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目的:探讨腹腔镜下治疗不同程度输卵管远端粘连梗阻后的临床结局。比较输卵管不同部位阻塞性不孕疏通后的临床结局。方法:根据HSG影像或腹腔镜诊断将输卵管阻塞分为远端粘连阻塞组(46例)和近端阻塞组(24例)。输卵管远端粘连阻塞组根据输卵管盆腔病变分为4期。对输卵管远端粘连阻塞组患者进行腹腔镜下分离粘连并输卵管造口术。对输卵管近端阻塞组行放射介入治疗或宫腔镜下输卵管插管治疗。结果:输卵管远端粘连阻塞组中,Ⅰ期11例,宫内妊娠6例;Ⅱ期15例,宫内妊娠4例;Ⅲ期10例,宫内妊娠1例;Ⅳ期10例,宫内妊娠1例。Ⅰ～Ⅱ期宫内妊娠率(38.5%)显著高于Ⅲ～Ⅳ期(10.0%)。输卵管近端阻塞组复通后妊娠率(66.7%)显著高于输卵管远端阻塞组(34.8%)。结论:腹腔镜治疗输卵管远端粘连阻塞后的临床结局与输卵管病变程度有关。输卵管炎症仅局限于输卵管间质部、峡部阻塞性不孕患者,复通后其妊娠率高。
Objective: To investigate the clinical outcome of laparoscopic treatment of distal tubal adhesions obstruction. Compare different parts of tubal obstruction infertility clear clinical outcomes. Methods: According to HSG imaging or laparoscopy, tubal obstruction was divided into distal occlusion group (n = 46) and proximal occlusion group (n = 24). Fallopian tube obstruction group according to tubal pelvic lesions divided into 4 phases. The distal tubal occlusion group patients with laparoscopic adhesions and tubal ostomy. On the proximal tubal obstruction group radiation interventional treatment or hysteroscopic tubal intubation. Results: In the distal tubal occlusion group, 11 cases were stage Ⅰ, 6 cases were intrauterine pregnancy, 15 cases were stage Ⅱ, 4 were intrauterine pregnancy, 10 were stage Ⅲ, 1 was intrauterine pregnancy, 10 were stage Ⅳ, 1 case of pregnancy. Intrauterine pregnancy rates (Ⅰ) ~ Ⅱ were significantly higher than those in Ⅲ ~ Ⅳ (38.5%) cases (10.0%). The pregnancy rate of the proximal tubal occlusion group (66.7%) was significantly higher than that of the distal tubal occlusion group (34.8%). Conclusion: The clinical outcome after laparoscopic treatment of distal tubal occlusion is related to the severity of tubal disease. Tubal inflammation is confined to the tubal interstitial, isthmic obstructive infertility patients, after the complex pregnancy rate is high.