宫腔镜和腹腔镜联合诊治457例女性不孕症的临床分析

发布时间：2018-05-17 00:41

  本文选题：不孕症 + 宫腔镜　； 参考：《苏州大学》2014年硕士论文

【摘要】：目的：分析女性不孕症的病因及宫腔镜和腹腔镜联合诊治女性不孕症的临床效果，并探讨影响术后自然妊娠的相关因素。 方法：回顾性分析2010年5月至2012年4月在我院（同济大学附属第一妇婴保健院）住院行宫、腹腔镜联合诊治术的女性不孕症患者的临床资料，通过门诊复诊记录和电话随访其术后妊娠情况，并进一步统计输卵管性不孕症的术后自然妊娠率及其影响因素。 结果：（1）本研究共收集到457例患者（随访到338例，失访119例，失访率为26.04%），其中双侧输卵管堵塞221例（48.36%），单侧输卵管阻塞92例（20.13%）；子宫内膜异位症111例（包括卵巢内膜样囊肿81例，盆腔腹膜内异症30例），多囊卵巢综合征（polycystic ovarian syndrome,PCOS）30例，卵巢良性肿瘤10例；子宫肌瘤31例，子宫纵隔16例，宫腔粘连17例，子宫内膜息肉31例，双子宫、双宫颈畸形3例；肝周围炎(Fitz Hugh Curtis syndrome,FHCS)16例；不明原因16例。手术并发症发生率为：0.44%，，患者的平均住院费用为1.13万元。（2）宫腹腔镜联合手术的术后自然妊娠率为41.10%，其中67.16%发生在术后6个月内；异位妊娠（均是输卵管妊娠）率为3.07%。术后接受体外受精-胚胎移植（In vitro fertilization-embryo transfer，IVF-ET）治疗的患者为103例，成功率为45.63%，异位妊娠率为3.88%。其中，输卵管切除组（n=23）IVF-ET的成功率为65.21%（15/23），输卵管保留组（n=80）IVF-ET的成功率为40.00%(32/80)，p=0.036，差异有统计学意义。经手术和IVF-ET综合治疗的总妊娠率为53.55%（181/338）。（3）本研究随访到单纯输卵管性不孕症177例，其术后自然妊娠率为40.11%（71/177），其中70.42%发生于术后6个月内（50/71）；异位妊娠率为3.39%（6/177）。输卵管性不孕症患者的术后自然妊娠率与不孕时间呈显著负相关（β=-0.178，P0.05），而与年龄和不孕症类型无关。（4）子宫内膜异位症Ⅲ/Ⅳ（单侧或双侧卵巢内膜样囊肿3cm~7cm）的术后自然妊娠率为42.65%（29/68）；其中有15例在术后又行IVF-ET治疗，成功妊娠6例，成功率40%；综合治疗后的妊娠率为51.47%（35/68）。（5）PCOS的不孕症患者行腹腔镜下卵巢打孔术，并术后予克罗米芬促排治疗，妊娠率为53.85%（14/26）。（6）子宫不全纵隔的不孕症患者行宫腔镜下子宫纵隔剪开+通液+放环术，并于术后3个月行宫腔镜下取环+通液术，术后自然妊娠率为76.92%（10/13）。 结论：（1）输卵管性因素是导致女性不孕症的主要原因；（2）宫、腹腔镜联合诊治术对女性不孕症的诊断和治疗均具有临床应用价值，并且其并发症发生率低，费用低，值得推广应用；术后半年内的自然妊娠率较高，如果术后1年未能自然妊娠再行辅助生殖技术治疗可以提高总的妊娠率；（3）宫腹腔镜联合手术治疗输卵管性不孕症患者的术后自然妊娠率与不孕时间呈显著负相关，即不孕时间越长术后自然妊娠的可能性越小。
[Abstract]:Objective: to analyze the etiology of female infertility and the clinical effect of hysteroscopy combined with laparoscopy in the diagnosis and treatment of female infertility. Methods: the clinical data of female infertility patients who were hospitalized in our hospital from May 2010 to April 2012 were analyzed retrospectively. The postoperative pregnancy rate of tubal infertility and its influencing factors were analyzed by follow-up records and telephone follow-up. Results A total of 457 patients (338 cases followed up, 119 cases missing) were collected in this study. The missing rate was 26.040.221 cases had bilateral tubal obstruction, 92 cases had unilateral fallopian tube obstruction, 111 cases had endometriosis (including 81 cases of ovarian endometrioid cysts) There were 30 cases of pelvic intraperitoneal heterosis, 30 cases of polycystic ovarian syndrome (PCOS), 10 cases of benign ovarian tumor, 31 cases of uterine myoma, 16 cases of uterine mediastinum, 17 cases of intrauterine adhesion, 31 cases of endometrial polyp, 3 cases of double uterus and 3 cases of cervical malformation. There were 16 cases of Curtis Hugh and 16 cases of unknown cause of perihepatic inflammation. The incidence of postoperative complications was: 1: 0.44, the average hospitalization cost of the patients was 11300 yuan. The rate of spontaneous pregnancy was 41.1010, 67.16% of which occurred within 6 months after operation, and the rate of ectopic pregnancy (all tubal pregnancy) was 3.07. 103 patients were treated with in vitro fertilization-embryo transfer IVF-ET. the success rate was 45.63 and the ectopic pregnancy rate was 3.88. The success rate of IVF-ET in salpingotomized group was 65.21 / 23, and the success rate of IVF-ET in fallopian tube retention group was 40.002 / 80 / 0.036. The difference was statistically significant. The total pregnancy rate after operation and combined treatment with IVF-ET was 53.55 / 181 / 338.The study followed up 177 cases of simple oviductal infertility. The postoperative natural pregnancy rate was 40.1171 / 177g, 70.42% of which occurred within 6 months after operation and 50 / 71a; the ectopic pregnancy rate was 3.396177m. The spontaneous pregnancy rate of oviductal infertility patients was negatively correlated with the duration of infertility (尾 -0.178U P0.05, but not with age and type of infertility). Endometriosis 鈪

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