| Objective:To develop a new scoring system to predict the prognosis of patients with tubal infertility after laparoscopy and put forward corresponding countermeasures through the improvement of the old scoring system of fallopian tube. Methods:A retrospective analysis was conducted on the clinical data of 423 cases of patients treated with hysteroscopy combined with laparoscopy because of tubal infertility from December 2011 to December 2013. All the patients were followed up for 2 years without IVF-ET. Based on the operation records, a new scoring system of fallopian tube(hereinafter referred to as the modified scoring method of fallopian tube) was developed with reference to the clinical commonly used scoring method of fallopian tube(r-AFS scoring standards of pelvic adhesion and the scoring system of distal tubal obstruction). Aiming at 4 directions including tubal texture, patency, degree of water accumulation and pelvic adhesion, the bilateral fallopian tubes were cumulatively and quantitatively scored(total score of 0-24) and then divided into the mildly abnormal group(less than 8 points), moderately abnormal group(8-15 points) and severe abnormal group(higher than 15 points). The obtained data were analyzed with t-test, Chi-Square test and ROC analysis by using SPSS20. 0 software. Rusults:1. After surgery, 233 cases had pregnancy(55.1%, 233/423), of which 163 cases had intrauterine pregnancy(38.5%, 163/423) and 70 cases had ectopic pregnancy(16.5%, 70/423). The pregnancy rate within 12 months was 49.7%, while the pregnancy rate after 12 months was 4.4%. 2. The modified scoring method indicated the close relationship between the factors(tubal texture, patency, degree of water accumulation and pelvic adhesion) and the surgical prognosis(P<0.05). 3. The modified scoring results of fallopian tube could be divided into three groups of <8 points, 8-15 points and >15 points. The surgical prognosis of the three groups had statistically significant differences(P<0.05). When the modified fallopian tube score was <8 points, the postoperative intrauterine pregnancy rate reached the highest of 60.1%. When the score was between 8-15 points, the postoperative ectopic pregnancy rate increased significantly to 21.5% and when the score was >15 points, the postoperative infertility rate increased significantly to 89.5%. 4. The ROC working curve was used to compare the value of the three scoring systems for prognosis prediction. The prognosis was divided into intrauterine pregnancy group and other prognosis group. The area under the curve of modified scoring method of fallopian tube was 0.569(P<0.05) and the optimal cut-off value was 4.5 points. Under this situation, the sensitivity was 88.6%, specificity was 74.5% and accurate rate was 63.1%. Compared with the other two traditional scoring methods, the modified method had the highest sensitivity and accuracy. Conclusions:1. The modified scoring method of fallopian tube attaches importance to the evaluation of tubal texture and patency degree as well as the degree of water accumulation and pelvic adhesion. Therefore, the modified scoring method can comprehensively and effectively evaluate the function of fallopian tube. 2. Compared with the r-AFS scoring of pelvic adhesion and the scoring of distal tubal obstruction, the modified scoring method is simple and practical and has more accurate predictive value on prognosis. 3. The optimal timing of pregnancy is 1 year after laparoscopy for tubal infertility. For the patients with less than 15 points scored by the modified method, they are suggested to have spontaneous pregnancy. For the patients with 8-15 points, they should be told the increased possibility of ectopic pregnancy. For the patients with more than 15 points, they can choose to expect natural pregnancy according to their wishes. And for the patients with no pregnancy 1 year after surgery or the elderly patients with decreased ovarian function, they should stop blindly waiting and the IVF-ET assisted reproductive technology is suggested for them. |
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