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目的探讨生育镜用于不孕症诊治的价值。方法用生育镜[包括经阴道注水腹腔镜(THL)与宫腔镜]对115例不孕症患者进行盆腔检查,观察内容包括输卵管通畅性、盆腔粘连情况等,以及盆腔完全评价率(即盆腔器官是否能被生育镜全部观察到)及术中、术后并发症。同时行THL下输卵管通液术和宫腔镜下输卵管口插管通液术。穿刺套管针成功从后穹窿穿刺入子宫直肠陷凹110例,其中原发性不孕(原发组)49例,继发性不孕(继发组)61例。既往输卵管检查为双侧阻塞者,原发组21例,继发组22例。结果术后输卵管双侧或一侧通畅者原发组34例(69.4%,34/49),继发组42例(68.9%,42/61),两组比较,差异也无统计学意义(P>0.05);既往输卵管检查为双侧阻塞者,术后双侧或一侧输卵管通畅者原发组10例(47.6%,10/21),继发组11例(50.0%,11/22),两组比较,差异无统计学意义(P>0.05)。盆腔粘连者原发组21例(42.9%,21/49),继发组37例(60.7%,37/61),两组比较,差异无统计学意义(P>0.05)。两组总的盆腔完全评价率为69.1%(76/110),其中原发组为77.6%(38/49),继发组为62.3%(38/61),两组比较,差异无统计学意义(P>0.05)。术后需行常规腹腔镜手术者20例(18.2%,20/110),原发组与继发组分别为4例(8.2%,4/49)和16例(26.2%,16/61),两组比较,差异有统计学意义(P<0.05);其中17例接受了微型腹腔镜手术。术中无盆腔脏器损伤、出血、直肠损伤或穿孔,术后无穿刺部位出血及盆腔感染等并发症发生。结论生育镜用于不孕症的诊治,操作简单、微创、安全、患者依从性好;对于临床或超声检查均无明显盆腔疾病证据的不孕症患者,生育镜可以取代经腹腹腔镜,成为一步到位的盆腔检查方法。
Objective To investigate the value of maternity mirror in diagnosis and treatment of infertility. Methods Pelvic examination was performed on 115 cases of infertility with fertility microscope [including translumenal laparoscopy (THL) and hysteroscopy]. The observations included tubal patency, pelvic adhesions, and pelvic complete evaluation (pelvic Organs can be all observed by the maternity mirror) and intraoperative and postoperative complications. At the same time under the THL tubal fluid and hysteroscopic tubal oral intubation fluid. Puncture of the trocar punctured the posterior fornix into the uterus and rectal pouch in 110 cases, of which 49 were primary infertility (primary group) and 61 were secondary infertility (secondary group). Past tubal examination for bilateral occlusion, the primary group of 21 cases, 22 cases of secondary. Results There were 34 cases (69.4%, 34/49) in the primary group and 42 cases in the secondary group (68.9%, 42/61) after operation. The difference between the two groups was not statistically significant ( P> 0.05). There were 10 cases (47.6%, 10/21) in primary group and 11 cases (50.0%, 11/22) in secondary group ), No significant difference between the two groups (P> 0.05). There were 21 cases (42.9%, 21/49) in the primary group and 37 cases (60.7%, 37/61) in the secondary group. There was no significant difference between the two groups (P> 0.05). The total pelvic complete evaluation rate was 69.1% (76/110) in both groups, of which 77.6% (38/49) in the primary group and 62.3% (38/61) in the secondary group, with no significant difference between the two groups Significance (P> 0.05). There were 20 cases (18.2%, 20/110) who underwent conventional laparoscopic surgery after operation, 4 cases (8.2%, 4/49) and 16 cases (26.2%, 16/61) , The difference between the two groups was statistically significant (P <0.05); of which 17 patients underwent mini laparoscopic surgery. No intraoperative pelvic organ injury, bleeding, rectal injury or perforation, no postoperative puncture site bleeding and complications such as pelvic infection. Conclusion Reproductive microscopy is used in the diagnosis and treatment of infertility, with simple operation, minimal invasion, safety and good patient compliance. For infertility patients with no evidence of pelvic disease on clinical or ultrasonographic examination, A one-step pelvic examination method.