输卵管妊娠患者输卵管开窗取胚术及切除术后继发不孕原因及输卵管损伤比较研究

发布时间：2018-02-24 17:05

  本文关键词： 不孕 输卵管妊娠 输卵管开窗取胚术 输卵管切除术 腹腔镜检查术 宫腔镜检查术　出处：《中国实用妇科与产科杂志》2015年12期 　论文类型：期刊论文

【摘要】：目的探讨输卵管妊娠患者经输卵管开窗取胚术和切除术后继发不孕的原因及输卵管受损情况。方法收集2008年12月至2010年10月在武警后勤学院附属医院住院治疗,既往有输卵管妊娠、经输卵管开窗取胚术或切除术病史的不孕患者130例。根据既往输卵管妊娠手术方式分为开窗取胚组(37例)和切除组(93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 94.62%患者存在输卵管性不孕因素,包括宫腔及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;盆腔粘连发生率91.54%。两组患者无妊娠史的输卵管形态异常在开窗取胚组发生率为62.16%,在切除组为48.39%;伞端闭锁或积水在开窗取胚组为62.16%,在切除术组为44.09%;管腔堵塞在开窗取胚组为81.08%,在切除术组为82.80%,两组间差异均无统计学意义(P0.05)。盆腔粘连程度方面,Ⅰ、Ⅱ、Ⅲ度粘连发生率在开窗取胚组分别为21.62%、32.43%、35.14%,在切除组分别为29.03%、27.96%、33.33%,两组在粘连发生率、发生程度上差异均无统计学意义(P0.05)。开窗取胚组有妊娠史和无妊娠史的输卵管形态异常发生率分别为48.65%和62.16%,伞端闭锁或积水发生率为45.95%和62.16%,管腔通畅发生率为24.32%和18.92%,差异无统计学意义(P0.05)。结论输卵管妊娠开窗取胚术后的不孕患者,不孕的主要原因为输卵管因素和盆腔粘连,包括输卵管形态异常及周围粘连和伞端异常、管腔堵塞。输卵管开窗取胚术和切除术对无妊娠史的输卵管形态、伞端异常和管腔通畅度影响无明显区别。在开窗取胚术后不孕患者中,保留的患侧输卵管与无妊娠史的输卵管受损无明显差异。
[Abstract]:Objective to investigate the causes of secondary infertility and damage of fallopian tube in patients with tubal pregnancy after tubal fenestration and resection. Methods from December 2008 to October 2010, the patients were hospitalized in the affiliated Hospital of Armed Police Logistics College. 130 infertile patients with previous history of tubal pregnancy, embryo extraction or resection through tubal fenestration. According to the previous procedure of tubal pregnancy, 37 cases were divided into fenestration group (n = 37) and resection group (n = 93). The degree of pelvic adhesion was observed by laparoscopy. The shape of fallopian tube, the end of fallopian tube, and so on, were observed under hysteroscopy under laparoscope to observe whether the tubal cavity was unobstructed. Results 94.62% patients had infertility of fallopian tube. Including abnormal shape of uterine cavity and fallopian tube or adhesions around, atresia at the end of the umbrella, obstruction of the lumen, at least one or more factors exist. The incidence of pelvic adhesion was 91.54.The incidences of abnormal tubal morphology without pregnancy in the two groups were 62.16 in the fenestration group and 48.39 in the excision group; 62.16 in the open window group and 44.09 in the resection group; and in the fenestration group in the umbrella end atresia group and 44.09% in the resection group. 81.08% in embryo group and 82.80% in excision group. There was no significant difference between the two groups in the degree of pelvic adhesion. The incidences of 鈪，

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