Ikechebelu J I, Mbamara S U
Department of Obstetrics/Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Niger J Med. 2011 Oct-Dec;20(4):462-5.
Laparoscopy and dye test is an important investigation in the evaluation of infertile women which has been underutilised in our practice. This review is aimed at determining whether the findings of this procedure are substantial enough to make it a first line evaluation for infertile women.
A review of the laparoscopic findings in infertile women who presented for evaluation and treatment at a private fertility centre was carried out. A total of 253 day-case laparoscopy and dye test procedures were reviewed, 115 (45.0%) were done for primary infertility, 137 (54.5%) for secondary infertility and 1 (0.4%) for primary amenorrhoea and infertility.
The mean period of infertility was 4.5 years with a range of 2-10 years and the women were aged between 19 and 52 years. Analysis of the result showed that 100 (39.5%) women had normal patent tubes while 153 (60.4%) had tubal pathologies like bilateral tubal occlusion in 97 (38.3%) and unilateral tubal occlusion in 56 (22.1%) women. Pelvic adhesion of varying degrees of severity was present in 108 (42.7%) women. Bilateral tubal occlusion was more common in nulliparous women and those aged between 30-39 years. One or both ovaries were normal (functional) in 189 (74.7%) women. Altogether, only 43 (17.0%) women were "normal" (had patent tubes, functional ovary and no pelvic adhesion). Additional pelvic pathology was present in 142 (56.1%) women. The commonest was uterine fibroid (leiomyomata) of various sizes in 100 (39.5%) of the women, followed by ovarian cyst in 56 (22.2%) and endometriosis in 11 (4.4%) women. Other pathologies observed include uterine abnormalities and unruptured ectopic pregnancy. Only 16 (37.2%) of the 43 "normal" women had no additional pelvic pathology.
The high prevalence o tuboperitoneal factor and additional pelvic pathology in these infertile women reveal the importance of laparoscopic evaluation. We recommend the use of laparoscopy and dye test as a first line investigation in our environment to detect these conditions early enough when treatment modalities like assisted reproduction will still be beneficial.
腹腔镜检查及输卵管通液试验是评估不孕女性的一项重要检查，但在我们的临床实践中未得到充分利用。本综述旨在确定该检查结果是否足够重要，使其成为不孕女性的一线评估方法。
对在一家私立生育中心接受评估和治疗的不孕女性的腹腔镜检查结果进行综述。共回顾了253例日间腹腔镜检查及输卵管通液试验病例，其中115例（45.0%）因原发性不孕进行检查，137例（54.5%）因继发性不孕进行检查，1例（0.4%）因原发性闭经和不孕进行检查。
不孕平均时长为4.5年，范围在2至10年之间，女性年龄在19至52岁之间。结果分析显示，100例（39.5%）女性输卵管通畅正常，153例（60.4%）有输卵管病变，其中97例（38.3%）为双侧输卵管阻塞，56例（22.1%）为单侧输卵管阻塞。108例（42.7%）女性存在不同程度的盆腔粘连。双侧输卵管阻塞在未生育女性及30至39岁女性中更为常见。189例（74.7%）女性一侧或双侧卵巢正常（功能正常）。总体而言，只有43例（17.0%）女性“正常”（输卵管通畅、卵巢功能正常且无盆腔粘连）。142例（56.1%）女性存在其他盆腔病变。最常见的是100例（39.5%）女性有各种大小的子宫肌瘤，其次是56例（22.2%）有卵巢囊肿，11例（4.4%）有子宫内膜异位症。观察到的其他病变包括子宫异常和未破裂的异位妊娠。43例“正常”女性中只有16例（37.2%）没有其他盆腔病变。
这些不孕女性中输卵管腹膜因素及其他盆腔病变的高患病率揭示了腹腔镜评估的重要性。我们建议在我们的环境中使用腹腔镜检查及输卵管通液试验作为一线检查，以便在辅助生殖等治疗方式仍有益时尽早发现这些情况。
