Delphi法建立输卵管性不孕患者输卵管功能评价指标体系

目的：建立输卵管性不孕患者生殖手术中输卵管功能的评价指标体系，为预后及术后指导受孕提供科学依据。方法：经查阅国内外文献并结合临床实际，采用自行设计的专家咨询表，通过三轮专家Delphi法和层次分析法确定生殖手术后输卵管功能评价的指标体系及权重。结果：三轮专家咨询的协调系数均为0.426，有统计学意义（P＜0.05）。一级至五级指标的专家权威系数分别在0.625～0.630、0.600～0.640、0.595～0.630、0.585～0.655和0.595～0.650之间。经过三轮专家咨询确定的指标体系包括2个一级指标、6个二级指标、19个三级指标、31个四级指标和33个五级指标。其中，输卵管通畅度在输卵管性不孕患者生殖手术预后的权重最高（0.673），双侧通畅高于单侧通畅，本身通畅高于手术复通，经手术复通者输卵管远端造口的权重高于近端导丝介入者，而两端均阻塞者最低。对于输卵管的形态判断，双侧通畅、本身形态正常的权重较高。经手术恢复形态者，伞端形态与结构较输卵管与卵巢相对位置更为重要，伞端狭窄的权重高于积水造口后，输卵管周围膜样粘连者高于输卵管扭曲上举者。术后输卵管形态仍异常者，权重由高到低依次为伞端无自由度、造口后无正常伞端、积水输卵管内部结构异常。结论：用Delphi法构建的输卵管不孕患者生殖手术后输卵管功能评价的指标体系可信度、可靠性高，可为输卵管性不孕患者生殖手术预后及术后指导受孕提供参考。

The Tubal Function Index Developed by Delphi Method was Used in Tubal Infertility

Objective:To develop the index system, an estimative system for tubal function in patients with tubal infertility, which provide scientific evidence for the prognosis follow-up visit and the postoperative pregnancy guidance. Methods: According to the literature retrieval and our clinical practice, we designed the expert questionnaire. With this expert questionnaire, the index system was developed to evaluate the tubal function after reproductive surgery by the three-round Delphi method and analytic hierarchy method. Results:The authoritative degree after the three-round expert questionnaire was 0.426, with the statistical significance (P<0.05). The Kendall coefficients of concordance of the first-dimension to the fifth-dimension were 0.625-0.630, 0.600-0.640, 0.595-0.630, 0.585-0.655 and 0.595-0.650. This index system was constituted with 2 first-dimension, 6 second-dimension, 19 third-dimension, 31 fourth-dimension and 33 fifth-dimension after three-round expert consultation. In all of the indices, the factor of tubal patency in tubal infertile patients after reproductive surgery had the highest weight (0.673). For the weight of tubal patency, it is higher in the bilateral than unilateral tubal patency, the original than recanalized patency, while it is the lowest in the bilateral obstruction. For the weight of tubal morphology, it is higher in the bilateral tubal patency with normal original morphology than others, the morphology and construction of fimbria than the relative location of tube and ovary, and the fimbria atresia than salpingostomy in hydrosalpinx, while it is higher in the peri-tubal adhesion thantubal angulation. For the weight of tubes with abnormal morphology after surgery, it is lower and lower from the fimbria without freedom, the continued abnormal fimbria after salpingostomy to the abnormal mucosa of hydrosalpinx. Conclusions: The index system developed by Delphi method for tubal function evaluation in tubal infertility is reliable and valid, which provide scientific suggestion for the reproductive surgical prognosis and guidance of postoperative pregnancy.