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经阴道水腹腔镜检查在调查沙眼衣原体感染的不孕妇女中的应用价值。

Usefulness of transvaginal hydrolaparoscopy in investigating infertile women with Chlamydia trachomatis infection.

作者信息

Shibahara H, Fujiwara H, Hirano Y, Suzuki T, Obara H, Takamizawa S, Idei S, Sato I

机构信息

Department of Obstetrics and Gynecology, Jichi Medical School, 3311-1, Yakushiji, Minamikawachi-machi, Kawachi-gun, Tochigi 329-0498, Japan.

出版信息

Hum Reprod. 2001 Aug;16(8):1690-3. doi: 10.1093/humrep/16.8.1690.

Abstract

BACKGROUND

A new technique called transvaginal hydrolaparoscopy (THL) was recently developed for the exploration of the tubo-ovarian structures in infertile patients without obvious pelvic pathology. This study was performed to investigate the usefulness of THL to evaluate Chlamydia trachomatis tubal infertility.

METHODS

Forty-one women with primary and secondary infertility participated in this study. Fourteen had past C. trachomatis infection. In 38 (92.7%) of the 41, access to the pouch of Douglas was obtained. In total, 71 (93.4%) out of 76 adnexa were clearly visualized. Thirty-seven patients were analysed and compared their tubal passages and peritubal adhesions using both hysterosalpingography (HSG) and THL. Twenty-four tubes from 14 patients with past C. trachomatis infection and 44 tubes from 23 patients without a history of C. trachomatis infection were compared.

RESULTS

For the diagnosis of the tubal passage, there were no significant differences in the discrepancy rates between HSG and THL, in patients with and without past C. trachomatis infection. In 14 (58.3%) of the 24 tubes from patients with past C. trachomatis infection and in eight (18.2%) of the 44 tubes from patients without infection, peritubal adhesion was diagnosed only by THL. There was a significant difference in the discrepancy rates of the diagnosis of peritubal adhesion between HSG and THL in the two groups (P = 0.0007 ).

CONCLUSIONS

These results suggest that C. trachomatis infection is highly associated with peritubal adhesion which is difficult to diagnose by HSG. Therefore, in C. trachomatis antibody-positive patients, exclusion of tubal pathology by THL or standard laparoscopy should be carried out to consider appropriate treatments. Although THL is not a substitute for laparoscopy, it can be proposed as a first line procedure in the early stages of the infertility investigation.

摘要

背景

一种名为经阴道水腹腔镜检查(THL)的新技术最近被开发出来,用于在没有明显盆腔病变的不孕患者中探查输卵管卵巢结构。本研究旨在探讨THL评估沙眼衣原体所致输卵管性不孕的有效性。

方法

41例原发性和继发性不孕女性参与了本研究。其中14例曾感染过沙眼衣原体。41例中有38例(92.7%)成功进入Douglas腔隙。总共76个附件中有71个(93.4%)被清晰观察到。对37例患者使用子宫输卵管造影术(HSG)和THL分析并比较其输卵管通畅情况和输卵管周围粘连情况。比较了14例曾感染沙眼衣原体患者的24条输卵管和23例无沙眼衣原体感染史患者的44条输卵管。

结果

对于输卵管通畅情况的诊断,有或无沙眼衣原体感染史的患者中,HSG和THL之间的差异率无显著差异。在曾感染沙眼衣原体患者的24条输卵管中,有14条(58.3%),在未感染患者的44条输卵管中,有8条(18.2%),输卵管周围粘连仅通过THL被诊断出来。两组中HSG和THL对输卵管周围粘连诊断的差异率有显著差异(P = 0.0007)。

结论

这些结果表明,沙眼衣原体感染与输卵管周围粘连高度相关,而HSG难以诊断这种粘连。因此,对于沙眼衣原体抗体阳性患者,应通过THL或标准腹腔镜检查排除输卵管病变,以考虑适当的治疗方法。虽然THL不能替代腹腔镜检查,但可作为不孕检查早期阶段的一线检查方法。

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