Jain Kuldeep
J Indian Med Assoc. 2014 Feb;112(2):85-6, 88.
The study aims to analyse the role of hysteroscopy-laparoscopy in diagnosis and treatment of infertility with effect on pregnancy outcome. The study group comprised 200 patients of 20-30 years age (125 with primary and 75 with secondary infertility). Hysterosalpingography (HSG) was done in all. Diagnostic as well as operative hysteroscopy-laparoscopy if required were performed in the same sitting in cases who have already been treated for 6 months and did not conceive, with unexplained cause or with abnormal HSG findings. All cases were followed up till they conceived or up to 1 year. Fifty patients of unexplained infertility were used as control and given only folic acid 5 mg/day. HSG was normal in 102/200 (51%) and abnormal in 98/200 (49%) cases in form of fimbrial block in 48 (48.97%) out of 98, cornual block 25 (25.51%), peritubal adhesions 15 (15.31%), filling defect in uterus 10 cases (10.20%). Hysteroscopy was abnormal in 150/200 cases (75%) with uterine synechiae 58 (38.66%) out of 150, endometrial hypertrophy 22 (14.67%), endometrial polyps 20 (13.33%), submucus fibroids 20 (13.33%), atrophy 25 (16.66%) and malformations 5 (3.33%). Hysteroscopy surgery was performed in 70 (46.66%), alone in 14 and with laparoscopic procedures in 56 cases, with subsequent pregnancy rate of 35.71-42%. HSG missed the abnormalities in 58 cases (38.66%) which were diagnosed with hysteroscopy with difference in findings in 58 cases (38.66%). Operative laparoscopy was performed in 140 cases (70%), divided between adhesiolysis in 38(27.14%), tubal surgery in 53 (37.86%), electrocoagulation or excision of endometriotic nodule in 25(17.86%) and ovarian drilling for polycystic ovarian disease in 24(17.14%). The HSG missed 30(20%) abnormal tubal and peritubal findings which were diagnosed with laparoscopy. All cases were followed for one year. Subsequent pregnancy rate was 64 (45.71%) after laparoscopic surgery. The results were analysed by applying Chi-square test and calculating p-value at 1 df. Hysteroscopy-laparoscopy is diagnostic and therapeutic both for uterine, tubal infertility and ovarian abnormalities. They give an advantage in diagnosis and treatment of female infertility at the same sitting. As compared to HSG, it is more accurate in 25% cases and improves the rate of pregnancy to 35%-45% almost comparable to 56.52% in cases with normal hysteroscopy-laparoscopy findings.
本研究旨在分析宫腔镜-腹腔镜联合检查在不孕症诊断和治疗中的作用及其对妊娠结局的影响。研究组包括200例年龄在20至30岁之间的患者（125例原发性不孕症患者和75例继发性不孕症患者）。所有患者均接受了子宫输卵管造影（HSG）检查。对于那些已经接受治疗6个月仍未受孕、病因不明或HSG检查结果异常的患者，若有需要，在同一次就诊时进行诊断性及手术性宫腔镜-腹腔镜联合检查。所有病例均随访至受孕或直至1年。选取50例不明原因不孕症患者作为对照组，仅给予每日5毫克叶酸。200例患者中，102例（51%）HSG检查结果正常，98例（49%）异常，其中98例中有48例（48.97%）为伞端阻塞，25例（25.51%）为宫角阻塞，15例（15.31%）为输卵管周围粘连，10例（10.20%）为子宫内充盈缺损。200例患者中150例（75%）宫腔镜检查结果异常，其中150例中有58例（38.66%）为子宫粘连，22例（14.67%）为子宫内膜增生，20例（13.33%）为子宫内膜息肉，20例（13.33%）为黏膜下肌瘤，25例（16.66%）为萎缩，5例（3.33%）为畸形。70例（46.66%）患者接受了宫腔镜手术，其中14例单独进行宫腔镜手术，56例联合腹腔镜手术，随后的妊娠率为35.71%至42%。HSG检查漏诊了58例（38.66%）异常情况，这些异常情况经宫腔镜检查得以诊断，58例（38.66%）检查结果存在差异。140例（70%）患者进行了手术腹腔镜检查，其中38例（27.14%）进行粘连松解，53例（37.86%）进行输卵管手术，25例（17.86%）进行子宫内膜异位结节的电凝或切除，24例（17.14%）针对多囊卵巢疾病进行卵巢打孔。HSG检查漏诊了30例（20%）输卵管及输卵管周围的异常情况，这些异常情况经腹腔镜检查得以诊断。所有病例均随访1年。腹腔镜手术后随后的妊娠率为64例（45.71%）。通过应用卡方检验并计算自由度为1时的p值对结果进行分析。宫腔镜-腹腔镜联合检查对于子宫性、输卵管性不孕症及卵巢异常均具有诊断和治疗作用。它们在同一次就诊时对女性不孕症的诊断和治疗具有优势。与HSG相比，在25%的病例中更准确，并且将妊娠率提高到35%至45%，几乎与宫腔镜-腹腔镜检查结果正常的病例中的56.52%相当。
