| Clinical Study in Evaluating the Efficacy of Diagnosis and Treatment of Tubal Infertility by Laparoscopy and Hysteroscopy. Objective: To analyse the effects of using hysteroscopy combined withlaparoscopy in patients with tubal obstructive infertility. Method: Thepatients who had been diagnosed as infertility (include primary infertility and secondary infertility) firstly performed hydrotubation, and then underwent hystero-salpingography(HSG) with compound Meglumine Oiatrizoate Injedion who had been defined as tubal occlusion. Finally, re-diagnosed and re- treated the patients who had been judged as bilateral tubal obstruction under HSG by using laparoscopy and hysteroscopy. With hysteroscopy, we observed the uterine cavity and uterotubal junction pathologies and performed the selective hydrotubation. Under the monitor of laparoscopy, we detected the degree of tubal obstruction and the site of occlusion. For interstitial and isthmus obstruction, tubal catheterization was employed via uterine cavity. Intra-uterus pathologies such as endometrial polyps, small uterus septa and uterine cavity adherion were treated under resection of polyp, septectomy and adhesiolysis. For hydrosalpinx and fimbrial portion adhesion, we utilized salpingostony and adhesiolysis, and tentatively applied retro-catheterization. Other operations such as ovary endometriosis cyst excision, pelvic endometriosis fulguration, wolffion dult cyst cystectomy, pelvic adhesiolysis and ovarian penetration were also used. Result: Through HSG we found that 19 oviducts were interstitial obstruction, 28 oviducts were isthmus obstruction, 12 oviducts were ampula, 5 oviduets were fimbriate portion. Through selective hydrotabation we found that, of all 32 cases (64 oviducts), 3 cases were bilateral patent (9.38%), 6 cases were unilateral patent and the other patent (18.75%), 6 cases were unilateral semi-obstructive and the other full-obstructive( 18.75), and 17 cases werebilateral obstructive 53.13%. 17 oviduets were interstitial obstruction (25.56%), 19 oviduets were isthmus obstruction (29.69%), 9 oviduets were hydrosalpinx (14.06%), 13 oviducts were fimbrial portion adhesion (20.31%), and among them, 3 oviducts had simultaneously interstitial and isthmus obstruction (4.69%), 3oviduets had hydrosalpinx and fimbriate adhesion(4. 69%). Under the combined use of laparoscopy and hysterscopy resulted in 13 oviducts patency of interstitial obstruction succeeded(20.31 %), failed in 4 oviducts (6.25%), and succeeded in 14 isthmus obstruction (21.88%), failed in 5 (include 2 penetration). After salpingostomy, 5 oviduct were patent, and 4 were still blocked. All the lysis of pelvic adhesion were performed. The recanalization on of different portion were 76.47%; in interseitial, 73.68% in isthmus, 55.56% in empula, 100% in fimbriate. Except for 2 penetrations in isthmus, there were no other complications happened. The recanalizition rate was 75%. Conclusion: With the simultaneous application of laparoscopy and hysteroscopy, they are complimentary for the fallopian tubal infertility.We took advantages both of them. Under one anesthesia, several operations were performed so that the pains and costs of patients were substantially decreased. Compared with the similar surgical procesures on the tubes and peives,blood loss was less and recovery was faster. Moreover, the occlusion portions were more definite and provided the reliable testimony for further treatment to infertile women.It is of some clinical value for the tubes recanalization. Although the pregnancy rate of these patients was low, the infertility might be associated with shorter post-opreation time , reobstruction of tubes and other etiologies such as immunological factors . |
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