CAJ | 학술논문

目的：探讨腹腔镜手术对不孕症患者的诊断及治疗价值。方法回顾性分析新疆医科大学第一附属医院2010年9月－2014年5月收治的319例不孕症患者的临床资料，对所有患者行腹腔镜下诊断及相应的手术治疗（包括盆腔粘连分解、输卵管造口术、输卵管灼断术等）。结果319例患者腹腔镜术中检查与术前子宫输卵管碘油造影结果的符合率为72．1％（230／319），其中有43例术中发现子宫肌瘤，56例术中发现输卵管系膜囊肿，8例患者术中发现子宫内膜异位症，有2例患者诊断为盆腔结核，1例术中发现结肠肌瘤（术前考虑卵巢囊肿），其余为不同程度的盆腔慢性炎症。轻度粘连69例，妊娠21例，宫外孕2例，妊娠率33．33％。中重度粘连250例，其中行灼断术34例，灼断术患者后行体外受精及胚胎移植（IVF-ET），妊娠13例，妊娠率38．23％（13／34）。其余216例，失访 3例，妊娠31例，宫外孕 3例、妊娠率15．9％。结论腹腔镜对诊断输卵管性不孕及盆腔疾病有重要价值，子宫输卵管造影仅能初级筛查，诊断价值有限。在治疗输卵管粘连梗阻中，腹腔镜的治疗价值有待进一步探讨，临床预后与盆腔炎症的程度有关，应个体化选择手术方案。
목적：탐토복강경수술대불잉증환자적진단급치료개치。방법회고성분석신강의과대학제일부속의원2010년9월－2014년5월수치적319례불잉증환자적림상자료，대소유환자행복강경하진단급상응적수술치료（포괄분강점련분해、수란관조구술、수란관작단술등）。결과319례환자복강경술중검사여술전자궁수란관전유조영결과적부합솔위72．1％（230／319），기중유43례술중발현자궁기류，56례술중발현수란관계막낭종，8례환자술중발현자궁내막이위증，유2례환자진단위분강결핵，1례술중발현결장기류（술전고필란소낭종），기여위불동정도적분강만성염증。경도점련69례，임신21례，궁외잉2례，임신솔33．33％。중중도점련250례，기중행작단술34례，작단술환자후행체외수정급배태이식（IVF-ET），임신13례，임신솔38．23％（13／34）。기여216례，실방 3례，임신31례，궁외잉 3례、임신솔15．9％。결론복강경대진단수란관성불잉급분강질병유중요개치，자궁수란관조영부능초급사사，진단개치유한。재치료수란관점련경조중，복강경적치료개치유대진일보탐토，림상예후여분강염증적정도유관，응개체화선택수술방안。
Objective To disscuss the value of laparoscopy treatment and diagnosis in infertility.Methods Clinical information of 319 infertile patients from September 2010 to May 2014 was reviewed.All the pa-tients received a Diagnosis and operate therapy (include salpingostomy,adhesionlysis,fallotoimy)under laparoscope.Results The results of laparoscopic surgery in 230 (72.1%,230/319)cases was consistent with hysterosalpingography.There were 43 cases of uterine fibroids,56 cases of mesosalpinx cyst,8 cases of endometriosis and 2 cases of pelvic tuberculosis,1 case had colon myoma (diagnosis ovarian cyst before operation),the rest were pelvic inflammatory disease.69 cases was with mild adhesions,21 cases of preg-nancy,two cases of ectopic pregnancy,the pregnancy rate was 33.33%.250 cases with moderate to severe adhesions,the fallopian tube were broken in 34 cases,which were underwent IVF-ET,13 cases of preg-nancy,the pregnancy rate was 38.23% (13/34).The remaining 216 cases with three cases lost,pregnancy 31 cases,3 cases of ectopic pregnancy,the pregnancy rate was 15.9%.Conclusion Laparoscopy has more important value in diagnosis than hysterosalpinggography (HSG).The treatment value of Laparoscopy in salpingitis need more reserth datas to ensure,clinical prognosis is related with the degree of disease.We should select opration method individualization.