输卵管性不孕病人行宫腹腔镜手术后自然妊娠结局分析

贾洪燕; 汤丽莎

doi:10.13898/j.cnki.issn.1000-2200.2022.01.017

输卵管性不孕病人行宫腹腔镜手术后自然妊娠结局分析

Analysis of spontaneous pregnancy outcome in patients with fallopian tube infertility after hysteroscopy and laparoscopy

摘要

摘要:
目的分析不同类型输卵管性不孕病人经宫腹腔镜手术后的自然妊娠结局。
方法回顾性分析因输卵管因素不孕行宫腹腔镜手术的病例226例。按照输卵管梗阻部位和侧别分为单侧输卵管近端梗阻、双侧近端梗阻、一侧近端一侧远端梗阻、单侧远端梗阻、双侧远端梗阻、不全梗阻，采用近端插管、伞端造口、伞端成型及盆腔粘连松解术等手术方式，术后至少有一侧输卵管通畅。比较不同类型输卵管性不孕病人手术治疗后1年内的自然妊娠情况。
结果单侧近端梗阻、双侧近端梗阻、单侧远端梗阻、双侧远端梗阻、不全梗阻的病人术后妊娠率差异均无统计学意义(P>0.05)。226例病人术中发现盆腔粘连192例，轻度盆腔粘连术后临床妊娠率46.7%，重度盆腔粘连术后临床妊娠率16.3%，差异有统计学意义(P < 0.01)。 < 35岁病人术后临床妊娠率27.5%，≥35岁病人术后临床妊娠率3.8%，差异有统计学意义(P < 0.01)。不孕年限 < 2年的病人术后临床妊娠率37.5%，2~5年的病人术后临床妊娠率21.8%，>5年的病人术后临床妊娠率14.3%，差异有统计学意义(P < 0.05)。
结论不同类型输卵管性不孕病人行相应的手术治疗是可行的，术后妊娠率无显著差异。重度盆腔粘连的病人术后妊娠率低，不适合期待试孕。年龄和不孕时限可能是影响术后妊娠的独立因素。

Abstract:
ObjectiveTo analyze the spontaneous pregnancy outcomes in patients with different types of fallopian tube infertility after hysteroscopy and laparoscopy.
MethodsA total of 226 cases with fallopian tube infertility were analyzed retrospectively.According to the location and side of tubal obstruction, it was divided into unilateral proximal tubal obstruction, bilateral proximal tubal obstruction, unilateral proximal and unilateral distal tubal obstruction, unilateral distal tubal obstruction, bilateral distal tubal obstruction and incomplete tubal obstruction.Proximal intubation, umbrella end colostomy, umbrella end molding and pelvic adhesiolysis were used, and at least one fallopian tube was unobstructed after operation.The spontaneous pregnancy outcomes in patients with different types of tubal infertility within one year after operation were compared.
ResultsThere was no significant difference in pregnancy rate among patients with unilateral proximal obstruction, bilateral proximal obstruction, unilateral distal obstruction, bilateral distal obstruction and incomplete obstruction(P>0.05).Among 226 patients, 192 cases with pelvic adhesions were found.The clinical pregnancy rate of mild and severe pelvic adhesion was 46.7% and 16.3%, respectively, the difference of which was statistically significant(P < 0.01).The clinical pregnancy rate was 27.5% in patients under 35 years old and 3.8% in patients over or equal to 35 years old, the difference of which was statistically significant(P < 0.01).The clinical pregnancy rate was 37.5% in patients with less than 2 years of infertility, 21.8% in patients with 2-5 years of infertility, and 14.3% in patients with more than 5 years of infertility, the difference of which was statistically significant(P < 0.05).
ConclusionsIt is feasible for patients with different types of fallopian tube infertility to receive corresponding surgical treatment, and there is no significant difference in postoperative pregnancy.Patients with severe pelvic adhesion have a low postoperative pregnancy rate and are not suitable for expectant pregnancy.Age and infertility duration may be independent factors affecting postoperative pregnancy.

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