宫腹腔镜联合诊治女性不孕症461例临床疗效分析

发布时间：2018-10-23 21:33

【摘要】：目的:探讨宫腹腔镜联合手术在女性不孕症诊断治疗价值以及术后妊娠结局的相关因素。方法:回顾性分析2008年1月~2014年5月因不孕症在海军总医院行宫腹腔镜联合检查和手术治疗的患者461例,宫腹腔镜下评估不孕症病因、术后电话随访妊娠情况、妊娠结局,比较原发性不孕症和继发性不孕症的妊娠率,观察年龄和盆腔粘连程度对妊娠结局的影响。结果:461例不孕症患者中,原发性不孕225例(48.8%),继发性不孕236例(51.2%)。不孕症的主要原因是盆腔粘连54.5%(251例)、输卵管阻塞50.8%(234例)、子宫内膜异位症157例(34.1%)。盆腔粘连、输卵管阻塞和宫腔粘连发生率继发生不孕症高于原发性不孕症,生殖器结核仅发生于原发性不孕者,其他不孕因素两者之间没有统计学差异。术后随访率为85.25%。术后自然妊娠50.6%,原发性不孕患者的妊娠率为49.5%,继发性不孕患者的妊娠率为51.8%,妊娠时间主要集中在术后1年内,足月分娩43.8%。20~30岁年龄组的妊娠率(54.9%)高于31~43岁组(45.5%)(P0.05)。无盆腔粘连、轻、中度粘连者和重度粘连者的妊娠率分别为61.5%、54.8%、40.6%和18.9%,无盆腔粘连者妊娠率和足月分娩率明显高于盆腔粘连者(P0.05);盆腔粘连组中轻、中度粘连者妊娠率和足月分娩率与重度粘连者比较,差异有统计学意义(P0.05),轻度和中度粘连间比较无统计学差异(P0.05)。结论:宫腹腔镜联合手术能更加直观的评估不孕症病因,同时可针对病因进行相应治疗,手术时间短、创伤小,能提高不孕患者的临床妊娠率和足月分娩率,对女性不孕症的诊断与治疗有重要临床价值。
[Abstract]:Objective: to investigate the value of combined hysteroscopy and laparoscopy in the diagnosis and treatment of female infertility and the related factors of postoperative pregnancy outcome. Methods: from January 2008 to May 2014, 461 patients with infertility underwent combined hysteroscopy and surgical treatment in Naval General Hospital were retrospectively analyzed. The etiology of infertility was evaluated under hysteroscopy, the pregnancy status and pregnancy outcome were followed up by telephone after operation. The pregnancy rates of primary infertility and secondary infertility were compared and the influence of age and pelvic adhesion on pregnancy outcome was observed. Results: 225 cases (48.8%) were primary infertility and 236 cases (51.2%) secondary infertility. The main causes of infertility were pelvic adhesion 54.5% (251 cases), tubal obstruction 50.8% (234 cases), endometriosis 157 cases (34.1%). The incidence of pelvic adhesion, tubal obstruction and uterine cavity adhesion followed by infertility was higher than that of primary infertility. Genital tuberculosis only occurred in patients with primary infertility, but there was no statistical difference between other infertility factors. The follow-up rate was 85.25%. The pregnancy rate of patients with primary infertility was 49.5%, and that of patients with secondary infertility was 51.8%. The pregnancy time was mainly concentrated within one year after operation. The pregnancy rate of the age group of 43.8.2020 + 30 years of term delivery was higher than that of the 31- 43-year-old group (45.5%) (P0.05). The pregnancy rates of patients without pelvic adhesion, mild and moderate adhesions and severe adhesions were 61.5% and 18.9%, respectively. The pregnancy rate and term delivery rate of patients without pelvic adhesions were significantly higher than those with pelvic adhesions (P0.05), while in pelvic adhesions group, the pregnancy rate and term delivery rate were significantly higher than those without pelvic adhesions (P0.05), while in pelvic adhesions group, the pregnancy rate was significantly higher than that in pelvic adhesions group (P 0.05). The pregnancy rate and term delivery rate of moderate adhesions were significantly higher than those of severe adhesions (P0.05), but there was no significant difference between mild and moderate adhesions (P0.05). Conclusion: combined hysteroscopy and laparoscopy can evaluate the etiology of infertility more intuitively, at the same time, it can treat the cause of infertility. The operation time is short, the trauma is small, and the clinical pregnancy rate and term delivery rate can be increased in infertile patients. It has important clinical value in the diagnosis and treatment of female infertility.
【作者单位】：内蒙古民族大学临床医学院;中国人民解放军海军总医院生殖中心;
【分类号】：R711.6

【相似文献】