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대한생식의학회지 제30권 제2호 2010년
난관 불임환자에서 난관 개통술시 진단복강경의 효용성
성균관대학교 의과대학 삼성제일병원 산부인과, 방사선과
박찬우, 김혜옥,허걸,양광문,김진영,송인옥,유근재,전종영,이경상,강인수,궁미경
Efficacy of Diagnostic Laparoscopy for TFTC (Transcervical Fallopian Tube Catheterization) in Tubal Infertility Patients
Chan Woo Park
Division of Reproductive Endocrinology and Infertility, Department of Ob&Gy, Department of Radiology, Samsung Cheil Hospital and Women's Healthcare Center Sungkyunkwan University School of Medicine
Objective: To evaluate whether diagnostic laparoscopy before transcervical fallopian tube catheterization (TFTC) would improve tubal recanalization rate and pregnancy rate in patients with bilateral proximal tubal blockage in hysterosalpingogram (HSG). Methods: The retrospective study was performed in those underwent TFTC from January 1998 to December 2001. A total of 50 patients with bilateral proximal tubal blockage in HSG were subjected to TFTC sequentially using repeated HSG (rHSG), selective salpingography (SS) followed by tubal catheterization (TFTC). Each procedure was terminated once patency had been achieved without proceding to the next technique. In Group A patients (n=35, 64 tubes), diagnostic laparoscopy was performed before TFTC was taken to exclude the tube combined with peritubal adhesion or distal tubal pathology. In Group B, patients (n=15, 26 tubes) were performed TFTC without diagnostic laparoscopy. Results: There were significant difference in clinical pregnancy rate (45.7% vs 15.4%, p=0.034) but no differences were found in recanalization rate (75.0% vs 73.1%) and complication rate (8.6% vs 13.3%). Although there is no signficant difference, more tubes were canalized by SS, which means tubal obstruction rather than occlusion, in Group A (25.0% vs 5.3%, p=0.069). Conclusion: Diagnostic laparoscopy would be effective in the selection of tube for the relatively inexpensive and less invasive TFTC or patients in need of assisted reproductive technologies. With the tubes without combined peritubal adhesion or distal tubal pathology, pregnancy rate was significantly increased.
키워드 : Diagnostic laparoscopy, Selective saipingography, Tubal catheterization
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