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目的探讨经阴道注水腹腔镜(THL)联合宫腔镜检查不孕症的临床效果和应用价值。方法对46例不孕症患者施行THL联合宫腔镜检查,其中原发性不孕(原发组)和继发性不孕(继发组)各23例。观察患者的输卵管通畅性、盆腔病变情况,记录THL手术时间、总手术时间、离院时间、术后阴道壁穿刺孔愈合时间、穿刺成功率与术中及术后并发症。结果原发组术后输卵管双侧通畅13例,继发组术后输卵管双侧通畅5例;两组比较,差异有显著性(P<0.05);原发组盆腔粘连6例,继发组盆腔粘连14例,两组比较,差异有显著性(P<0.05);术后需要进一步施行常规腹腔镜手术的患者仅7例(7/46,15%);46例不孕症患者THL手术时间、总手术时间、术后离院时间和阴道壁穿刺孔愈合时间分别为(10.5±1.7)min、(32.2±4.6)min、(87.3土12.5)min和(4.5±0.5)d;穿刺成功率为96%(46/48);无直肠损伤、术后穿刺部位出血、盆腔感染等并发症发生。结论THL具有准确、微创、安全、经济、不需住院等优点,联合应用宫腔镜检查效果更佳。THL和宫腔镜联合检查可作为不孕症早期检查的一线方法。
Objective To investigate the clinical effect and application value of transvaginal laparoscopy (THL) combined with hysteroscopy in the examination of infertility. Methods 46 cases of infertility patients underwent THL combined with hysteroscopy, of which 23 cases of primary infertility (primary group) and secondary infertility (secondary group). Observe the tubal patency, pelvic lesions, record the time of THL operation, the total operation time, the time of leaving the hospital, the healing time of postoperative vaginal wall puncture, the puncture success rate and intraoperative and postoperative complications. Results In the primary group, there were 13 cases of bilateral tubal patency and 5 cases of bilateral tubal patency in the secondary group. The difference between the two groups was significant (P <0.05) Pelvic adhesions in 14 cases, the difference between the two groups was significant (P <0.05); only 7 patients (7/46, 15%) required further conventional laparoscopic surgery; 46 cases of infertility patients with THL surgery The time of operation, the time of operation, the time of leaving hospital and the healing time of vaginal wall puncture were (10.5 ± 1.7) min, (32.2 ± 4.6) min, (87.3 ± 12.5) min and (4.5 ± 0.5) d respectively. The rate was 96% (46/48). No rectal injury, postoperative puncture site bleeding, pelvic infection and other complications occurred. Conclusion THL has the advantages of accurate, minimally invasive, safe, economical, without hospitalization, combined hysteroscopy better. THL and hysteroscopy combined examination can be used as a first-line method of infertility early detection.