| Objective: By analyzing the clinical data of tubal infertility patients and observing the pregnancy outcome and the time of spontaneous intrauterine pregnancy after hysteroscopy combined with laparoscopy,to explore the preoperative and intraoperative evaluation of TFI patients and the relationship between tubal injury degree and pregnancy outcome,so as to guide the clinical treatment of TFI patients and improve pregnancy rate.Methods: From November 2015 to November 2017,collected and sorted out TFI patients who were treated in Dalian Maternal and Child Health Hospital and excluded other causes of infertility.Preoperative hysterosalpingography showed simple tubal obstruction infertility,and hysteroscopy combined with laparoscopy were performed for diagnosis and treatment,and a retrospective analysis was made.Using Gerard Mage's fallopian tube scoring system,the fallopian tube was evaluated from three aspects: the degree of tubal obstruction,the integrity of mucosal folds at the fimbria end,and the texture of the tube wall.The degree of fallopian tube injury was divided into stages I to IV.(1)Patients with bilateral fallopian tube recanalization after surgical treatment were followed up for 1 year after operation for natural pregnancy.The postoperative fallopian tube recanalization rate,pregnancy outcome and intrauterine natural pregnancy time of patients with stage I~IV TFI were compared and analyzed.(2)The results of HSG examination before operation were compared with the evaluation of fallopian tubes during operation.(3)Combined with clinical data,the high-risk factors affecting fallopian tube recanalization were analyzed.Results: 1.A total of 174 patients with bilateral tubal obstruction and scoring in the same stage had total fallopian tube recanalization rate of 89.7%(312/348).The fallopian tube recanalization rates in stages I~IV were 95.8%(46/48),94.1%(128/136),86.5%(90/104)and 80%(48/60),respectively.Compared between groups,the fallopian tube recanalization rate in phases I and II was significantly higher than that in phases III and IV.2.Bilateral recanalization was successful in 148 patients after the operation.The natural pregnancy rate after follow-up for one year was 41.9%(62/148),ectopic pregnancy rate was 7.4%(11/148)and infertility rate was 50.7%(75/148).The natural intrauterine pregnancy rates after tubal surgery in each stage were 81.8%(18/22),54.8%(34/62),22.7%(10/44)and 0%(0/20),respectively.The ectopic pregnancy rates were 0(0/22),1.6%(1/62),11.4%(5/44)and 25.0%(5/20),respectively.Infertility rates were 18.2%(4/22),43.6%(27/62),65.9%(29/44)and 75.0%(15/20),respectively.There were statistically significant differences in the postoperat I~IVe intrauterine pregnancy rate,ectopic pregnancy rate and infertility rate among patients in stage I to iv(P< 0.05).Among them,no intrauterine pregnancy occurred in stage IV patients and no abnormal pregnancy occurred in stage I patients.3.The peak of spontaneous intrauterine pregnancy occurred at the 6th,8th and 8th months after operation for patients with tubal injury in stages I,II and III respectively.84.0% of stage I and 88.2% of stage II patients' intrauterine natural pregnancy occurred 4-9 months after operation.90.9% of stage III occurred within 6-9 months after operation,and no intrauterine pregnancy occurred in stage IV.4.The tubal obstruction rate of HSG examination before operation was59.2%(379/640),the obstruction rate of hysteroscopy and laparoscopy was 56.4%(361/640),the diagnostic coincidence rate of HSG examination was 95.2%,the sensitivity was 94.4%,the specificity was 86%,the false positive rate was 13.6%,and the false negative rate was 5.5%.5.Younger age for first sex,history of pelvic infection,uterine cavity operation,conservative treatment of tubal pregnancy,pelvic cavity operation and multiple sexual partners are the relevant high-risk factors affecting fallopian tube recanalization(P <0.05).Conclusions: 1.Tubal recanalization rate,pregnancy outcome,time of spontaneous intrauterine pregnancy and stages of tubal injury in patients with TFI treated by hysteroscopy and laparoscopy.With the increase of stages,recanalization rate decreases,the natural intrauterine pregnancy rate gradually decreases after operation,infertility rate increases,and the risk of ectopic pregnancy also increases.2.The time of spontaneous intrauterine pregnancy after different stages of tubal injury is different.I~III stage can wait until one year after operation.Phase III intrauterine natural pregnancy rate is low,and the expected period of natural pregnancy after operation should not exceed 1 year.Direct assisted reproduction may also be considered.Stage IV patients suggest direct assisted reproductive technology.3.The high-risk factors affecting fallopian tube recanalization are the young age of first sexual life,pelvic infection,uterine cavity operation history,tubal pregnancy,pelvic and abdominal surgery,multiple sexual partners,etc.4.The results of HSG examination before operation and laparoscopic examination during operation have high consistency,and are still an effective examination method for clinically determining tubal patency.Fallopian tube scoring system has application value in the prognosis evaluation and treatment of TFI,and has certain guiding significance in the prediction of pregnancy outcome and the selection of pregnancy mode for TFI patients. |
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