经阴道水腹腔镜检查是否会使标准诊断性腹腔镜检查在不明原因不孕症的检查中过时？

Does transvaginal hydrolaparoscopy render standard diagnostic laparoscopy obsolete for unexplained infertility investigation?

作者信息

Dechaud H, Ali Ahmed S A, Aligier N, Vergnes C, Hedon B

机构信息

Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU Arnaud De Villeneuve, 371, avenue du doyen Gaston Giraud, Montpellier, France.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2001 Jan;94(1):97-102. doi: 10.1016/s0301-2115(00)00305-5.

DOI:10.1016/s0301-2115(00)00305-5

PMID:11134833

Abstract

OBJECTIVE

To evaluate the feasability of transvaginal hydrolaparoscopy in infertile patients undergoing basic infertility investigations, and to determine its usefulness in comparison with standard laparoscopy.

MATERIALS AND METHODS

Twenty-three unexplained infertile women were prospectively included. Selected patients had no history of pelvic disease or previous pelvic surgery and had normal findings on gynecological examination and vaginal sonography. The patients received general anesthesia and underwent the transvaginal hydrolaparoscopy immediately prior to a standard laparoscopy by a different operator. The main outcome measures were the rate of successful access to the pouch of Douglas, the duration of the procedure, and the rate of complications. In order to compare the accuracy of the transvaginal hydrolaparoscopy to the standard laparoscopy, findings in terms of tubal pathology, endometriosis, and adhesions were analyzed.

RESULTS

The successful rate of access to the pouch of Douglas was 95.7%. The rate of complications was 4.3%. The mean duration of the transvaginal hydrolaparoscopy procedure was 8 min. The concordance between transvaginal hydrolaparoscopy and laparoscopy for pelvic cavity examination was statistically significant (k=0.57, P=0.02). In 40.9% of cases, the transvaginal hydrolaparoscopy procedure has shown a normal pelvic examination confirmed by laparoscopic diagnosis. According to the findings by laparoscopy, transvaginal hydrolaparoscopic diagnosis was correlated well in 81.8% of cases. When transvaginal hydrolaparoscopy showed pathological findings, there were no normal laparoscopies. Pathological laparoscopies were found in 18.2% of the normal transvaginal hydrolaparoscopies.

CONCLUSION

The transvaginal hydrolaparoscopy is a reproducible and safe method to investigate the pelvis and its structures. The diagnostic accuracy of the transvaginal hydrolaparoscopy suggests that more than 40% of standard laparoscopies for unexplained infertility could be avoided.

摘要

目的

评估经阴道水腹腔镜检查在接受基本不孕症检查的不孕患者中的可行性，并确定其与标准腹腔镜检查相比的有用性。

材料与方法

前瞻性纳入23例不明原因不孕的女性。入选患者无盆腔疾病史或既往盆腔手术史，妇科检查和阴道超声检查结果正常。患者接受全身麻醉，并在由另一位操作者进行标准腹腔镜检查之前立即接受经阴道水腹腔镜检查。主要观察指标为进入Douglas腔隙的成功率、手术持续时间和并发症发生率。为了比较经阴道水腹腔镜检查与标准腹腔镜检查的准确性，分析了输卵管病变、子宫内膜异位症和粘连方面的检查结果。

结果

进入Douglas腔隙的成功率为95.7%。并发症发生率为4.3%。经阴道水腹腔镜检查的平均手术时间为8分钟。经阴道水腹腔镜检查与腹腔镜检查在盆腔检查方面的一致性具有统计学意义（k=0.57，P=0.02）。在40.9%的病例中，经阴道水腹腔镜检查显示盆腔检查正常，经腹腔镜诊断证实。根据腹腔镜检查结果，经阴道水腹腔镜诊断在81.8%的病例中相关性良好。当经阴道水腹腔镜检查显示病理结果时，没有腹腔镜检查结果正常的情况。在正常经阴道水腹腔镜检查病例中，18.2%发现有病理腹腔镜检查结果。