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子宫输卵管造影正常的患者宫腔内人工授精未成功受孕后的腹腔镜评估

[Laparoscopic assessment following failure to achieve pregnancy after intrauterine inseminations in patients with normal hysterosalpingograms].

作者信息

Jedrzejczak Piotr, Serdyńska Monika, Brazert Maciej, Pelesz Marek, Pawelczyk Leszek

机构信息

Klinika Niepłodności i Endokrynologii Rozrodu, Katedra Ginekologii i Poloznictwa, Akademia Medyczna im K Marcinkowskiego w Poznaniu.

出版信息

Ginekol Pol. 2006 Aug;77(8):582-8.

Abstract

OBJECTIVES

To assess the diagnostic benefit of laparoscopy in infertile women thought to be at low risk for altered pelvic anatomy.

DESIGN

Retrospective chart review.

PATIENTS

127 infertile patients who underwent laparoscopic evaluation of the pelvis failing to conceive after intrauterine inseminations (IUI) with normal hysterosalpingography (HSG).

INTERVENTION

Diagnostic and/or therapeutic laparoscopy.

MAIN OUTCOME MEASURES

Presence of pelvic pathology and predictors of pelvic disease.

RESULTS

Although the hysterosalpingograms were read as normal in all women, endometriosis stage I-II was found in 64 (50,4%) patients, stage III and stage IV in 4 (3,1%). Adhaesions were diagnosed laparoscopically in 22 (17%) patients and distal tubal disease in 26 (20%). All of this abnormalities were directly treated by laparoscopic intervention. The time between HSG and laparoscopy was positively correlated with appearance of distal tubal disease and pelvic adhaesions.

CONCLUSION

Laparoscopic findings could lead to a change of treatment decisions in high number of infertile patients with normal hysterosalpingography.

摘要

目的

评估腹腔镜检查对被认为盆腔解剖结构改变风险较低的不孕女性的诊断价值。

设计

回顾性病历审查。

患者

127例不孕患者,她们在子宫输卵管造影(HSG)正常的情况下接受宫内人工授精(IUI)后未受孕,随后接受了盆腔腹腔镜评估。

干预措施

诊断性和/或治疗性腹腔镜检查。

主要观察指标

盆腔病变的存在情况及盆腔疾病的预测因素。

结果

尽管所有女性的子宫输卵管造影结果均显示正常,但64例(50.4%)患者发现有I-II期子宫内膜异位症,4例(3.1%)为III期和IV期。腹腔镜诊断22例(17%)患者有粘连,26例(20%)有远端输卵管疾病。所有这些异常均通过腹腔镜干预直接治疗。HSG与腹腔镜检查之间的时间与远端输卵管疾病和盆腔粘连的出现呈正相关。

结论

腹腔镜检查结果可能会使大量子宫输卵管造影正常的不孕患者的治疗决策发生改变。

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