【摘要】 目的 分析宫腔镜联合腹腔镜在不孕症诊治中的应用和意义。 方法 回顾性分析2007年1月-2009年12月采用宫腔镜联合腹腔镜手术诊治92例女性不孕症患者的临床资料。 结果 92例中原发不孕39例，继发不孕53例；其中有盆腔病变者86例，占93.5%。不孕原因居前四位分别是盆腔粘连31例（33.7%），输卵管阻塞24例（26.1%），子宫内膜异位症10例（10.9%），子宫内膜息肉8例（8.7%）。输卵管阻塞24例行宫腔镜引导下单极电凝器钝性逆行分离术或造口术，有20例输卵管复通，复通率66.7%。术后6~12个月年随访，妊娠率为19.6%（18/92），其中宫内妊娠15例，宫外孕3例。 结论 腹腔镜联合宫腔镜检查能快速准确地明确女性不孕的确切原因及部位，并可采取针对性治疗措施，是目前诊治不孕症的可靠方法。【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.
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 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.
①关于药物引起的卵巢抑制:1篇系统评价发现,使用卵巢抑制药治疗子宫内膜异位症与安慰剂或达那唑相比,妊娠率无明显差异.该评价还发现,卵巢抑制药引起的不良反应包括体重增加、潮热和骨质疏松症,达那唑可能引起剂量相关的体重增加和雄激素样作用. ②宫腔内人工授精+促性腺激素:1个RCT发现,宫腔内人工授精+促性腺激素治疗与不治疗相比,可明显提高活产率.第2个RCT发现,期待疗法与宫腔内人工授精+垂体降调节+促性腺激素治疗后的分娩率无明显差异.第3个RCT发现,宫腔内人工授精+促性腺激素治疗与单用宫腔内人工授精相比,仅明显提高妊娠率. ③体外受精:我们没有找到关于子宫内膜异位症引起不孕妇女接受受精体外治疗的RCT. ④手术治疗:两个比较腹腔镜手术与诊断性腹腔镜的RCT发现,在妊娠率和活产率方面结论不一.
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.
目的:比较不同麻醉方法在腹腔镜妇科不孕检查及治疗术中的效果和安全性。方法:选择不孕拟在腹腔镜下行检查及治疗术的患者60例,随机分为三组,每组20人,分别进行连续硬膜外麻醉(简称EA组);静吸复合全身麻醉(简称GA组);连续硬膜外麻醉加静吸复合全身麻醉(简称EGA组),观察比较三种麻醉方法对患者呼吸,循环及麻醉效果的影响。结果:三种麻醉方法均可保证手术完成,EA组术中管理较为麻烦,GA组循环波动大,EGA组麻醉效果更好,各种药物用量减少,患者血液动力学更稳定,恢复快,管理更轻松。结论:连续硬膜外麻醉加静吸复合全身麻醉(EGA)可避免其它两种麻醉方式不足,各取长处,更适用于腹腔镜妇科不孕检查及治疗术麻醉。
Objective To evaluate the effectiveness and safety of aromatase inhibitors in ovulation induction for women with unexplained infertility. Methods The databases such as CNKI (1994 to June 2011), WanFang Data (1982 to June 2011), PubMed (1966 to June 2011) and The Cochrane Library (Issue 6, 2011) were searched to collect randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) for the comparison between aromatase inhibitors (AIs) and clomiphene citrate (CC). The quality of the retrieved trials was critically appraised and meta-analyses were conducted using RevMan 5.0.1 software. Results Nine studies were included; all of them were published in English. The results of meta-analyses showed there were no significant differences between AIs and CC in the pregnancy rate (RR=1.02, 95%CI 0.71 to 1.47), miscarriage rate (RR=1.00 95%CI 0.61 to 1.63), multiple pregnancy rate (RD= –0.02, 95%CI –0.07 to 0.03), and incidence rate of adverse events (RD=0.00, 95%CI –0.01 to 0.01); there were still no significant differences between the AIs+gonadotropin (Gn) group and the CC+Gn group in the pregnancy rate (RR=0.98, 95%CI 0.68 to 1.42), miscarriage rate (RR=1.23, 95%CI 0.70 to 2.15), multiple pregnancy rate (RD=0.00, 95%CI –0.10 to 0.10), and incidence rate of adverse events (RD=0.00, 95%CI –0.10 to 0.01). Conclusion Whether aromatase inhibitors can replace clomiphene citrate in ovulation induction for women with unexplained infertility is still an issue that has to be identified by performing well-designed large scale RCTs with longer follow-up duration.
Objective To assess the effectiveness and safety of traditional Chinese medicinal herbs for subfertility. Method Databases used including MEDLINE, EMBASE, CBM and the Cochrane Controlled Trial Register (CCTR). Potentially related trials in reference lists of studies were hand searched. Published RCTs in any languages and length whether they were blind or unblind, were included. Treatments were Chinese medicinal herbs (single or compound), and controls were placebo, standard medical intervention, or no intervention. Data were extracted independently by two reviewers and analyzed with Revman 4.2 softeware. Results 7 randomized trials, including 1 042 patients met inclusion criteria. Methodological quality of all trials was poor. Chinese medicinal herbs were effective compared with routine antibiotics [RR 1.49, 95％CI (1.37 to1.62), Plt;0.000 01] and resulted in higher pregnancy rate [RR 1.46, 95%CI (1.09 to,1.96), P=0.01]. There were no adverse events reported in treatment group. Conclusions Some Chinese medicinal herbs may be effective for subfertility. However, the evidence is too weak to draw a conclusion. More strictly designed, randomized, double-blind, placebo-controlled trials are required.