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目的探讨宫腔镜联合腹腔镜行宫颈输卵管插管疏通术治疗输卵管近中段阻塞的效果。方法2000年1月至2004年6月在佛山市第一人民医院选择经腹腔镜下输卵管通液后证实为输卵管近中段阻塞的患者136例,应用宫腔镜联合腹腔镜行宫颈输卵管插管疏通术。结果136例患者224条输卵管近中段阻塞。输卵管外周有粘连者186条,输卵管外观正常仅管腔阻塞38条。术后输卵管通畅154条,疏通率68.75%。64条宫角粘连的输卵管插管失败52条(52/64,81.25%),插管疏通失败率较无宫角粘连者明显增高(P<0.01)。随访经双侧插管疏通成功者76例,宫内妊娠28例,宫内妊娠率36.84%;插管侧输卵管妊娠7例,输卵管妊娠率9.21%(7/76),宫内妊娠率明显高于输卵管妊娠率(P<0.05)。导管组宫内妊娠率明显高于导丝组(P<0.01),两者输卵管妊娠率差异无显著性意义(P>0.05)。结论宫腔镜联合腹腔镜输卵管插管疏通术对输卵管近中段阻塞有较好的治疗效果,影响输卵管疏通和术后妊娠率的因素主要是输卵管阻塞程度及是否有宫角粘连。
Objective To investigate the effect of hysteroscopy combined with laparoscopic cervical tubo-intubation in the treatment of proximal tubal obstruction. Methods From January 2000 to June 2004, 136 cases of proximal tubal obstruction confirmed by laparoscopic tubal ophthalmoscopy were selected in the First People’s Hospital of Foshan City from January 2000 to June 2004. Hysteroscopy combined with laparoscopic cervical tubal catheterization was used to clear Surgery. Results 136 cases of 224 tubal proximal obstruction. Tubal adhesions were peripheral 186, tubal appearance of normal lumen obstruction 38. Tubal patency after 154, dredging rate of 68.75%. There were 52 failed tubal intubation (52/64, 81.25%) in 64 of the uterine horn adhesions, and the failure rate of intubation was significantly higher than that without the uterine horn adhesions (P <0.01). Follow-up was successful in 76 cases of bilateral intubation, uterine pregnancy in 28 cases, intrauterine pregnancy rate was 36.84%; tubal tubal pregnancy in 7 cases, tubal pregnancy rate was 9.21% (7/76), intrauterine pregnancy was significantly higher The incidence of tubal pregnancy (P <0.05). The intrauterine pregnancy rate in catheter group was significantly higher than that in guide wire group (P <0.01). The difference in tubal pregnancy rate between the two groups was not significant (P> 0.05). Conclusions Hysteroscopy combined with laparoscopic tubal catheterization has a good therapeutic effect on proximal tubal obstruction. The main factors influencing tubal dredging and postoperative pregnancy rate are the degree of tubal occlusion and whether there is any hyalisomegaly.