腹腔镜诊治女性不孕症118例临床剖析.docVIP

腹腔镜诊治女性不孕症118例临床剖析 　　【摘要】目的：探讨腹腔镜在原因不明女性不孕症诊治中的作用。方法：回顾性分析因不孕症住院行腹腔镜检查术的118例患者的诊治情况， 其中原发不孕53例，继发性不孕65例。结果：118例患者术中发现输卵管伞端积水闭锁和（或）合并盆腔粘连65例(55.1%)，子宫内膜异位症31例(26.3%) ，多囊卵巢综合征15例(12.7%)，盆腔结核3例，输卵管畸形2例，原因不明2例。在原发不孕和继发不孕患者病因构成比中，原发不孕中子宫内膜异位症发生率显著高于继发不孕，继发不孕中输卵管因素要显著高于原发性不孕( P0.05)。镜下给予针对性的治疗，术后2年45例(44.1% )妊娠。结论：输卵管因素和盆腔炎性粘连是女性不孕的主要因素，子宫内膜异位症在原发性不孕中更值得关注。腹腔镜手术不仅对原因不明女性不孕症的病因诊断有重要价值，而且可在镜下进行针对性治疗。 　　【关键词】不孕症；腹腔镜检查 　　文章编号：1009-5519（2007）20-3009-03 中图分类号：R71 文献标识码：A 　　Analysis of laparoscopic diagnosis and treatment in 118 cases of female infertility 　　REN Tao，XIONG Xiao-ying 　　（Department of Obstetrics and Gynecology，Zhongshan Boai Hospital，Guangdong 528400,China） 　　【Abstract】Objective:To explore the value of laparoscope in etiological diagnosis and treatment of unexplained infertility. Methods: The treatment and diagnosis of 118 patients with infertility，including 53 primary cases and 65 secondary cases undergoing laparoscopy were retrospectively analyzed.Results：Among those cases，the blockage of the fimbriated extremity of fallopian tube and pelvic inflammatory accretion accounted for 55.1%，endometriosis was 26.3% and PCOS was 12.7% respectively. In primary cases the incidence of endometriosis was higher than that in secondary cases. However fallopian tube and pelvic inflammatory accretion were most common in secondary infertility(P0.05).At the same time all the cases received the treatment under laparoscopy.The pregnancy rate after operation was 44.1%(45/102) in a follow up time of two years. Conclusion：Fallopian factor and pelvic inflammatory accretion are the main factors of female infertility.Endometriosis should be paid attention to in the primary infertility.It is valuable to use laparoscopy to diagnose the female infertility and give the appropriate treatment. 　　【Key words】Infertility；Laparoscopy 　　 　　婚后有正常性生活未避孕同居2年未受孕者称不孕症( intertility)。女性不孕症的原因较为复杂，传统的检查方法如输卵管通液术、子宫输卵管碘油造影术、B超、内分泌及免疫检查等虽能对大部分女性不孕原因作出诊断，但仍有部分患者经上述系列检查未能明确病因，导致治疗的盲目性。腹腔镜作为一种微创性手术，具有创伤