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输卵管妊娠后不孕患者宫腔镜与腹腔镜联合治疗分析

胡春秀1,陈亚琼2,陈俊1   

  1. 1. 武警医学院附属医院
    2.
  • 收稿日期:2010-02-08 修回日期:2011-04-05 出版日期:2011-08-15 发布日期:2011-08-15
  • 通讯作者: 胡春秀

Clinical analysis of female infertility following tubal pregnancy after hysteroscopic and laparoscopic surgery.

  • Received:2010-02-08 Revised:2011-04-05 Published:2011-08-15 Online:2011-08-15

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摘要： 摘要 目的：探讨既往输卵管妊娠的不孕患者宫腹腔镜联合治疗的临床特点。方法：回顾性分析2008年12月至2009年8月住院的最后一次妊娠为输卵管妊娠，排除男性不育的女性不孕患者的治疗情况。结果：既往输卵管妊娠的不孕患者91例占同期不孕患者总数（602例）的15.12%，既往异位妊娠中药物治疗、手术切除患侧输卵管、保守手术后的不孕率分别为29.90%、32.99%、37.11%。腹腔镜下输卵管外形正常者占20.7%，积水闭锁占23.3%，粘连占59.3%,部分切除占10.7%，其他盆腔内病变占14.3%。宫腔镜下发现输卵管堵塞占63.3%，堵塞的输卵管在宫腔镜下导丝介入后疏通率为66.3%，对比导丝介入前后左侧及右侧输卵管通畅度结果有统计学意义。结论：既往输卵管妊娠是引起不孕的重要因素，不孕的主要原因为输卵管的形态改变和管腔堵塞，宫腔镜及腹腔镜联合对于治疗输卵管妊娠后不孕具有优势。

关键词: 输卵管妊娠, 不孕, 腹腔镜手术, 宫腔镜手术, 输卵管通液, 输卵管介入

Abstract: Abstract Objective: To investigate the clinical characteristics and post-operation outcome in infertile women following tubal pregnancy. Methods: We retrospectively analyzed the data of consecutive in-hospital female infertility cases which the last pregnancy was tubal pregnancy and rule out male infertility from Dec 2008 to Aug 2009. Results: A total of 602 female infertility cases was admitted to Pingjin Hospital, Medical College of Chinese People’s Armed Policed Forces during this period. In these patients, infertility following tubal pregnancy accounted for 15.1% (91/602). All of them were managed with a combined interventional procedure (laparoscopy and hysteroscopy) in our department. Under laparoscopy the gross pathological changes of fallopian tubes involved normal appearance (20.7%), dropsy and atresia (23.3%), adhesions (59.3%), partial resection (10.7%), and other diseases of pelvic cavity (14.3%). After laparoscopic operation, infertility case with tubal blockage accounted for 63.3% under hysteroscopic tubal catheterization. The patency rate of blocked fallopian tubes after hysteroscopy directed guidewire tubal catheterization was 66.3%. Conclusion: previous tubal pregnancy which cause abnormal oviduct morphology and tubal blockage is the important reason of female infertility. Laparoscopy and hysteroscopy can advantage infertility women due to previous tubal pregnancy to resume reproductive.

Key words: Tubal pregnancy, Infertility, Laparoscopy, Hysteroscopy, Fluid infusion of fallopian tubes, Tubal involvement