| Objective:To investigate factors with pelvic adhesions and effects of laparoscopic treatment in tubal factor infertility patients.Methods : Total of 239 tubal factor infertile patients undergoing laparoscopic surgery in the department of Gynecology of General Hospital of Ningxia Medical University and Affiliated Hospital of Cardiovascular Diseases were studied retrospectively. According to the extent of pelvic adhesions, tubal umbrella adhesions and atresia,159 cases were classified into adhesion groups,including 52 cases in grade I,48 cases in grade II,55 cases in grade III and 4 cases in grade IV based on adhesion score. The 80 cases with no obvious pelvic adhesion were matched as control group. Among 4 cases with grade IV adhesion were excluded from adhesion group the relationship between pelvic adhesions and related history, abdominal lesions,tubal patency and the prognosis were studied. The therapeutic value of laparoscopy in tubal factor infertility was also investigated.Results:(1)Related factors: the frequency of pelvic adhesion and less than 2 years(51.6%,80/155) and more than 7 years(16.8%,26/155) of infertility in adhesion group were significantly higher than in control groups(respectively, 28.8%,23/80;13.8%,11/80).(2) History: compared with the control group(10.0%,8/88;40.0%,32/80:6.3%,5/80;22.5%,18/80),patients with pelvic adhesions present more incidence medical abortion(12.3%,19/155),pelvic inflammatory disease(56.1 %, 87/155), pelvic and adjacent organs surgery(20.6 %,32/155),uterine cavity operation(35.5%,55/155).(3)Endoscopy exploration: the incidence of pelvic endometriosis lesions( 8.4 %, 13/155),abdominopelvic tuberculosis(5.2%,8/155), hydrosalpinx(38.7%,60/155), tube distorted(54.8%,85/155) and salpingostomy(58.7%,91/155) in adhesion group were higher than those in control group(respectively,6.3%,5/80;5.0%,4/80;8.8%,7/80;12.5%,10/80;7.8%,6/80) and gradually increased as the severity of adhesions. The rate of distant tubal recanalization didn’t show statistical difference(p>0.05).(4)Prognosis: a total of 169 cases were successful followed up and 56 cases have been pregnant(pregnancy rate 33.1%).The rate of normal pregnancy in adhesion group was lower than the control group, the abortion rate was higher. However, the rate of ectopic pregnancy of 11.6%(13/112) in adhesion group was significantly higher than 7.0%(4/57) in control group. Among cases with grade III adhesion exhibited the highest rate of ectopic pregnancy(16.7%,6/36).(5)Multivariate analysis: it was found that pelvic inflammatory disease history(OR=14.891,95%CI 为 1.23~1.39)and pelvic and adjacent organs surgery history(OR=0.145,95%CI 为 1.80~1.89) were risk factors with pelvic adhesions.Conclusions: The connection between pelvic adhesions and tubal factor infertility is very close. It was found that the patient’s occupation(OR=2.792,95%CI 1.358 ~ 5.738),surgical abortion history( OR=0.450, 95%CI 0.264 ~0.767),infertile time(OR=0.450,95%CI 1.010~1.364),pelvic inflammatory disease history(OR=14.891,95%CI 1.23~1.39),pelvic and adjacent organs surgery history(OR=0.145,95%CI 1.80~1.89)and the numbers of HSG(OR=0.453,95%CI 0.307~0.669) were risk factors with pelvic adhesions. of tubal factor infertile patients, which may decrease the possibility of tubal recanalization and increase the risks of long-term ectopic pregnancy,abortion and tubal obstruction again. The possibility of postoperative pregnancy after laparoscopy treat tubal factor infertility with pelvic adhesions may be closely associated with the extent of tubal obstruction and pelvic adhesions. Laparoscopy plays a major role in the diagnosis and treatment of tubal factor infertility. |
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