Luber K, Beeson C C, Kennedy J F, Villanueva B, Young P E
Am J Obstet Gynecol. 1986 Jun;154(6):1264-70. doi: 10.1016/0002-9378(86)90710-6.
Sixty-nine patients with tubal infertility secondary to pelvic inflammatory disease were surgically treated by one of three infertility surgeons, who used microsurgery for repair of the tubal pathologic condition and early second-look laparoscopy 6 to 30 days postoperatively for lysis of postoperative adhesions. No patient was included in this group whose disease was thought to have originated from endometriosis or prior abdominal surgery. The average follow-up time was 43.1 months (range 12 to 85.9). Nine patients were excluded from the analysis. Pregnancy outcome by procedure, expressed as the percentage of patients conceiving, was as follows: adhesiolysis, 69% (61% term, 8% ectopic); fimbrioplasty, 35% (25% term, 10% ectopic); salpingostomy, 30% (18% term, 12% ectopic); and cornual implantation, 60% (40% term, 20% ectopic). No added therapeutic value could be attributed to the use of early second-look laparoscopy. Given the relatively poor outcome of fimbrioplasty and salpingostomy, it may be prudent to advise patients with bilateral partial and/or total tubal occlusion against tuboplasty in favor of in vitro fertilization and embryo transfer.
69例继发于盆腔炎的输卵管性不孕患者由三位不孕不育外科医生之一进行手术治疗，他们采用显微外科手术修复输卵管病变，并在术后6至30天进行早期二次腹腔镜检查以松解术后粘连。该组未纳入疾病被认为源于子宫内膜异位症或既往腹部手术的患者。平均随访时间为43.1个月（范围12至85.9个月）。9例患者被排除在分析之外。按手术方式的妊娠结局，以受孕患者的百分比表示如下：粘连松解术，69%（足月产61%，异位妊娠8%）；伞端成形术，35%（足月产25%，异位妊娠10%）；输卵管造口术，30%（足月产18%，异位妊娠12%）；输卵管子宫角植入术，60%（足月产40%，异位妊娠20%）。早期二次腹腔镜检查未显示出额外的治疗价值。鉴于伞端成形术和输卵管造口术的结局相对较差，对于双侧部分和/或完全输卵管阻塞的患者，建议其不要进行输卵管成形术，而选择体外受精和胚胎移植可能更为谨慎。
