【作者】 王丽娟；

【导师】 史惠蓉；

【作者基本信息】 郑州大学 ， 妇产科（专业学位）， 2016， 硕士

【摘要】 目的伴随着我国经济水平的不断发展,人民生活水平不断提高的同时,食品安全、环境污染、生活节奏的加快、工作压力的加大等等种种问题也日益突出,人们在生活水平不断提高的同时,与生活水平提高相反,人们的生育能力却在逐渐的下降,不孕不育的夫妇日益增多,不孕不育症严重影响着育龄期夫妇的生活和工作,以及他们的身心健康,我们通过对宫腹腔镜联合手术在女性不孕症方面的回顾性分析,来为不孕患者分析引起不孕不育症的原因并提供有一定价值的治疗方案,以降低不孕症的发病率,增加不孕症患者受孕的机率。方法本组200例,年龄在23~41岁之间,平均年龄在31.5岁。不孕时间在2~10年,平均值4.8年。原发不孕56例,继发不孕144例(22例曾经生育,最多的妊娠次数为4次,其中96例有盆腔手术史)。对于所有患者均行基础内分泌检查、丈夫精液检查、妇科检查、免疫抗体及妇科B超等检查,以便于对其他导致不孕的因素进行排除。对其中6例切除了一侧输卵管(2例卵巢囊肿蒂扭转,4例宫外孕)。98例(其中2例由于宫外孕而导致单侧输卵管切除)术前行子宫输卵管碘油(hysterosalpingography,HSG)造影检查,术后检查结果为输卵管通畅116条,不通52条,通而不畅26条。通过手术前后对所有患者行宫、腹腔镜下输卵管通液术,椐此了解输卵管的情况。最后将宫腹腔镜联合诊治不孕症与传统诊疗方法如输卵管通液,B超及子宫输卵管碘油造影检查等进行比较。结果宫、腹腔镜下,导致女性不孕症的原因主要有盆腔炎症、多囊卵巢综合征、子宫方面因素、卵巢良性肿瘤、子宫内膜异位症等病因。在宫腔镜下,共发现宫腔病变22例;在腹腔镜下,共发现盆腔病变178例;宫、腹腔镜下共同发现病变的病例为8例,根据不同的情况行腹腔镜盆腔粘连松解术146例,多囊卵巢打孔术10例,盆腔子宫内膜异位灶电灼术16例,卵巢囊肿剔除术8例,输卵管整形及造口术40例,宫腔镜子宫中隔电切术10例,子宫内膜息肉电切术2例,子宫肌瘤剔除术6例;宫腔粘连分解术4例,黏膜下子宫肌瘤切除术6例。98例194条输卵管术前子宫输卵管碘油造影检查显示通而不畅(26条)或不通(52),宫、腹腔镜联合检查镜下通而不畅14条,通液证实阻塞34条,在子宫输卵管碘油造影检查的结果中30条通畅的输卵管出现假阳性。结论不孕症的传统诊疗方法如输卵管通液,B超及子宫输卵管碘油造影检查等,都有一定局限性。而通过采用宫、腹腔镜的联合手术,很好地克服了仅使用单一的方法诊断不孕不育症不够全面的缺点,从而对了解女性生殖器官情况更加的全面,并且又可以在镜下同时进行治疗,从而使临床治疗效果达到更好。所以,我们建议:对于虽经过其他多种检查途径,但仍不能明确病因的患者,或者是患者年龄较大的情况,为了尽快明确病因并及时得到有效治疗应首先选择宫、腹腔镜联合的诊治手段。更多还原

【Abstract】 ObjectiveWith the continuous development of China’s economic level, people’s living standards continue to improve at the same time, food safety, environmental pollution, accelerated pace of life, increasing work pressure and so on all kinds of issues are also increasingly prominent, people’s living standards rising at the same time, fertility has gradually decreased, infertility increasing number of couples, infertility serious impact on the lives of couples of reproductive age and work, we combined surgery by laparoscopy in female infertility retrospective analysis to analyze the causes of infertility patients of infertility and provide some valuable treatment programs to reduce the incidence of infertility, increase the chances of pregnancy in patients with infertility. MethodsThe group of 200 cases, aged between 23 to 41 years, mean 31.5 years. Infertility for 2 to 10 years, an average of 4.8 years. 56 cases of primary infertility, secondary infertility, 144 cases(22 cases had fertility, pregnancy up to 4 times, 96 cases of pelvic operation history). All patients were confirmed by gynecological examination, B-gynecology, basic endocrine, immune antibodies and husband semen routine examination, exclusion of other infertility factors. 6 cases of removal side of the tube(4 cases of ectopic pregnancy, 2 cases of ovarian cyst torsion). 98 cases(including 2 cases of ectopic pregnancy cut side of the tube) had performed the surgery hysterosalpingography(hysterosalpingography, HSG) angiography, tubal patency display 116, barrier 52, passable 26. All patients before and after surgery were palace, laparoscopic tubal surgery, tubal patency understand. Finally, the diagnosis and treatment of infertility Laparoscopy combined with traditional treatment methods, such as tubal, B ultrasound and hysterosalpingography examination were compared. ResultsHysteroscopy Combined with Laparoscopy cause of female infertility for pelvic inflammatory disease, uterine factors, endometriosis, polycystic ovary syndrome, benign ovarian tumors. Found 178 cases of laparoscopic pelvic diseases, hysteroscopy intrauterine lesions found in 22 cases, Laparoscope lesions were found in 8 cases, depending on the circumstances of each inspection laparoscopic lysis of pelvic adhesions 146 cases, the fallopian tubes and plastic manufacturing 10 cases of oral surgery, 40 cases of pelvic endometriosis lesions fulguration 16 cases of polycystic ovarian drilling technique, ovarian cyst excision in 8 cases, 6 cases of myomectomy; hysteroscopic septum transurethral resection surgery in 10 cases, submucosal myomectomy in 6 cases, 4 cases of intrauterine adhesions decomposition, endometrial polyp resection in 2 cases. 98 cases of 194 former tubal surgery hysterosalpingography examination showed nowhere(52) or through the poor(26), Laparoscope combined liquid through microscopic examination confirmed that blocking 34, 14 passable, 30 tubal patency of false positive results in hysterosalpingography check in.ConclusionsTraditional treatment methods, such as tubal infertility, B ultrasound and hysterosalpingography inspection, there are certain limitations. Hysteroscopy Combined with Laparoscopy surgery overcome only a single method of diagnosis of infertility is not comprehensive enough shortcomings can be more comprehensive understanding of the situation of female genital mutilation, and also at the same time in the endoscopic treatment, to obtain a better diagnosis and treatment effect. Therefore, we recommend not checking for through other clear cause of infertility or older patients who should be preferred palace, abdominal endoscopic joint examination to confirm the cause of timely treatment as soon as possible.更多还原