Gerber B, Krause A
Department of Obstetrics and Gynecology, University of Rostock, Germany.
Arch Gynecol Obstet. 1996;258(4):193-200. doi: 10.1007/s004040050123.
Acute salpingitis (AS) has a major impact on the reproductive health of women. In this study second-look laparoscopy was assessed for its ability to predict reproductive function after AS. We questioned 158 women who had had a second-look laparoscopy with tubal dye insufflation after laparoscopically proven AS between September 1984 and August 1989. The answers of 69 women with at least two years of involuntary infertility were analyzed. The mean follow-up period was 76 months (range 53-108 months). Second-look laparoscopy revealed bilateral tubal occlusion in 21.7% (15/69). Bilateral tubal occlusion was found in 9.5% (2/21) after mild stage, 20% (4/20) after moderate stage and 32.1% (9/28) after severe stage AS. The rate of infertility during follow-up was 9.5% (stage I), 35% (stage II) and 39.9% (stage III). Eighty per cent (12/15) of women with proven bilateral tubal occlusion after treated AS had involuntary infertility, and 14.8% (8/54; P = 0.000001) of women with one or both tubes patent also had infertility. Specificity, sensitivity and positive predictive value for subsequent infertility were 85.2%, 80% and 84.1%, respectively. Pelvic adhesions (21/69) were strongly correlated with bilateral tubal occlusion (8/21; 38.1%; P = 0.029), a history of chronic pelvic pain (14/21; 66.7%; P = 0.00024), as well as failure to achieve an intrauterine pregnancy (10/21; 47.6%; P = 0.024). Recurrent pelvic infections occurred in 16% (12/69) and ectopic pregnancies in 7.3% (5/69). Operations for infertility and pelvic pain (excluding ectopic pregnancy), were carried out in 11.6% (8/69). We conclude that second-look laparoscopy after treated AS have accurate evaluation of reproductive function.
急性输卵管炎（AS）对女性生殖健康有重大影响。在本研究中，对二次腹腔镜检查预测AS后生殖功能的能力进行了评估。我们询问了158名在1984年9月至1989年8月期间经腹腔镜证实患有AS后接受了输卵管通液二次腹腔镜检查的女性。分析了69名至少有两年原发性不孕的女性的回答。平均随访期为76个月（范围53 - 108个月）。二次腹腔镜检查显示21.7%（15/69）存在双侧输卵管阻塞。轻度AS阶段后9.5%（2/21）发现双侧输卵管阻塞，中度阶段后20%（4/20），重度阶段后32.1%（9/28）。随访期间的不孕率为9.5%（I期）、35%（II期）和39.9%（III期）。经治疗的AS后证实有双侧输卵管阻塞的女性中80%（12/15）患有原发性不孕，一侧或双侧输卵管通畅的女性中14.8%（8/54；P = 0.000001）也患有不孕。对后续不孕的特异性、敏感性和阳性预测值分别为85.2%、80%和84.1%。盆腔粘连（21/69）与双侧输卵管阻塞（8/21；38.1%；P = 0.029）、慢性盆腔疼痛病史（14/21；66.7%；P = 0.00024）以及未能实现宫内妊娠（10/21；47.6%；P = 0.024）密切相关。复发性盆腔感染发生率为16%（12/69），异位妊娠发生率为7.3%（5/69）。因不孕和盆腔疼痛（不包括异位妊娠）进行手术的比例为11.6%（8/69）。我们得出结论，治疗后的AS进行二次腹腔镜检查可准确评估生殖功能。
