Strandell Annika
Reproductive Medicine, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.
Curr Womens Health Rep. 2003 Oct;3(5):367-74.
Laparoscopic surgery has developed quickly and is preferred over laparotomy for most surgery in female infertility. In vitro fertilization (IVF) has emerged as the main treatment for tubal infertility, but surgery still has a definite place. In particular, patients with hydrosalpinx should undergo a laparoscopy for evaluation of salpingectomy before IVF or reconstructive surgery for attempts of spontaneous conception. Mild-to-moderate adhesions are also suitable for surgery. Although it has been shown that fibroids influence implantation negatively, the value of myomectomy for small and intramural or subserosal fibroids has been insufficiently investigated. The surgical management of endometriosis is controversial. The ablation of endometriotic peritoneal implants might increase the spontaneous conception rate. Repeat surgery in severe disease should be avoided. The indications and results for these and other fertility-enhancing procedures are evaluated according to the most recent publications.
腹腔镜手术发展迅速，在女性不孕症的大多数手术中，它比剖腹手术更受青睐。体外受精（IVF）已成为输卵管性不孕的主要治疗方法，但手术仍有一定的地位。特别是，输卵管积水患者在进行IVF或尝试自然受孕的重建手术前，应接受腹腔镜检查以评估输卵管切除术。轻度至中度粘连也适合手术。虽然已表明子宫肌瘤对着床有负面影响，但对于小的肌壁间或浆膜下肌瘤行肌瘤切除术的价值尚未得到充分研究。子宫内膜异位症的手术治疗存在争议。子宫内膜异位症腹膜植入物的消融可能会提高自然受孕率。应避免在严重疾病中进行重复手术。根据最新出版物评估这些及其他提高生育能力手术的适应症和结果。
