腹腔镜诊治输卵管结核性不孕症的临床分析

目的探讨腹腔镜在诊治输卵管结核性不孕中的临床价值。方法对本院7年中经腹腔镜确诊的输卵管结核性不孕症患者42例临床资料进行回顾分析。结果本组患者确诊时平均年龄（29．6±3．5）岁，原发性不孕33例，继发性不孕9例。腹腔镜术前常规行诊刮术排除官腔结核。腹腔镜下双侧输卵管受累者28例，单侧受累14例，镜下主要表现有输卵管肿胀、卷曲、僵硬、表面有粟粒样结节，管腔内有干酪样物质，盆腔存在不同程度粘连。对于轻度粘连者行分离粘连后予以通液治疗，输卵管梗阻严重者镜下作输卵管间质部电凝结扎，术后本组自然妊娠率5．5％。13例患者接受IVF-ET治疗，4例妊娠。结论腹腔镜检查可提高输卵管结核诊断准确性，并行初步治疗。输卵管结核术后复通并有正常功能者较少，术后自然妊娠率低。病变严重者作输卵管电凝结扎并抗结核治疗，通过辅助生育治疗有希望解决不孕症问题。

Clinical Analysis of the Diagnosis and Treatment for Tubal Tuberculosis Caused Infertility by Laparoscopes

Objective To investigate the diagnosis and treatment of tubal tuberculosis caused infertility by using laparoscopes. Method We reviewed 42 cases of tubal tuberculosis caused infertility in the past 7 years. The diagnosis of all these 42 patients was made by performing laparoscopes. Result The average age of these 42 patients was （29.6±3.5） year-old. The major symptom of them was infertility. 33 of them were constitutional infertility and 9 cases were secondary infertility. We excluded intrauterine tuberculosis routinely by exploratory curettage before laparoscopic diagnosis. Bilateral fallopian tubes involvement was observed in 28 cases through laparoscopic diagnosis, and 14 cases have unilateral involvement. The main features observed under laparoscope were tubal swelling, curly, surface with nodules, the lumen with cheese-like substance, and with different degrees of pelvic adhesions. Cases with mild adhesion were treated with separation of the tubal and cases with serious adhesion were treated with tubal obstruction under laparoscope. After treatment, 5.5% could have natural pregnancy, 13 patients received IVF-ET treatment, with four cases of pregnancy. Conclusion Laparoscopy can improve the accuracy of diagnosis, and be able to perform initial treatment. However, not many patients with tubal tuberculosis had recovered and regained normal function after laparoscopy resulting in lower natural pregnancy rate. We may be able to cure infertility by tubal ligation using electric coagulation and anti-TB treatments.