应用防粘连隔离膜在腹腔镜下盆腔粘连松解治疗不孕症的临床意义(1)
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【摘要】 目的 探讨腹腔镜下盆腔粘连松解术中应用防粘连隔离膜治疗不孕症的安全性和有效性。方法 自2006年2月至2008年12月,对226例不孕患者在本院用腹腔镜行盆腔粘连松解,随机分为2组,治疗组112例术中应用防粘连剂。记录盆腔粘连与松解情况、输卵管通畅性及术后妊娠情况。结果 ①腹腔镜下盆腔粘连松解,输卵管染色通液中发现42条近端梗阻,治疗组疏通199条输卵管,对照组疏通211条输卵管;②术后无并发症发生,72~96 h出院;③随访情况:术后随访13~23个月。治疗组输卵管再闭塞率2.01%(4/199)低于对照组,两组比较治疗组差别有显著意义。治疗组受孕率59.82%(67/112),对照组2例失访,受孕率41.07%(46/112),两个治疗组比较其差别有显著意义(P<0.01)。结论 腹腔镜下盆腔粘连松解术中应用防粘连剂治疗不孕症可行、有效,术后再闭塞率低,受孕率高。
【关键词】不孕;女性;盆腔粘连松解;预防粘连
Study on hydro-laparoscopic pelvic adhesiolysis apply membrane for anti-adhesionin the infertile woman
LI Wen-cheng,SHU Ai-e,WANGYou-kuai,et al.Hospital Of Huaihua,NanHua University,Hunan418000,China
【Abstract】 Objective To investigate the safety and efficacy of hydrolaparoscopic pelvic adhesiolysis applied membrane for anti-adhesion in the infertile women.Methods From February 2006 to December 2008,226 infertile patients underwent hydrolaparoscopic pelvic adhesiolysis applied membrane for anti-adhesion.They have been divided into two groups,The study group apply membrane for anti-adhesion after operation.The diuation of the operation and discharge,pelvic adhesions scored,oviducts patency,complications and pregrancy rate were investigated.Results ①Hydrolaparoscopic pelvic adhesiolysis.42 oviducts were of proximal occlusion by dye-test.There were 199 oviducts unobstructedin the study group and 211 oviducts unobstructedin the control group.②The duration of be hospitalized 72-96 hours,no complications occurred.③the condition of follow-up:in the 13-23 months’ follow-up,The rate of oviduct block again after operation was 2.01%(4/199)in the study group is lower than in the control group(P<0.01).The rate of pregnancy was 59.82%(67/112)in the study group is higher than the control group(P<0.01).Conclusion Hydrolaparoscopic pelvic adhesiolysis apply membrane for anti-adhesion is safe,efficacious,the rate of oviduts block again after operation is lower with higher pregrancy.
【Key words】
Infertility; Female; Pelvic adhesiolysis; Anti-adhehesion
女性因素不孕占40%,其中15%~20%女性不孕由盆腔粘连所致[1],经腹腔镜下能有效松解盆腔粘连,但是术后易复发,为探索一种更有效的方法, 南华大学附属怀化医院自2006年2月至2008年12月对226例存在不同程度盆腔粘连的不孕症患者实施了腹腔镜下盆腔粘连松解术,术中盆腔粘连松解处留置粘停宁(壳聚糖)及输卵管伞部置入20 mm×5 mm粘停宁裁剪条2条,术后观察效果满意。
1 资料与方法
1.1 一般资料 自2006年2月至2008年12月对291例不孕症患者(22例已切除单侧输卵管)进行HSG检查(其中外院检查18例),HSG检查时依据造影剂显示情况分为:①输卵管全程显示,盆腔内有较多造影剂弥散为通畅;②阻塞(梗阻):输卵管中、远端不显影或仅部分显影,没有造影剂弥散盆腔;③通而不畅(部分梗阻):造影剂排出输卵管进入盆腔,输卵管显影,但形态粗细不规则,造影剂部分进入盆腔且弥散不均匀[2] ......
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