网络首发:2011-11-20,
纸质出版:2011
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不孕病史与腹腔镜下盆腔病变诊断关联性分析[J]. 中山大学学报(医学科学版), 2011,32(6).
Relevance Analysis between Infertility History and Laparoscopic Pelvic Lesions Diagnosis[J]. Journal of Sun Yat-sen University (Medical Sciences), 2011, 32(6).
【目的】 探讨不孕症患者术前病史和腹腔镜诊断盆腔病变不孕因素之间关联性,为临床不孕症处理提供依据。【方法】 收集2008年11月至2009年10月间因不孕症在我院妇科住院行腹腔镜诊治术的病例379例,按入选标准收集其既往病史资料包括患者的不孕时限、不孕类型、既往手术以及子宫输卵管造影(HSG)等。按照标准有361例纳入研究,将其不同临床特点按腹腔镜下诊断为盆腔输卵管因素、内异症或者双因素三方面进行分类汇总分析。【结果】 从入选361例患者腹腔镜下盆腔诊断结果分析显示,在不同年限组间比较,盆腔疾病构成比是不一样,差别有统计学意义(P<0.05)。盆腔输卵管因素在不孕年限≥10年组最高(76.5%),而盆腔子宫内膜异位症所占比例最低(5.9%)。原发不孕与继发不孕盆腔疾病构成比差别无统计学意义(P>0.05)。按照既往不同手术史情况分组,盆腔输卵管因素及子宫内膜异位症因素所占病因构成比差别无统计学意义(P>0.05)。有盆腔手术史患者,盆腔输卵管因素有增高趋势。HSG诊断右、左两侧输卵管通而不畅组与对应通畅组比较,腹腔镜下诊断正常、堵塞与盆腔粘连差别无统计学意义(P均>0.05)。右、左两侧输卵管通而不畅组与堵塞组比较,腹腔镜下诊断正常、堵塞与盆腔粘连的情况差别有统计学意义(P均<0.05)。当HSG诊断双侧输卵管通畅时,腹腔镜诊断与HSG结果一致性达100%;诊断双侧输卵管堵塞时,一致性只有72.0%。【结论】不孕患者既往病史对于判断其病因很有意义,相对价廉的HSG对盆腔输卵管炎性不孕病因有着良好预测作用。
【Objective】 To investigate the relevance between the preoperatively history of infertility patients and laparoscopic diagnosis of pelvic lesions
and to provide the basis for clinical treatment of infertility. 【Methods】 From November 2008 to October 2009
379 patients who went to hospital for laparoscopic examinations because of infertility treatment in gynecology department of our hospital were enrolled in the research. The patients’ infertility period
infertility types
history of surgery
and hysterosalpingography results were collected according to the criteria. According to the inclusion criteria
361 cases were included in the study. The different clinical characteristic were classified and analyzed according to laparoscopic diagnosis
which included pelvic/oviduct infertility
pelvic endometriosis or both of them. 【Results】 The analysis of pelvic diagnosis by laparoscope of 361 cases showed that the constituent ratio of pelvic disease was different comparing among the groups of different infertility periods
and the difference was statistically significant (P <0.05). In the groups of infertility period ≥10 years
pelvic /oviduct infertility factor was highest (76.5%)
and pelvic endometriosis in this group was lowest (5.9%). Primary infertility was not statistical different comparing with secondary infertility in laparoscopic pelvic lesions diagnosis (P > 0.05). According to the grouping of different surgery history
the etiology constituent ratios of pelvic lesions did not show statistically significant (P > 0.05). The patients having history of pelvic surgeries have a trend of higher percentages of the pelvic/oviduct factor infertility. The analysis of the results of HSG showed that when comparing the partial patency group of right or left oviduct with the corresponding patency one
there was no statistical difference (Both P > 0.05) under the diagnosis of laparoscope which including the diagnosis of normal
tubal blockage and pelvic adhesion. But when comparing the partial patency group of right or left oviduct with the corresponding blockage one
it was statistically different (Both P <0.05) under the diagnosis of laparoscope. When the HSG diagnosis of bilateral tube was patent
the result of laparoscopic diagnosis was consistent with it by 100%. But when the HSG diagnosis of bilateral tube was blockage
the consistency was only 72.0%. 【Conclusions】 The past medical histories of infertile patients are very meaningful for judging their infertility reasons. Relatively cheap hysterosalpingography has a good prediction effect for finding pelvic/oviduct inflammatory infertility reason.
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