Related factors associated with pelvic adhesion and its influence on fallopian tube recanalization in infertile patients
10.3760/cma.j.issn.0529-567x.2012.11.006
- VernacularTitle:不孕症患者盆腔粘连的相关因素及程度对输卵管再通的影响
- Author:
Haiyan HOU
;
Yaqiong CHEN
;
Xiao CHEN
;
Chunxiu HU
;
Zhenhua YANG
;
Jun CHEN
;
Xiangling KONG
- Publication Type:Journal Article
- Keywords:
Pelvis;
Adhesions;
Infertility,female;
Laparoscopy;
Hysteroscopy
- From:
Chinese Journal of Obstetrics and Gynecology
2012;(11):823-828
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate factors with pelvic adhesions and the effect of different degrees pelvic adhesions on fallopian tube recanalization in infertile patients.Methods Total of 527 infertile patients undergoing hysteroscopy and laparoscopic surgery in Affiliated Hospital of Chinese People's Armed Police Forccs Logistics College were studied retrospectively.According to the extent of pelvic adhesions,tubal umbrella adhesions and atresia,377 cases were classified into adhesion groups,including 73 cases in grade Ⅰ,221 cases in grade Ⅱ,75 cases in grade Ⅲ and 8 cases in grade Ⅳ based on adhesion score.The 150 cases with no obvious pelvic adhesion were matched as control group.Among 8 cases with grade Ⅳ ahesion were exluded from ahesion group the relationship between pelvic adhesions and related history,abdominal lesions,tubal patency and the prognosis were studied.Results(1)Related factors:the frequency of pelvic adhesion and more than 7 years of infertility of 23.9％(88/369)in adhesion group were significantly higher than 12.0％(18/150)in control groups.(2)History:compared with the control group(12.7 ％,19/150;28.7％,43/150;11.3％,17/150;12.0％,18/150;17.3％,26/150),patients with pelvic adhesions present more incidence abortion(23.6％,87/369),uterine cavity operation(38.2％,141/369),ectopic pregnancy(20.9％,77/369),pelvic inflammatory disease(25.5％,94/369)and abdominopelvic surgery (31.4％,116/369).(3)Endoscopy exploration:the incidence of hydrosalpinx(24.7％,91/369),tube distorted(15.7％,58/369)and salpingostomy(72.9％,269/369)in adhesion group were higher than those in control group(2.0％,3/150;4.0％,6/150;12.0％,18/150),but relatively lower incidence of pelvic endometriosis lesions(5.7％,21/369)and mesosalpinx cysts(16.3％,60/369)than those in control group(16.0％,24/150;30.0％,45/150).The rate of proximal tubal recanalization(59.5％,91/153)in adhesion group was lower than 75.4％(52/69)in control group.However,the rate of distant tubal recanalization of 84.4％,(281/333)in adhesion group and;13/15 in control group didn't show statistical difference.(4)Prognosis:the rate of ectopic pregnancy of 9.7％(29/299)in adhesion group was significantly higher than 3.1％(4/128)in control group.Among cases with grade Ⅲ adhesion exhibited the highest rate of ectopic pregnancy(13.0％,7/54;OR =4.62,95％ CI:1.29-16.50).(5)Multivariate analysis:it was found that more than two drug abortions(OR =3.29,95％ CI:1.34-8.07),pelvic and (or)abdominal surgery history(OR =2.20,95％ CI:1.35-3.57)and pelvic inflammatory disease history (OR =1.54,95％ CI:1.21-1.97)were risk factors with pelvic adhesions.Conclusion More than or equal to two drug abortion history,pelvic inflammatory disease and pelvic and abdominal surgery damage were important factors for pelvic adhesions of infertility patients,which may decrease the possibility of proximal tubal recanalization and increase ectopic pregnancy risk.
