摘要
目的 探讨不孕症患者盆腔粘连的相关因素及不同程度的盆腔粘连对输卵管再通的影响.方法 收集2008年1月至2009年12月在武警后勤学院附属医院因不孕症接受宫-腹腔镜联合手术检查和治疗的527例患者的临床资料,对术中探查结果进行评价,根据盆腔粘连程度、范围、输卵管伞端粘连、闭锁及手术情况分为两组,盆腔粘连者377例,按粘连程度分为Ⅰ～Ⅳ度,其中Ⅰ度73例,Ⅱ度221例,Ⅲ 度75例,Ⅴ度8例.排除无法手术且无法自然受孕的Ⅳ度粘连患者,盆腔粘连组共369例;无盆腔粘连患者作为对照组共150例.分析盆腔粘连的相关因素及与既往病史、盆腹腔病变、输卵管功能及预后的关系.结果（1）相关因素：盆腔粘连组不孕时间＞7年（23.9％,88/369）的比例高于对照组 （12.0％,18/150）.（2）病史：盆腔粘连组药物流产史（23.6％,87/369）、宫腔操作史（38.2％,141/369）、输卵管妊娠史（20.9％,77/369）、盆腔炎史（25.5％,94/369）、盆腹腔手术史（31.4％,116/369）的发生率均高于对照组（分别为 12.7％,19/150;28.7％,43/150;11.3％,17/150;12.0％,18/150;17.3％,26/150）.（3）宫-腹腔镜联合探查结果：术中发现盆腔粘连组患者的输卵管积水（24.7％,91/369）、扭曲（15.7％,58/369）、伞端整形和（或）造口 （72.9％,269/369）的发生率也高于对照组（分别为2.0％,3/150;4.0％,6/150;12.0％,18/150）,且随粘连程度加重而发生率升高;而盆腔内异症病灶（5.7％,21/369）、输卵管系膜囊肿（16.3％,60/369）的发生率低于对照组（分别为16.0％,24 /150;30.0％,45/150）;输卵管近端复通率（59 5％,91/153）低于对照组（75.4％,52/69）,两组远端[整形和（或）造口后]复通率（84.4％,281/333;13/15）比较,差异无统计学意义（P＞0.05）.（4）预后：盆腔粘连组术后异位妊娠的发生率（9.7％,29/299）显著高于对照组（3.1％,4/128）,其中 Ⅲ度盆腔粘连者异位妊娠的发生率最高（13.0％,7/54,OR=4.62,95％ CI为1.29 ～16.50）.（5）多因素分析结果：≥2次的药物流产史（OR=3.29,95％CI为1.34～8.07）、盆腹腔手术史（OR=2.20,95％ CI 为1.35 ～ 3.57）和既往盆腔炎病史（OR=1.54,95％ CI为1.21 ～1.97）是盆腔粘连发生的危险因素.结论 ≥2次药物流产史、盆腔炎和盆腹腔手术史是造成不孕患者盆腔粘连的重要因素,盆腔粘连将降低近端输卵管复通率并增加远期异位妊娠的发病风险.
Objective To investigate factors with pelvic adhesions and the effect of different degrees pelvic adhesions on fallopian tube recanalization in infertile patients.Methods Total of 527 infertile patients undergoing hysteroscopy and laparoscopic surgery in Affiliated Hospital of Chinese People＇s Armed Police Forccs Logistics College were studied retrospectively.According to the extent of pelvic adhesions,tubal umbrella adhesions and atresia,377 cases were classified into adhesion groups,including 73 cases in grade Ⅰ,221 cases in grade Ⅱ,75 cases in grade Ⅲ and 8 cases in grade Ⅳ based on adhesion score.The 150 cases with no obvious pelvic adhesion were matched as control group.Among 8 cases with grade Ⅳ ahesion were exluded from ahesion group the relationship between pelvic adhesions and related history,abdominal lesions,tubal patency and the prognosis were studied.Results（1）Related factors：the frequency of pelvic adhesion and more than 7 years of infertility of 23.9%（88/369）in adhesion group were significantly higher than 12.0%（18/150）in control groups.（2）History：compared with the control group（12.7 %,19/150;28.7%,43/150;11.3%,17/150;12.0%,18/150;17.3%,26/150）,patients with pelvic adhesions present more incidence abortion（23.6%,87/369）,uterine cavity operation（38.2%,141/369）,ectopic pregnancy（20.9%,77/369）,pelvic inflammatory disease（25.5%,94/369）and abdominopelvic surgery （31.4%,116/369）.（3）Endoscopy exploration：the incidence of hydrosalpinx（24.7%,91/369）,tube distorted（15.7%,58/369）and salpingostomy（72.9%,269/369）in adhesion group were higher than those in control group（2.0%,3/150;4.0%,6/150;12.0%,18/150）,but relatively lower incidence of pelvic endometriosis lesions（5.7%,21/369）and mesosalpinx cysts（16.3%,60/369）than those in control group（16.0%,24/150;30.0%,45/150）.The rate of proximal tubal recanalization（59.5%,91/153）in adhesion group was lower than 75.4%（52/69）in control group.However,the rate of distant tubal recanalization of 84.4%,（281/333）in adhesion group and;13/15 in control group didn＇t show statistical difference.（4）Prognosis：the rate of ectopic pregnancy of 9.7%（29/299）in adhesion group was significantly higher than 3.1%（4/128）in control group.Among cases with grade Ⅲ adhesion exhibited the highest rate of ectopic pregnancy（13.0%,7/54;OR =4.62,95% CI：1.29-16.50）.（5）Multivariate analysis：it was found that more than two drug abortions（OR =3.29,95% CI：1.34-8.07）,pelvic and （or）abdominal surgery history（OR =2.20,95% CI：1.35-3.57）and pelvic inflammatory disease history （OR =1.54,95% CI：1.21-1.97）were risk factors with pelvic adhesions.Conclusion More than or equal to two drug abortion history,pelvic inflammatory disease and pelvic and abdominal surgery damage were important factors for pelvic adhesions of infertility patients,which may decrease the possibility of proximal tubal recanalization and increase ectopic pregnancy risk.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2012年第11期823-828,共6页
Chinese Journal of Obstetrics and Gynecology
