[Analysis of reoperation for infertility women with tubal pregnancy after conservative surgery].

ABSTRACT

OBJECTIVE: To evaluate the cause of infertility and tubal abnormality in women of tubal pregnancy after conservative treatment with laparotomy or laparoscopy through a combination of laparoscopy, hysteroscopic tubal catheterization and hydrotubation. METHODS: Laparoscopy was performed to observe pelvic adhesions, tube shape, fimbriated extremity of fallopian and other factors related with infertility for 37 inpatients with infertility after tubal pregnancy and undergoing conservative surgery during December 2008 and October 2010. Meanwhile, hysteroscopic tubal catheterization and hydrotubation were performed with laparoscopy to examine tube patency. RESULTS: Among them, 97.3% had tube infertility caused by tube abnormality and adhesions, or tube obstruction alone or concurrently. For all tubes, tube obstruction accounted for 79.7% (59/74) , fimbrial occlusion of fallopian tube 54.1% (40/74) and tube abnormality 52.7% (39/74) . Pelvic adhesion occurred at a rate of 89.2% and there were I degree (21.6%), II degree (32.4%), III degree (35.1%) and IV degree (0). For tubes with pregnancy history, 48.6% showed tube abnormality, 45.9% fimbrial occlusion of fallopian tube and 75.7% (28/37) tube obstruction. Comparatively, for the tubes without pregnancy history, 56.8%showed tube abnormality, 62.2%fimbrial occlusion of fallopian tube and 86.5%tube obstruction. No significant difference existed in tube shape, umbrella end and tube obstruction between the tubes with pregnancy history and those without pregnancy history. Neither statistically significant difference was found in adhesion degree, tube shape, umbrella end and tube obstruction of diseased and normal tubes between laparotomy and laparoscopy groups. CONCLUSION: Infertility of women after tubal pregnancy and conservative surgery is mainly caused by abnormal tube including pelvic adhesion, tube morphological abnormality and tube obstruction. No marked inter-group difference exists in fertility damage after conservative surgery with laparotomy or laparoscopy.