【摘要】 目的 分析宮腔鏡聯合腹腔鏡在不孕癥診治中的應用和意義。 方法 回顧性分析2007年1月-2009年12月采用宮腔鏡聯合腹腔鏡手術診治92例女性不孕癥患者的臨床資料。 結果 92例中原發不孕39例，繼發不孕53例；其中有盆腔病變者86例，占93.5%。不孕原因居前四位分別是盆腔粘連31例（33.7%），輸卵管阻塞24例（26.1%），子宮內膜異位癥10例（10.9%），子宮內膜息肉8例（8.7%）。輸卵管阻塞24例行宮腔鏡引導下單極電凝器鈍性逆行分離術或造口術，有20例輸卵管復通，復通率66.7%。術后6~12個月年隨訪，妊娠率為19.6%（18/92），其中宮內妊娠15例，宮外孕3例。 結論 腹腔鏡聯合宮腔鏡檢查能快速準確地明確女性不孕的確切原因及部位，并可采取針對性治療措施，是目前診治不孕癥的可靠方法。【Abstract】 Objective To investigate the application and role of laparoscopy combined with hysteroscopy in the diagnosis and treatment of infertile patients. Methods Ninety-two patient with infertility who examined and treated with laparoscopy combined with hysteroscopy in this hospital were retrospectively analyzed from January 2007 to December 2009. Results There were 39 patients with primary infertility and 53 patients with secondary infertility.The main reason of infertility was pelvic diseases (93.5%). In the pelvic diseases,the common causes included pelvic adhesion (31 cases, 33.7%), obstruction of oviduct (24 cases, 26.1%), endometriosis (10 cases, 10.9%), and endometrial polyp (8 cases, 8.7%). Twenty-four patients with obstruction of oviduct were treated with hysteroscopy conducting unipolar electrocoagulation tool, 20 fallopian tubes were unobstructed. The recover rate was 66.7%. All the patients received follow-up by 6 - 12 months, and the pregnancy rate was 19.6% (18/92). Out of these 18 patients, 15 patients were intrauterine and 3 extrauterine. Conclusion Laparoscopy combined with hysteroscopy can find out the exact reasons of infertility and offer the respective treatment, and be a reliable method to diagnose and treat infertility patient.
現有治療排卵功能障礙性不孕的臨床證據如下,①克羅米酚.1個系統評價結果表明,對不規則排卵婦女,克羅米酚與安慰劑相比,明顯提高了妊娠率.另外4個克羅米酚和他莫昔芬的研究表明,這兩種藥物對排卵率和妊娠率的影響無統計學差異.1個隨機對照試驗(RCT)表明,6個月療程的克羅米酚加二甲雙胍比單用克羅米酚可明顯提高妊娠率.②環芬尼:1個RCT表明,環芬尼與安慰劑相比,對妊娠率的影響無統計學差異.③促性腺激素(HMG):1個系統評價表明,HMG治療與尿促卵泡素(urofollitropin)治療相比,兩者妊娠率無統計學差異.2個RCT表明,重組的促濾泡素和尿促卵泡素治療相比,兩者的持續妊娠率和活產率無統計學差異.以往的研究發現,雖然僅限于那些沒有配合使用GnRHa的婦女,但HMG與尿促卵泡素治療相比,發生卵巢過度刺激綜合征的危險性較小.觀察性研究證據表明,促性腺激素使用可能使卵巢非侵襲性腫瘤發病及多胎妊娠發生增加.④腹腔鏡下卵巢打孔:1個系統評價和其后的1個小樣本RCT表明,促性腺激素治療和卵巢打孔治療相比,對妊娠率影響的無統計學差異,但卵巢打孔術后多胎妊娠的發生率明顯較低.促性腺激素脈沖療法:有1個系統評價結果,但沒有發現促性腺激素脈沖療法有效.
Objective To investigate the application of hysteroscopy in pathological changes of infertility uterus. Methods The clinical data of 226 cases of infertility females receiving hysteroscopy from January 2007 to June 2009 in Sichuan Provincial Hospital for Women and Children were retrospectively analyzed. Results In 226 cases, hysteroscopic examination identified 147 cases of intrauterine diseases (65.04%), including 56 cases of intrauterine adhesion (24.78%), 32 cases of endometritis (14.16%), 27 cases of endometrial polyps (11.94%), 15 cases of uterine malformation (6.64%), 9 cases of submucous myoma (3.98%), 3 cases of endometrial tuberculosis (1.33%), 3 cases of uterus cavity narrow (1.33%), 2 cases of cervical internal relaxation (0.88%). No postoperative complications occurred, except for a small amount of vaginal bleeding. Conclusion For the diagnosis of the pathological changes in uterus, hysteroscopy is a direct and accurate method with less operative duration, less trauma, less pain, quick recovery, no complications, and no necessity for hospitalization. It is worth to be popularized.
目的:比較不同麻醉方法在腹腔鏡婦科不孕檢查及治療術中的效果和安全性。方法:選擇不孕擬在腹腔鏡下行檢查及治療術的患者60例,隨機分為三組,每組20人,分別進行連續硬膜外麻醉(簡稱EA組);靜吸復合全身麻醉(簡稱GA組);連續硬膜外麻醉加靜吸復合全身麻醉(簡稱EGA組),觀察比較三種麻醉方法對患者呼吸,循環及麻醉效果的影響。結果:三種麻醉方法均可保證手術完成,EA組術中管理較為麻煩,GA組循環波動大,EGA組麻醉效果更好,各種藥物用量減少,患者血液動力學更穩定,恢復快,管理更輕松。結論:連續硬膜外麻醉加靜吸復合全身麻醉(EGA)可避免其它兩種麻醉方式不足,各取長處,更適用于腹腔鏡婦科不孕檢查及治療術麻醉。
【摘要】 目的 探討絕經期促性腺激素及氯米芬在促排卵治療中適宜的治療方法。 方法 2004年8月〖CD3/5〗2008年5月對80例不孕患者實施促排卵治療。測定血雌激素、黃體生成素水平、陰道B型超聲、子宮頸黏液評分及基礎體溫測定監測排卵,并觀察不良反應的發生情況。 結果 使用氯米芬及絕經期促性腺激素排卵率分別為773%和856%；卵巢過度刺激綜合癥發生率為150%,大多由使用絕經期促性腺激素方案引起,且起始劑量150 U；未破裂卵泡黃素化綜合征的發生率為90%。 結論 絕經期促性腺激素和氯米芬治療排卵障礙性不孕有較好的療效,絕經期促性腺激素和氯米芬促排卵治療效果與卵巢的狀態及激素水平有關。促性腺激素的使用應強調個體化,以達到較好的治療效果并降低卵巢過度刺激綜合癥的發生。【Abstract】 Objective To explore the proper method with human menopausal gonadotropin and clomiphene in facilitating ovulation treatment. Methods Eighty infertility patients with the facilitating ovulation treatment were included from August 2004 to May 2008. Ovulation monitoring was based on the level of estrogen and luteinizing hormone, transvaginal B ultrasound, the cervical Inlser score and assay of basal body temperature. Besides, adverse reactions were observed. Results The rates of ovulation of clomiphene and human menopausal gonadotropin were 77.3% and 85.6%. The rate of ovarian hyperstimulation syndrome (OHSS), which was mostly caused by human menopausal gonadotropin with 150 IU, was 150%. The rate of luteinized unruptured follicle syndrome (LUFS) was 90%. Conclusion Individual therapy with human menopausal gonadotropin and clomiphene is essential to infertility patients with ovulation barrier. The efficacy of human menopausal gonadotropin and clomiphene is relevant to the ovarian condition and the hormone levels. Individual using of hormone is important in the facilitating ovulation treatment, which is helpful to increase the effective efficacy and prevent the OHSS.
ObjectiveTo systematically review the efficacy of acupuncture for PCOS infertility.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of acupuncture for PCOS infertility from inception to January 5th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 28 RCTs involving 2 192 patients were included. The results of meta-analysis showed that compared with western medicine alone, acupuncture could increase the pregnancy rate (RR=1.80, 95%CI 1.45 to 2.23, P<0.000 01) and ovulation rate (RR=1.33, 95%CI 1.15 to 1.54, P=0.000 1), and reduce levels of LH (SMD=?0.62, 95%CI ?0.96 to ?0.28, P=0.000 4) and LH/FSH (SMD=?0.65, 95%CI ?1.02 to ?0.29, P=0.000 5). Acupuncture combined with western medicine could increase the pregnancy rate (RR=1.75, 95% CI 1.50 to 2.03, P<0.000 01) and ovulation rate (RR=1.29, 95%CI 1.18 to 1.41, P<0.000 01), decrease levels of LH (SMD=?1.09, 95%CI ?1.64 to ?0.53, P=0.000 1), LH/FSH (SMD=?1.30, 95%CI ?2.35 to ?0.25, P=0.02), and levels of T (SMD=?1.13, 95%CI ?1.59 to ?0.66, P<0.000 01).ConclusionsCurrent evidence shows that acupuncture alone or combined with western medicine can significantly improve ovulation rate, pregnancy rate and reduce hormone level. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To systematically evaluate the efficacy and safety of letrozole combined with metformin in the treatment of polycystic ovarian syndrome (PCOS) infertility. Methods PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP, Wanfang, and SinoMed were searched from establishment to December 31, 2022. The literature on randomized controlled trials of letrozole combined with metformin in the treatment of PCOS infertility were included. RevMan 5.4 software was used for meta-analysis. Results A total of 29 articles including 3226 subjects were included, with trial group of 1614 treated with letrozole combined with metformin, and control group of 1612 treated with letrozole alone. The meta-analysis results showed that the clinical pregnancy rate [relative risk (RR)=1.76, 95% confidence interval (CI) (1.61, 1.92)], induced ovulation rate [RR=1.22, 95%CI (1.17, 1.28)], and number of dominant follicles [mean difference (MD)=1.15, 95%CI (0.86, 1.43)] in the trial group were higher than those in the control group (P<0.05). The follicle growth time [MD=?5.41 d, 95%CI (?6.03, ?4.80) d], estradiol level [MD=?7.57 pmol/L, 95%CI (?10.59, ?4.56) pmol/L], luteinizing hormone level [MD=?2.27 U/L, 95%CI (?2.59, ?1.95) U/L], testosterone level [MD=?1.29 nmol/L, 95%CI (?1.74, ?0.85) nmol/L], fasting blood glucose level [MD=?0.91 mmol/L, 95%CI (?1.71, ?0.65) mmol/L], fasting insulin level [MD=?25.93 pmol/L, 95%CI (?29.06, ?22.80) pmol/L], insulin resistance index [MD=?1.40, 95%CI (?1.61, ?1.19)], and the incidence of ovarian hyperstimulation syndrome [RR=0.44, 95%CI (0.22, 0.88)] in the trial group were lower than those in the control group (P<0.05). There was no statistically significant difference in follicle stimulating hormone level, incidence of adverse reactions, and spontaneous abortion rates between the two groups (P>0.05). Conclusion Existing evidence suggests that compared to using trazole alone, the combination of letrozole and metformin can improve ovulation induction and pregnancy outcomes in patients with PCOS infertility. The combination of the two drugs can reduce levels of estradiol, testosterone, and luteinizing hormone in patients, while effectively reducing the incidence of ovarian hyperstimulation syndrome.
ObjectiveTo investigate the effect of laparoscopic surgery combined with the following treatment of gonadotropin-releasing hormone agonist (GnRH-a) on the patients with endometriotic infertility and the value of endometriosis fertility index (EFI) system on forecasting the pregnancy outcome. MethodsFrom January 2005 to July 2011, the clinical data of 15 patients with endometriotic infertility patients were analyzed retrospectively. All the patients underwent laparoscopic surgery, and the effect was evaluated according to the endometriosis fertility index (EFI). Then all the patients were divided randomly into two groups on the basis of the different assisted treatment after the laparoscopic surgery:the control group (without any other therapy) and the GnRh-a group (combined with GnRH-a). Eventually, the pregnant rates were calculated respectively in the different groups or according to the different EFI. ResultsAt last, 103 cases finished the follow-up. The pregnancy rate in the control group after 6 months, 1 year and 3 years therapy were 12.5%, 31.2%, and 41.7%, respectively; while in the GnRh-a group were 0%, 16.3%, and 40.0%, respectively. There were no difference between the two groups after the 1 year and 3 years therapy (P>0.05). Besides, all of the 55 cases in the GnRh-a group had side-effects, but no severe adverse effect was encountered. All the side-effects were disappeared after stopping the treatment. The pregnancy rate of the patients with the EFI score of 8-10 was respectively 31.3% 1 year and 62.5% 3 years after the treatment. However, the pregnancy rate of the patients with the EFI score of 5-7 was respectively 15.2% 1 year and 26.0% 3 years after the treatment. There were only 9 patients with the EFI score of 0-4, and all of them were not pregnant. The EFI score had positive correlation with the pregnancy rate 1 year and 3 years after the treatment (rs=0.204, P=0.039; rs=0.437, P<0.001). ConclusionThe treatment of GnRh-a after the laparoscopic surgery can not only increase the rate of the pregnancy, but also delay the pregnancy occasion and increase the occurrence of the side-effects. The EFI may be valuable for forecasting the rate of pregnancy in patients with endometriotic infertility. The patients with EFI score higher than 8 may expect the pregnancy, while the ones with below 7 probably have much lower rate of natural pregnancy rate.
Objective To assess the effectiveness and safety of Chinese medicinal herbs for female immune-caused subfertility. Methods Databases included: MEDLINE (1966-2002.2), EMBASE (1984-2002.2), CBM (1978-2002.2) and Cochrane Controlled Trial Register, CCTR (Issue 1, 2002). Reference lists of trials were handsearched. Published randomized controlled trials (RCTs) whether blind or unblind, any languages and length of follow up were included. Treatments included Chinese medicinal herbs (single or compound). Controls were placebo and western medicine, or no intervention. Data were extracted independently by two reviewers and analyzed with Revman 4.2. Results Six RCTs were included, all of which were poor in methodological quality. Because of different therapies in the treatment and control groups, we did not perform meta-analysis. The No.1 anti-immune tablet was more effective than corticosteroid plus condom during intercourse both in the pregnancy rate (RR 3.75, 95%CI 1.61 to 8.75, P=0.002) and AsAb negative rate (RR 1.66, 95%CI 1.23 to 2.22, P=0.000 8). Bushen Xiezhuo Soup was more effective than antibiotic in the pregnancy rate (RR 2.97, 95%CI 1.60 to 5.50, P=0.000 6) and antisperm antibody (AsAb) negative rate (RR 2.33, 95%CI 1.54 to 3.54, Plt;0.000 1)。Zhenqi Zhuanyin Soup was as effective as IUI in pregnancy rate (RR 1.80, 95%CI 0.58 to 5.60, P＝0.31) but more effective than IUI in AsAb negative conversion rate (RR 9.61, 95%CI 3.22 to 28.67, Plt;0.000 1), Zhenqi Zhuanyin Soup combined with IUI was more effective than IUI in pregnancy rate (RR 3.60, 95%CI 1.32 to 9.85,P=0.01) and AsAb negative rate (RR 8.92, 95%CI 2.98 to 26.75, Plt;0.000 1). Conclusions Some Chinese medicinal herbs may work well in subfertility treatment. However, the evidence is too weak to draw a conclusion for there are deficiencies in strict randomization, blinding and follow-up.More strictly designed, randomized, double-blind, placebo-controlled trials are required.