The Application of Transvaginal Hydrolaparoscopy in Reproductive Medicine

经阴道注水腹腔镜是经自然腔道的内镜手术,可用于女性盆腔探查及手术治疗.对于不孕症患者,经阴道注水腹腔镜具有创伤小、可发现盆腔微小病变、明确不孕病因的优势.目前研究证实,经阴道注水腹腔镜与经腹腹腔镜相比,手术疗效和术后并发症相似,但术后盆腔粘连、疼痛均较轻,术后恢复更快.经阴道注水腹腔镜可应用于不孕患者病因探查、输卵管检查、盆腔粘连分离和子宫内膜异位症的治疗等.多囊卵巢综合征患者行经阴道注水腹腔镜下卵巢打孔术,手术创伤小,可降低黄体生成激素(LH)水平,改善代谢综合征,获得30％左右的自然妊娠率.本文旨在综合评述经阴道注水腹腔镜在不孕症患者检查与治疗中的应用和研究现状.Transvaginal laparoscopy,one of the natural orifice transluminal endoscopic surgeries,can be used to discover and treat abnormal lesion in female pelvis.For infertile patients,transvaginal laparoscopy,especially transvaginal hydrolaparoscopy (THL),has been described as a more sensitive and minimally invasive technique to detect subtle lesions and causes of infertility.It was found that the curative effect and postoperative complication of THL are similar to laparoscopy.However,the incidences of adhesion and pain are much lower,the postoperative recovery is quickcr,when compared with laparoscopy.THL was mainly used for the pelvic examination to detect the cause of infertility,pelvic adhesiolysis,treatment of endometriosis and hydrotubation.Ovarian drilling by THL could be a minimally invasive choice to treat polycystic ovary syndrome,which reduce LH level and improve metabolic syndrome,and achieve 30％ of natural conception rate.This article focuses on the application and research progress of THL in the infertility diagnosis and treatment.“十二五”国家科技支撑计划; 北京大学第三医院临床重点支持项目3185-188,2253