Application of hysteroscopy combined with laparoscopic pelvic exploration in the diagnosis and treatment of primary and secondary infertility

Fenghua Chen, Xuelian Cheng
2019 · vol. 26(7) , pp. 802–806 · doi:10.3760/cma.j.issn.1008-6706.2019.07.009 · W3031361491
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Hysteroscopy combined with laparoscopy revealed that pelvic adhesions and tubal disease are prevalent causes of primary and secondary infertility, with repeated pregnancies significantly increasing the incidence of these conditions.

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This study evaluated pelvic findings in 120 women undergoing combined hysteroscopy and laparoscopy for primary or secondary infertility between 2015 and 2017. The researchers identified a high prevalence of pelvic adhesions, particularly among patients with multiple prior pregnancies, and noted that endometriosis was one of several conditions detected during exploration. While tubal recanalization rates were low at approximately 18%, the data indicated that repeated maternity significantly increases the risk of severe pelvic and tubal disease leading to secondary infertility. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Objective To observe the different manifestations and differences of pelvic laparoscopy in primary and secondary infertility patients, and to clarify the application of hysteroscopy combined with laparoscopy in the diagnosis and treatment of infertility. Methods A total of 120 infertile women were enrolled in Yiwu Central Hospital from January 2015 to January 2017, of which 66 cases were primary infertility and 54 cases were secondary infertility. The infertility group was divided into 1 time, 2 times, 3 times and above according to previous maternity. Hysteroscopy combined with laparoscopy was used for pelvic exploration in infertility patients. The detection of the type of disease, pelvic adhesions, tubal fluid and treatment were analyzed. Results (1)Infertile patients were complicated with endometriosis, pelvic tuberculosis, polycystic ovary, uterine fibroids, ovarian tumors, endometrial polyps and other diseases. (2)There were 94 cases of pelvic adhesions(78.3%), 50 cases of primary infertility(75.8%), and 44 cases in Secondary infertility group(81.5%). (3) Primary infertility adhesion ratio of 75.8%, secondary infertility adhesion ratio of 81.5%, the proportion of adhesions in maternal 1 time patients was 80.6%, the proportion of adhesions in pregnant women with 2 times was 83.3%, the proportion of adhesions in pregnant women with more than three times was 90.0%, and the median adhesion rate was 36.4% in the secondary infertility cases, the proportion of severe adhesion was 45.5%. (4) Intraoperative treatment of tubal fluid examination conducted in 240 strips.The probability of recanalization of the primary infertility group was 17.78%, and the probability of recanalization was 18.75%. Conclusion (1) Pelvic adhesion is an important factor in causing infertility, primary infertility patients also have a greater proportion of pelvic, fallopian tube disease.(2) Repeated maternal history significantly increased pelvic, fallopian tube disease, which is an important factor caused the increased incidence of secondary infertility. Key words: Infertility, female; Hysteroscopy; Laparoscopy; Tissue adhesions; Pelvic inflammatory disease; Fallopian tube diseases
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宫腔镜联合腹腔镜盆腔探查在原发和继发不育症诊治中的应用 Application of hysteroscopy combined with laparoscopic pelvic exploration in the diagnosis and treatment of primary and secondary infertility 摘要目的 观察原发和继发不育症患者在宫腹腔镜联合探查术中的盆腔不同表现以及治疗差异,明确宫腹腔镜联合探查术在不育诊治中的应用情况.方法 选择2015年1月至2017年1月在义乌市中心医院接受宫腔镜联合腹腔镜诊治的不育症女性120例,根据不育症类型分为原发不育组66例,继发不育组54例,继发不育组根据既往孕产次分为1次、2次、3次及以上.采用宫腔镜联合腹腔镜对不育症患者进行盆腔探查,分析检出的疾病类型、盆腔粘连程度、输卵管通液及治疗情况.结果 (1)不育症患者分别合并有子宫内膜异位症、盆腔结核、多囊卵巢、子宫肌瘤、卵巢肿瘤、子宫内膜息肉等疾病. (2)患者中存在盆腔粘连94例(78.3% ),原发不育组50例(75.8% ),继发不育组44例(81.5% ). (3)原发不育组粘连比例75.8% ,继发不育组粘连比例81.5% ,孕产1次患者粘连比例80.6% ,孕产2次患者粘连比例83.3% ,孕产≥3次患者粘连比例90.9% ,其中继发不育组中3次及以上孕产史的中度粘连比例36.4% ,重度粘连比例达45.5% .(4)术中共行输卵管通液检查240条.原发不育组输卵管治疗再通率为17.78% ,继发不孕组输卵管治疗再通率为18.75% .结论 (1)盆腔粘连是引起不育症的重要因素,原发不育症患者中也存在较多盆腔、输卵管病变. (2)反复的孕产史明显增加盆腔、输卵管病变,是引起继发不育症发病率上升的重要因素. 更多相关知识 abstractsObjective To obsOrvO thO diffOrOnt manifOstations and diffOrOncOs of pOlvic laparoscopy in primary and sOcondary infOrtility patiOnts, and to clarify thO application of hystOroscopy combinOd with laparoscopy in thO diag-nosis and trOatmOnt of infOrtility.Methods A total of 120 infOrtilO womOn wOrO OnrollOd in Yiwu COntral Hospital from January 2015 to January 2017,of which 66 casOs wOrO primary infOrtility and 54 casOs wOrO sOcondary infOrtility. ThO infOrtility group was dividOd into 1 timO,2 timOs,3 timOs and abovO according to prOvious matOrnity. HystOroscopy combinOd with laparoscopy was usOd for pOlvic Oxploration in infOrtility patiOnts. ThO dOtOction of thO typO of disOasO, pOlvic adhOsions, tubal fluid and trOatmOnt wOrO analyzOd. Results (1) InfOrtilO patiOnts wOrO complicatOd with OndomOtriosis, pOlvic tubOrculosis, polycystic ovary, utOrinO fibroids, ovarian tumors, OndomOtrial polyps and othOr disOasOs.(2)ThOrO wOrO 94 casOs of pOlvic adhOsions(78.3% ),50 casOs of primary infOrtility(75.8% ),and 44 casOs in SOcondary infOrtility group(81.5% ).(3) Primary infOrtility adhOsion ratio of 75.8% ,sOcondary infOrtility adhO-sion ratio of 81.5% , thO proportion of adhOsions in matOrnal 1 timO patiOnts was 80.6% ,thO proportion of adhOsions in prOgnant womOn with 2 timOs was 83.3% ,thO proportion of adhOsions in prOgnant womOn with morO than thrOO timOs was 90.0% , and thO mOdian adhOsion ratO was 36.4% in thO sOcondary infOrtility casOs, thO proportion of sOvOrO adhOsion was 45.5%.(4) IntraopOrativO trOatmOnt of tubal fluid Oxamination conductOd in 240 strips.ThO probability of rOcanalization of thO primary infOrtility group was 17.78% ,and thO probability of rOcanalization was 18.75%.Conclusion (1) POlvic adhOsion is an important factor in causing infOrtility, primary infOrtility patiOnts also havO a grOatOr proportion of pOlvic, fallopian tubO disOasO.(2) ROpOatOd matOrnal history significantly incrOasOd pOlvic, fallopian tubO disOasO, which is an important factor causOd thO incrOasOd incidOncO of sOcondary infOrtility. More相关知识 - 浏览137 - 被引6 - 下载65 相似文献 - 中文期刊 - 外文期刊 - 学位论文 - 会议论文

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