等方面差异均无统计学意义(均P ＞0.05).结论输卵管妊娠保守手术后的不孕患者,不孕的主要原因为输卵管因素,包括盆腔粘连和输卵管形态异常、管腔堵塞.保守手术时采用开腹手术或者腹腔镜手术,对继发不孕的患者,生育力损害无明显区别.
목적 평개수란관임신보수수술후적불잉환자,경복강경탐사연합궁강경하수란관구삽관통액,불잉적인소급수란관생육공능수손정황.방법 2008년12월지2010년10월재천진의과대학제이부속의원급중국인민무장경찰부대후근학원부속의원주원치료,유수란관임신보수수술사적불잉환자37례,채용복강경관찰분강점련정도、수란관형태、수란관산단등정황;병재복강경감호하행궁강경하수란관구삽관통액,관찰수란관관강시부통창.결과 97.3％ (36/37)적환자존재수란관불잉적인소,포괄수란관형태이상혹주위점련、산단폐쇄、관강도새,지소유1개혹다개인소합병존재.안매례환자2조수란관계산,수란관관강도새79.7％(59/74),산단폐쇄54.1％(40/74),형태이상적발생솔52.7％(39/74).분강점련발생솔평균89.2％,기중Ⅰ도21.6％,Ⅱ도32.4％,Ⅲ도35.1％,무Ⅳ도점련.유임신사적일측수란관관강도새75.7％、형태이상48.6％、산단폐쇄45.9％.무임신사적일측수란관,평균수란관관강도새86.5％、산단폐쇄62.2％,형태이상56.8％.환측수란관화대측수란관재수란관형태、산단형태、관강도새방면상비교차이무통계학의의(P＞0.05).개복보수치료화복강경보수치료적환자재점련정도、환측급대측수란관형태、산단형태、관강도새등방면차이균무통계학의의(균P ＞0.05).결론 수란관임신보수수술후적불잉환자,불잉적주요원인위수란관인소,포괄분강점련화수란관형태이상、관강도새.보수수술시채용개복수술혹자복강경수술,대계발불잉적환자,생육력손해무명현구별.
Objective To evaluate the cause of infertility and tubal abnormality in women of tubal pregnancy after conservative treatment with laparotomy or laparoscopy through a combination of laparoscopy,hysteroscopic tubal catheterization and hydrotubation.Methods Laparoscopy was performed to observe pelvic adhesions,tube shape,fimbriated extremity of fallopian and other factors related with infertility for 37 inpatients with infertility after tubal pregnancy and undergoing conservative surgery during December 2008 and October 2010.Meanwhile,hysteroscopic tubal catheterization and hydrotubation were performed with laparoscopy to examine tube patency.Results Among them,97.3％ had tube infertility caused by tube abnormality and adhesions,or tube obstruction alone or concurrently.For all tubes,tube obstruction accounted for 79.7％ (59/74),fimrial occlusion of fallopian tube 54.1％ (40/74) and tube abnormality 52.7％ (39/74).Pelvic adhesion occurred at a rate of 89.2％ and there were Ⅰ degree (21.6％),Ⅱ degree (32.4％),Ⅲ degree (35.1％) and Ⅳ degree (0).For tubes with pregnancy history,48.6％ showed tube abnormality,45.9％ fimrial occlusion of fallopian tube and 75.7％ (28/37)tube obstruction.Comparatively,for the tubes without pregnancy history,56.8％ showed tube abnormality,62.2％ fimbrial occlusion of fallopian tube and 86.5％ tube obstruction.No significant difference existed in tube shape,umbrella end and tube obstruction between the tubes with pregnancy history and those without pregnancy history.Neither statistically significant difference was found in adhesion degree,tube shape,umbrella end and tube obstruction of diseased and normal tubes between laparotomy and laparoscopy groups.Conclusion Infertility of women after tubal pregnancy and conservative surgery is mainly caused by abnormal tube including pelvic adhesion,tube morphological abnormality and tube obstruction.No marked inter-group difference exists in fertility damage after conservative surgery with laparotomy or laparoscopy.