微创医学

目的探讨举宫器配合经阴道注水腹腔镜(transvaginal hydrolaparoscopy,THL)联合宫腔镜在不孕症诊治中的应用价值。方法对64例子宫输卵管造影(HSG)提示至少有一侧输卵管通畅而不孕症的患者施行举宫器配合THL联合宫腔镜检查。结果 62例成功行THL,术前HSG双侧输卵管通畅50例,THL联合宫腔镜下输卵管口插管通液术后双侧输卵管通畅57例。62例中存在盆腔粘连29例,因粘连而需转为标准腹腔镜(hydrolaparoscopy,LAP)21例占33.8%(21/62)。在THL下完成手术41例,THL手术时间(9.5±6.7)min、总手术时间(18.5±5.3)min,穿刺成功率为96.9%(62/64);2例水注入直肠系膜,无直肠穿孔、出血、盆腔感染等并发症发生。盆腔完全评价率为93.5%(58/62)。留院观察时间6～12 h、在THL下完成手术41例中,妊娠18例,妊娠率43.9%(18/41),改LAP者妊娠7例,妊娠率为33.3%(7/21),P>0.05,差异无统计学意义。结论 THL具有操作简单、准确、微创、安全、经济、留院观察时间短等优点,举宫器配合THL与宫腔镜联合检查可作为临床或超声检查均无明显盆腔疾病证据的不明原因不孕症患者检查的首选方法,可避免盲目行经腹腹腔镜手术。

Objective To investigate the clinical effect and value of acyesis examination by laparoscopy combining transaginal hydrolaparoscopy(THL) with uterine manipulator.Method 64 acyesis patients who were admitted HSG showing at least one side of passable oviduct were checked via hysteroscope combining THL with uterine manipulator.Results Laparoscopy was put in uterus rectum pouch successfully in 62 cases.Before operation,HSG showed that there were 50 cases of both oviducts passable.After the operation of uterine tube orifice intubating hydrotubation via THL combining hysteroscope,there were 57 cases of both sides of oviducts passable.Of these 62 cases,29 cases of pelvic adhesion,so 21 cases had to change to LAP,accounting for 33.8%(21/62).41 cases received operation via THL.The THL operation time was(9.5±6.7) min.The total operation time was(18.5±5.3) min.The success ratio of puncture was 96.9%(62/64).In 2 cases,water was injected in mesorectum,without any complications such as rectal perforation,bleeding and pelvic infection.The complete assessment rate of pelvic cavity was 93.5%(58/62).The observation time in hospital was 6 to 12 hours.There were 18 cases of pregnancy in absolute THL group whose pregnancy rate was 43.9 %(18/41),and 7 cases in change to LAP group whose pregnancy rate was 33.3%(7/21),and there was no significant difference(P>0.05).Conclusion The diagnosis and treatment of acyesis via THL is easy to operate.It is also accurate,safe,economical and with short observation time in hospital.THL combining hysteroscope is the preferred method for unknown cause acyesis patients without obvious signals of pelvic disease in clinical or ultrasound examination,which can avoid meaningless abdominal laparoscope