摘 要

　　 目的:应用腹腔镜诊断技术,探讨继发不孕症的病因，评价腹腔镜对继发不孕症的诊断价值。方法：应用腹腔镜，对136例继发不孕症妇女的盆腔疾病和不孕的影响因素进行分析。结果：腹腔镜检查发现盆腔器质性病变134例,检查阳性率为98.5%。慢性盆腔炎、盆腔粘连和子宫内膜异位症是引起继发不孕的主要盆腔疾病，占继发不孕的94.8%。慢性盆腔炎、盆腔粘连是继发不孕症的第一位病因，占53.6%（73/136）；子宫内膜异位症是第二位病因，占41.2%（56/136）。慢性盆腔炎、盆腔粘连患者中90.4%有一侧或双侧输卵管梗阻；子宫内膜异位症患者中仅7.2%有输卵管梗阻。慢性盆腔炎、盆腔粘连者多无急性盆腔炎病史，60.2%（44/73）没有自觉症状。结论: 生殖道炎症和节育手术引起盆腔感染是继发不孕的重要原因，且以亚临床感染为主，应引起临床高度重视。应用腹腔镜技术对继发不孕症的病因诊断有重要价值，对继发不孕的盆腔疾病分出亚类，便于针对性地治疗，并可在直视下通液,动态观察输卵管通畅度和形态。

关键词 腹腔镜; 继发不孕症; 盆腔疾病;

Analysis of 136 Female Patients with Secondary Infertility After Laparoscopy TANG Junying,XU Xiaorong,JIANG Shufen. Department of Obstetrics and Gynecology,First University Hospital,Chongqing Medical University,Chongqing 400016,China

Abstract Objective:To investigate the cause of secondary infertility and evaluate the diagnostic value of laparoscopy in disgnosis of secondary infertility. Methods:the relationship between pelvic disease and secondary infertility in 136 female patients with laparoscopy was analyzed. Results:134 of 136 cases with secondary infertility (98.5%) had pelvic diseases.Pelvic inflammatory disease/pelvic adhesions and endometriosis were major causes resulting in secondary infertility, approximately 94.8%.The first cause of secondary infertility was pelvic inflammatory disease/pelvic adhesions(53.6%)and the second was endometriosis(41.2%).There were 90.4% patients with pelvic inflammatory disease/pelvic adhesions and 7.2% with endometriosis presented fallopian obstruction.Most of the patients with pelvic inflammatory disease/pelvic adhesions didn’t have history of acute process and 60.2% were asymptomatic. Conclusion:Genital inflammatory disease and operation concerning conception control are the important causes of secondary infertility which deserve to be drawn attention.The important value of laparoscopy in diagnosis secondary infertility is that it could definite the pelvic cause ,direct treatment and investigate the shape and the patent degree of fallopian under the direct dynamic observation by hytrotubation.

Key words laparoscopy secondary infertility pelvic disease

　　随着腹腔镜技术在妇科领域的应用，在腹腔镜直视下诊断盆腔疾病，为不孕症快速、准确的诊断开辟了新的途径。由于婚前性行为、生殖道炎症增多及节育手术的广泛开展，继发不孕症患者明显增多。本文对136例继发不孕症患者进行腹腔镜检查，分析继发不孕的病因。

资料与方法

1.1 研究对象及资料

　　1997年6月至2000年6月因不孕症在本院行腹腔镜检查及手术的患者220例，其中原发不孕84例（38.2%）、继发不孕136例（61.8%）。136例继发不孕者中，年龄22～45岁，平均28.2岁，不孕年限最短为1年，最长15年，平均不孕年限为5.2年。125例有人工流产史，同时/或有引产史9例、有分娩史12例。有1次人工流产史者49例（36.0%），有2次人工流产史者45例（33.1%），有3次以上人工流产史42例（30.9%）。