| Objective:discuss the extent of the pelvic adhesions and infertility treatment efficacy related by refining scores of the previous pelvic adhesion scoring system.Methods:The women receiving laparoscopic-hysteroscopy joint management for adhesive infertility between October 2008 and April 2011 at the first hospital of Zibo City were included.All patients had no contraindication laparoscopic surgery,and immune problems and male semen abnormalities factors were excluded in all cases.Conventional preoperative preparation, clean after menstruation 3～7 d under general anesthesia laparoscopy treatment According to intraoperative exploration of pelvic adhesions, and observed from the following description:1)Both ovaries, fallopian tube distal and proximal, uterus and bladder uterus rectum pouch back off peritoneal adhesions, the extent and nature;2)if the tubal end is blocked; 3) Tubal fimbria and ovarian adhesions;4) Whether the anterior and posterior wall of uterine adhesions, which detailed the extent of pelvic adhesions score._According to the refined scores of pelvic adhesions, this study will add the index score together, and be divided into mild, moderate and severe groups, score from 1 to 8, mild adhesions; score 9 to 16 minutes, moderate adhesions; total points 17 to 24 minutes, severe adhesions. After surgery,the Patients will have gynecology clinic or telephone follow-up, follow-up periods are 6 months to 2 years, followed up cases are 55 cases, follow-up rate is 96.5%(55/57), including whether the pregnancy follow-up, time to pregnancy, methods of pregnancy,and the statistics of which will be analyzed. Using SPSS 10 software, count data at a rate that, by using the chi-square test, P<0.05 was considered statistically significant. Results:1.92 patients by laparoscopy combined operation and pathologic diagnosis, found that some patients often have 2 or more than 2 kinds of factors leading into infertility, pelvic adhesion of 57 cases(61.9%),16 cases of endometriosis (17.3%),8 cases of endometrial polyps (8.6%). Tip:pelvic adhesions is higher than other reasons (P<0.05), the difference was statistically significant. Therefore, based on the findings of the study of infertility pelvic adhesions is for certain patients the primary cause.2 The previous history of pelvic adhesions group's correlation with the extent of pelvic adhesions:according to the pelvic adhesions refined score, the study of following-up 55 cases of adhesion of infertile patients will be divided into mild pelvic adhesions (n=17,30.9%), moderate pelvic adhesions (n=20,36.4%), severe pelvic adhesions (n=18,32.7%). Including a history of abdominal surgery (appendicitis surgery, cesarean section, etc.) 15 cases accounted for 27.3%; Pelvic inflammatory disease in 9cases,16.4%; History of medical abortion in 11 cases, 20.0%;History of intrauterine operations in 11 cases, accounting for 20.0%; pelvic tuberculosis in 4 cases, accounting for 7.3%.The results suggest that compared with different extent of adhesion previous abdominal surgery group, the history of medical abortion,intrauterine operation and pelvic tuberculosis,there was no significant difference (P>0.05). In group of mild and moderate adhesions,Pelvic inflammatory disease was significantly lower than the group with severe pelvic adhesions incidence (P<0.01, P<0.01).3.pregnancy rate after operation:postoperative pregnancy in 27 cases (49.9%), wherein the intrauterine pregnancy in 24 cases (43.6%),3cases of ectopic pregnancy (5.5%), in utero natural pregnancy in 18 cases (32.7%),6(10.9%) cases of IVF-ET.1 years of intrauterine pregnancy rate (36.4%,20/55),1 years after intrauterine pregnancy rate (7.3%,4/55).4. the relationship between pelvic adhesions and Postoperative pregnancy rate:4.1 comparation between different degrees of pelvic adhesion and uterus natural pregnancy:mild pelvic adhesion group in utero spontaneous pregnancy rate (52.9%,9/17), moderate pelvic adhesion group in utero spontaneous pregnancy rate (40%,8/20), severe pelvic adhesions group in utero spontaneous pregnancy (5.5%,1/18). Difference between Mild and moderate does not have statistical significance (x2=0.15,P>0.05); but the mild and severe differences were statistically significant (x2= 17.76, P<0.01); moderate and severe differences were statistically significant (x2=9.47,P< 0.01). Tip the lighter degree of adhesions,have more natural conception chance of success.4.2Comparison between different groups of pelvic adhesions and intrauterine pregnancy within 1 year:Mild pelvic adhesions 1-year intrauterine pregnancy rate (47.0%,8/17);Moderate pelvic adhesions 1-year intrauterine pregnancy rate (40.0%,8/20), and severe pelvic adhesions 1-year intrauterine pregnancy rate (22.2%,4/18).Tip:In groups of mild and moderate pelvic adhesions,intrauterine pregnancy rate is higher than a year of severe pelvic adhesions group, the difference was statistically significant (P<0.05, P< 0.05).4.3.Ectopic pregnancy:cases occurred in 3cases of ectopic pregnancy, in which mild adhesion in 1 cases (5.8%), moderate adhesion in 1 cases(5.0%), severe adhesion in 1 cases (5.5%). Rate of groups of ectopic pregnancy incidence between different degrees of Pelvic adhesion was compared, the difference was not statistically significant (P>0.05).5. Pregnancy rate after IVF-ET operating:Follow-up of 55 cases of pelvic adhesions in patients with infertility underwent laparoscopic surgery and operated VIF-ET,in 21 cases (38.1%); The intrauterine pregnancy in6 cases (10.9%), 2 cases of ectopic pregnancy (3.6%).Conclusion:1. The study found that pelvic adhesions is the leading cause for some infertility patients 2. this study will refine the scores of the extent of pelvic adhesions, more objectively, comprehensively assess the scope and extent of pelvic adhesions and help objectively reflect the pelvic lesions, provide the basis for the clinical treatment of infertility and predict the rate of postoperative pregnancy. |
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