输卵管再通术联合腹腔镜治疗输卵管性不孕症

目的:探讨梗阻输卵管治疗的有效途径及复通输卵管受孕的影响因素.方法:输卵管造影确诊的近段梗阻患者306例,利用输卵管再通装置先行输卵管再通术(FTR),对输卵管近段再通后显示远段积水粘连的68例,再施行腹腔镜伞端造口术.结果:306例近段输卵管梗阻经FTR治疗,除7例再通失败外,完全再通231例;近段再通后显示远段积水的68例接受腹腔镜伞端造口术.术后1～2个月造影复查输卵管通畅率为92.26%(465/504);追踪随访48个月受孕率为36.93%(113/306).结论:FTR联合腹腔镜治疗输卵管梗阻性不孕症疗效显著,两者通过优势互补有效地提高了输卵管的再通成功率,但经腹腔镜造口术复通的患者受孕率较低.

Fallopian Tube Recanalization Combined with Treatments using Laparoscopes in Infertile Patients due to Fallopian Tube Obstruction

Objective:To explore effective treatments for the recanalization of obstructive fallopian tubes and to assess the factors influencing the conception rate in patients with recanalized fallopian tubes.Methods:306 salpingographically diagnosed cases of patients with fallopian tube obstruction at the proximal segment were collected.Fallopian tube recanalization (FTR) was initially performed using a FTR device.For patients in whom distal salpingian adhesion and hydrosalpinx were found after FTR,salpingian fimbral fistulization was operated under the guidance of laparoscopes.Results:306 cases with proximal fallopian tube obstruction had been treated by FTR,7 cases failed and 231 of the cases acquired successful tubal recanalization and complete patency.In the 68 post-FTR still with distal salpingian adhesion and hydrosalpinx cases,fallopian fimbral fistulization was operated under the guidance of laparoscopes.In our series of patients,the patency rate of fallopian recanalization salpingogrphically showed 92.26% (465/504) in one to two months post-operatively and the conception rate was 36.93% (113/306) in a follow-up time of 48 months. Conclusion:The curative effect of FTR combined with treatments using laparoscopes in infertile women due to fallopian tube obstruction was remarkable.The success rate of the fallopian recanalization was remarkably improved because the potentials of the two techniques were complementary with each other.However,the conception rate in infertile women due to fallopian obstruction treated solely with the technique of fallopian fistulization under the guidance of laparoscopes was still considerably low.