Clinical Analysis Of The Treatment Of Oviduct Infertility Performed By Hysteroscope Combined With Laparoscope

Objective:The reason of infertility is complex and relating to many subjects,so it can say that the diagnose and treat level of infertility reflect different reagon medical treat level.Oviduct obstruction is a major cause of female infertility, and it mostly occurs in secondary infertility.The female infertility is 60% of infertility,and oviduct infertility is 1/3 of female infertility. Laparotomy is the traditional therapy method of oviduct infertility, but hysteroscope, laparoscope or hysteroscope combined with laparoscope are being performed more frequently because of the development of endoscope to cure this kind of infertility. But the reports about curative effect are different.To explore the clinical value of the operation of hysteroscope combined with laparoscope in treating oviduct infertility cases, 176 cases of oviduct infertility treated by four methods have been analyzed during the January of 2004 and the January of 2005 in the third affiliated hospital of Zhengzhou University. There is no the system Comparation of the four methods about superiority and circumscrib around the world.Materials and methods1.General material 176 cases of oviduct infertility were treated during January of 2004 and January of 2005 in the third affiliated hospital of Zhengzhou University which were divided into 4 groups by different operation method including group I (42 cases) treated by hysteroscope combined with laparoscope, group II (50 cases) treated by hysteroscope, group III (45 cases) treated by laparoscope and group IV (39 cases) treaded by laparotomy. There was no significant difference among the different occlusion portion constituent ratio, the average of age and infertility time of the four groups (P>0.05). 176 cases included 58 cases of primary infertility and 118 cases of second infertility. All of these patients were in accordance with the following qualifications①were confirmed fallopian tube , obstruction by salpingo-hystero-graphy(HSG),②their infertility time was longer than 2 years,③had eumenorrhea and ovulation,④semen of their husband was normal,⑤the function of important organs such as heart,lung,liyer,kidney was normal,⑥were excluded the structural pathological changes of uterus or pelvis during operation.2. Methods Operation time,bleed amount and hospital stay of group I and group IV,the recanalization ratio, the intrauterine pregnancy ratio and the obstruction ratio of the infertility patients after one year of operation of the four groups were contrasted.3. Statistical analysis Statistical analysis was performed by using SPSS11.0 statistics software.The difference of ratio was analyzed by. using x~2-test,ANOVA.The difference of average in four groups was compared with t-test, and a value =0.05 was taken as statistical significance.Results1. Operations All of the operations were successful. Operation time,bleed amount and hospital stay were(63.83+/-18.70)minutes,(35.60+/-25.33)ml and(7.64+/-1.78) days in group I ; (76.51+/-26.72) minutes, (53.97+/-26.88) ml,,(9.72+/-1.56) days in group IV, respectively. The difference was significant between group I and group IV (P<0.05).2. The recanalization ratio after operations The recanalization ratio was 89.74%, 73.19%,76.25%,71.83%,respectively.The difference was significant between group I and the other groups (P <0.05).The recanalization ratio after operations of oviduct proximal occlusion of group II was higher than that of oviduct distal occlusion, The difference was significant (P <0.05).The recanalization ratio after operations of oviduct proximal occlusion of group III was lower than that of oviduct distal occlusion, The difference was significant (P <0.05) .3. The intrauterine pregnancy ratio All of the patients were followed up after operations by telephone or letter, and the average following up time is 24 months. The intrauterine pregnancy ratio and the ectopic pregnancy ratio of four groups were 47.62%,0;26.00%,6.00%;26.66%,8.89%;25.64%,5.12%,respectively.The difference of the intrauterine pregnancy ratio was significant between group I and the other groups (P <0.05) .All of the ectopic pregnancies were tubal pregnancies. The pregnancy ratio descended along time going, and it fall very sharply after one year.4. The obstruction ratio of the infertility patients after one year of operation The obstruction ratio of the infertility patients after one year of operation was 24.39%, 29.79%, 26.19% and 47.50%, respectively. There was no significant difference between group I and group II or between group I and group III(P >0.05), but the difference was significant between group I and groupIV(P <0.05).Conclusion1. Intubation and recanalization by hysteroscope can settle the problem of oviduct proximal occlusion, and laparoscope can divide pelvic adhesion and recover the normal shape and function of oviduct distal portion. Hysteroscope combined with laparoscope in treating oviduct infertility cases can get complementary therapeutic efficacy.2. The advantage of the operation of hysteroscope combined with laparoscope is shorter operation time, shorter hospital stay, little interference with organs, little bleed amount and higher rate of success compared with the traditional laparotomy.3. Hysteroscope combined with laparoscope enhances the rate of recanalization after operations, so it can descend the ectopic pregnancy ratio of infertility after operation.4. It is important to direct pregnancy for the pregnancy ratio descended along time going.