{"paper_id":"0c61beac-32f8-485a-90fb-07ebf774b171","body_text":"I.J. Education and Management Engineering, 2013, 2, 1-7 \nPublished Online February 2013 in MECS (http://www.mecs-press.net) \nDOI: 10.5815/ijeme.2013.02.01 \nAvailable online at http://www.mecs-press.net/ijeme \n \nAnalysis of 188 Cases of Laparoscopic Diagnosis of Infertility \nMinhua Gao \nChangzhou Maternity and Chidren Health Hospital Changzhou, China \nAbstract \nIn this paper, we have applied ventroscopy in diagnosing and curing of acyesis. We had gathered 188 cases o f \nventroscopy about acvesis from February 2006 to December 2009 in our hospital. The effect showed that there \nwere 115 acyesis cases caused by fallopian tube factor, which ranks first. And there were 35 acyesis cases \ncaused by endometriosis, which ranks se cond. Other acyesis cases number was 23. About 48.9% patients in \nthose 188 cases were pregnant after being cured. So, we can diagnose the reason of acvesis in time by means of \nventroscopy. \n \nIndex Terms: Peritoneoscope; Acyesis; Curative effect \n \n© 2013 Published by MECS Publisher. Selection and/or peer review under responsibility of the International \nConference on E-Business System and Education Technology \n1. INTRODUCTION  \nIn these days, acyesis has been common in gynecolog ic disease. Because the reason of acyesis is very \ncomplex, so according the factors which can cause acyesis, it can be divided into three classes: functional \nsterility, immune infertility and organic sterility. The diagnosis about acyesis has been improved greatly since we \nstarted to use peritoneoscope technology. To those acyesis cases whose reasons are not clear, peritoneoscope has \nshown its superiority many times. So, many hospitals have used ventroscopy as routine examination. The once \neasy operation in peritoneoscope has been performed completely with laparoscopy. Some organic pathological \nchanges of acyesis patients can be diagnosed and cured with laparoscopy. [1] The reasons of acyesis are very \ncomplex, it is difficult to diagnose correctly by using or dinary examining methods. This can cause blindness \ncuring. In this paper, we have discussed the application of laparoscopy in acyesis reasons. \n2. Documents and methods \nA. Cases \n* Corresponding author.  \nE-mail address: Gaomh8686@163.com \n\n2 Analysis of 188 Cases of Laparoscopic Diagnosis of Infertility \n188 pieces of acyesis patients whose age from 21 to 39, and the average age is 27 ye ars old. In those patients, \nthe shortest acyesis time was two years, and the longest was ten years. About 72 cases belonged to primary \ninfertility, and the rest belonged to secondary infertility. All the patients had been examined at the common \nmethod, and their husbands’ spermatic fluid is normal, which can remove the husbands’ factors. The curing of \nhydrotubation and ovulation induction treatment all had no effect. \nB. Device of ventroscopy \nIn our hospital, we mainly used laparoscopy & monitoring system which produced by Storz Corporation, CO2 \ninsufflator, cold light source and hydrotubator. \nC. Checking process of ventroscopy \nUsually, we use ventroscopy to check patients when they are in proliferative stage of menstruation which is \nthe best time. \nWe use continuou s epidural anesthesia and heart rate monitoring. When we start to check, we first create a \n10mm size incision which is square and vertical below navel chakra. After the buccal cavity being pierced by \nveress needle, CO 2 will be full in buccal cavity. Then w e put endoscope into abdominopelvic cavity after \npuncturing successfully. We also need to put surgical instruments into left lower quadran and right lower \nquadran. Then we can test two fallopian tubes whether are passable.[2] \nThe diagnosing rules: We can c onsider the patient suffers from salpingitis if there is bonding in uterus, \nfallopian tube and ovary; or the impassable fallopian tube can’t be passable after be pressed by general testing \npress. We also usually consider the patient suffers from endometrio sis uterine when we see endometrium in the \npouch of Douglas, utero -sacral ligament, fallopian tube and ovary. And we consider the patient suffers from \nStein-Leventhal syndrome when the two fallopian tubes are bigger than normal, there are more follicles, and the \npreovulatory follicle, hole of ovulation are all can’t be seen. \nD. Curing and follow-up visit \nThe 188 cases about acyesis have been diagnosed by means of peritoneoscope, and we have implemented \nshaping procedure. We have treated salpingitis with hot co mpress and massage, injected abdominopelvic cavity \none or two times atfter the menses had been passed seven days. All these measures will not be stopped until they \nare pregnant. The patients who suffered from endometriosis uterine should be treated for thr ee periods by using \nGnRH-a. Those patients who suffered from Stein -Leventhal syndrome should be treated three periods by \ncombining traditional Chinese and western medicine. [3] We have recorded the pregnant time and ending time \nduring the process. \nE. Processing of statistics \nThe dada processing should be usedχ2 examining, and the statistics data will be meaningful when P<0.05. \n3. Results \nTable 1 shows the checked pelvic cavity about 188 cases about acyesis patients. The number of pelvic cavity \nlesion is 175, and t he proportion is 93.1% of total cases. The proportions of primary infertility and secondary \ninfertility are 54.2% and 65.5% respectively, which are the main reasons of acyesis. The proportion of primary \ninfertility is higher than the proportion of secondary infertility obviously. These two kinds of statistics have great \nsignificance（χ2=4.7003，P<0.05）. And the others lesions statistics are not important （P>0.05）. \n \n \n\n Analysis of 188 Cases of Laparoscopic Diagnosis of Infertility 3 \nTABLE I.  188 CASES DIAGNOSING OF VENTROSCOPY (%) \nTypes of lesions secondary \ninfertility \nprimary \ninfertility  \nNumber \nof cases \nPelvic cavity adhesion 78（67.2） 37（51.4） 115 \nPelvic cavity \n endometriosis uterina 21（18.1） 14（19.4） 35 \nBenign cyst in an ovary 9 （7.8） 6 （8.3） 15 \npolycystic ovary 2 （1.7） 1 （1.4） 3 \nhysteromyoma 4  (3.4) 3 （4.2） 7 \nNormal pelvic cavity 2  (1.7) 11（15.3） 13 \nTotal 116 72 188 \n \nTable 2 shows the types and numbers about laparoscopic surgery. \nTABLE II.  TYPES OF LAPAROSCOPIC SURGERY \nTypes Number \nLysis of pelvic adhesions 107 \nPlastic operation of salpingostomy 31 \nElectrocautery of pelvic cavity \nendometriosis uterina 12 \nRemoving operation of ovary cyst 15 \nRemoving operation of \nhysteromyoma 7 \n Drilling operation of ovary 3 \nTotal 175 \n \nAfter being checked by means of ventroscopy, there were 115 cases with pelvic inflammatory disease (61.2%), \nand 53 cases patients had been pregnant after being cured (46.1%); there were 35  cases with endometriosis \nuterine (18.6%), the number of them had been pregnant after be cured is 24; there were 15 cases with ovary cyst \n(8%), and 8 cases patients had been pregnant; there were 3 cases with Stein -Leventhal syndrome (1.6%), and \ntwo of them  had been pregnant after being cured. About 5 cases patients had been pregnant in 20 cases with \nunclear reasons (10.6%). The total pregnancy proportion is 48.9%.[4] \n4. Analysis \nThe reasons about barrenness are very complex. The main reasons which caused by fe male consist of ovary \nfactors, fallopian tube factor, uterus factor and immunity factor. Usually, it is difficult to diagnose barrenness. \nThe common methods include hysterosalpingography (HSG), measuring fundamental temperature, and \nmonitoring ovulation by B ultrasound scanning and dilatation and curettage of uterine (D&C). Every checking \nmethod has its own limitations, and costs long time. Many barrenness patients can’t be diagnosed after long-time \nchecking. Even some patients have been misdiagnosed when t hey were checked by hysterosalpingography \n(HSG). In our medical group, we once met 11 cases patients who had been misdiagnosed when using \nhysterosalpingography, and the two side fallopian tubes had been passable after the test with Methylene Blue. \n\n4 Analysis of 188 Cases of Laparoscopic Diagnosis of Infertility \nAbout o ne third cases caused by this reason. Usually, the common method can’t diagnose the disease of \nendometriosis uterine, but ventroscopy can do it well. \nSome barrenness reasons can be found by means of ventroscopy, and we must pay attention to check during \nthe process of checking. \nA. Flushing test by peritoneoscope \nTubal infertility is always the common pathogeny in all infertility diseases. We can depend on flushing test by \nperitoneoscope by means of 20mi NS liquid whose density is 0.9% and 0.5 ml Methylene Blue . We should \nobserve the whole process of Methylene Blue liquid passes the two side fallopian tubes, and we can diagnose \nthat whether the fallopian tubes are unobstructed, and we also can know that the degree of fallopian tubes’ \nperistalsis and the location  of obstruction. The whole test can correct the wrong diagnosis of false positive by \nusing hysterosalpingography (HSG). Flushing test by peritoneoscope can be used to diagnose fallopian tube \nobstruction directly and correctly, which is fit for fallopian tube anaplasty case.[5] \nB. Chronic pelvic inflammatory disease \nAbout 50% of patients with barrenness during the process of using peritoneoscope suffered from chronic \ninflammation in the internal reproductive organs, such as tubal adhesive, distortion, bending, close and hydrops. \nSometimes there is straw yellow water vacuole on chorion surface and there is a little straw yellow effusion in \nDIPI.[6] But the most diseases are pelvic cavity adhesion and adhesive band with different forms. However, \nabout one third of the patients with this kind of disease don’t sense anything in usual. \nC. Endometriosis of pelvis \nSome researches show that there are 30% or 40% cases of barrenness belong to endometriosis of pelvis. The \nunusuall focuses which found during the process of vent roscopy are mostly sub clinical types. Most of these \nkinds of patients almost all have the obvious clinical manifestations. By using peritoneoscope, we have seen that \nthe color of utero -sacral ligament, DIPI, peritoneum, ligament posterior lobe, surface of  ovary and perimetrium \nare hyacinthine. And we also have observed that there were existed yellow, red and white focuses or peritoneum \nfold. The ovary was bigger than normal, which has been formed a chocolate -color cyst. And it also it was also \nconnected with adhesive band, womb, annexa uteri, epiploon and intestinal tube. Usually, the serious pelvic \ncavity adherence unsmooth oviducts are the important characteristic. We can find that there is dated \nnoncondensing blood in DIPI after the patients’ menses have  been passed three or five days. Sometimes, it is \nhelpful to diagnose by getting biopsy during the process of ventroscopy. Ventroscopy is very important when it \nis used to diagnose endometriosis. The early endometriosis is usually focused on the surface of peritoneum. With \nthe progression of disease, it affects it’s around tissue, which can cause the formation of pelvic cavity adherence \nand chocolate-color cyst. The main reasons which cause barrenness include: moderate and severe endometriosis \ncan damage th e normal pelvic structure. For example, the adherence between uterus and rectum can cause \nretrodisplacement; the adherence of fallopian tube ending can cause the depression of collecting egg function; \nthe acyesis which caused by moderate endometriosis uterine maybe formed by active macrophage. \nAt present, most of specialists think that surgery is the chief measure to cure endometriosis uterine. And they \nthink that time is the dangerous factor which cause endometriosis uterine. So the patient can be cured well if the \ndisease be found early. Many foreign specialists such as Morita have found that the fresh and active \nendometriosis uterine is better than dated one. In 1990s, the specialists of Canada have found that although the \nacyesis which caused by the longitudinal endometriosis uterine has been delayed, the peritoneoscope surgery can \nreprove sufferer’s gestation. The sufferers with endometriosis, especially the early sufferers, they always almost \nhave not any clinic manifestation, such as dysmenorrheal, bellyache and retrodisplacement. And it is difficult to \nfind the early ectopic focus by purely depending on clinic manifestation, type -B ultrasonic and some other \naccessory examination.[7] These kinds of sufferers needn’t have the characteristics of surgery, and they only can \nbe diagnosed by means of ventroscopy. The television ventroscopy surgery has good visual angle, we can find \n\n Analysis of 188 Cases of Laparoscopic Diagnosis of Infertility 5 \nthe estopic focus about rectum uterus pouch, utero -sacral ligament and ligament posterior lobe easily. Now, \nventroscopy surgery ha s been the standard when diagnosing endometriosis. At the same time, ventroscopy \nsurgery can cure it by means of all kinds of different surgical instruments, which can make sufferers avoid taking \nlong-time medicines after surgery. \nThe effect of peritoneum -type endometriosis surgery is better than the surgery of ovary endometriosis cyst. \nThe effect of pure endometriosis surgery is better than the surgery of utero -sacral ligament. And the comparing \ndifference between the surgery two -side ovary endometriosis a nd single -side ovary endometriosis hasn’t any \nobvious statistical meaning. So, the effect of early endometriosis surgery by means of peritoneoscope is better \nthan the surgery which not only has endometriosis, but also has ovary cyst. And the peritoneum -type \nendometriosis only can be found during the process of ventroscopy. So we should use peritoneoscope to \ndiagnose the sufferers with acyesis as soon as we can. \nBy dividing endometriosis into peritoneum -type endometriosis and ovary endometriosis with cyst ty pe can \nhelp us to diagnose and cure. From the distribution of sufferers’ pregnancy time after they have been cured, we \ncan find that the pregnancy chance will be reduced greatly after the surgery one year and one and a half years. So, \nwe should try our best to instruct the sufferers after they have been cured. If they still haven’t been pregnant after \nthese time, and this shows that some other factors are still affecting them, and we should use other curing \nmethods. \nD. Pelvic tuberculosis \nWe can find pelvic viscera adherence by means of peritoneoscope surgery. Fallopian tube is always obstructed \nor inflexible, which just like a string of beads. We can find the typical tuberculosis focus by means of biopsy, \nand most parts of fallopian tube are obstructed. \nE. Uterine malformation \nDepending on peritoneoscope surgery, we can find hypoplasia of uterus, saddle form uterus, uterus bicornis \nand rudimentary horn of uterus. We also can find that there is a muscular tuberculum between uterus’ two -side \nannexas. \nF. Observing ovary by means of peritoneoscope \nSome patients who suffer sterility disease also have menstrual disorder. And we can diagnose their sexual \ngland function by using peritoneoscope. Female sexual gland can be divided into the following types: normal \novary whose sh ape and size are all normal; small ovary; streak ovary; atrophic ovary; sclerosing polycystic \novary; ovariotestis ； mixed-type sex gland agenesis. We can diagnose the disease of indurascent \npolyovularfollicle by means of peritoneoscope. We can know the reaso ns of sterility by combing internal \nsecretion and pathology. And we also can know the function about ovary and thalamencephalon. \n5. Conclusions \nAccording to the clinic practice in these several years, there are several kinds of surgeries by using \nperitoneoscope: \nA. Lysis surgery of pelvic adhesive \nThe peritoneoscope surgery can keep the temperature and humidity of pelvic adhesive constant, which can \nreduce the excitation of viscera and pelvic adhesive relatively. On the other hand, the functions of strong \nillumination and magnifying of lens body not only can reduce the adhesive again, but also is convenient to \noperate, even the tiny pathological changes. During the process of surgery, we mainly use surgical scissors with \n\n6 Analysis of 188 Cases of Laparoscopic Diagnosis of Infertility \nelectric coagulation to separate the adhesi ve between organs and cut all kinds of adhesives, which restores the \nviscera’s position. The ovary will be exposed and fixed the end by removing tubal adhesive. \nB. Clear of endometriosis focus \nThe tiny focus can be cleared by using fulgerize or laser. To the endometrial cysts with different size, we can \nabsorb the substance in cysts by puncturing and then cut them. But the endometrial cysts should be peeled \nentirely, and we should try our best to hold more normal ovary tissue, which can avoid the adhesive agai n after \nsurgery. Usually, the disease can be divided into two types: peritoneum type of endometriosis and endometrial \ncyst type, we can cure by using fulgerize and cyst removing surgery. The peritoneum type of endometriosis \nmeans that the focuses lie on the surface of peritoneum. Most of them are punctiform, hydatidiform or nodositas, \nand locate Jarjavay's ligaments or rectouterine pouch, which are cardinal red, violet, brown or coffee. If we find \nthese focuses during the process of surgery, we should damage them instantly by means of fulgerize surgery. \nThe ovary endometrial cysts usually locate the area where in the back of womb and Jarjavay's ligaments. We \ncan separate the adhesive firstly if the cysts are small. We always puncture those cysts before separ ation, and \nfind the interface between cysts’ wall and normal ovary tissue after the coffee cysts’ liquid outflow. Then we \nremove the cysts from ovary tissue entirely by means of elastic separating plier. If the cysts are big, we often cut \novary envelope firstly by means of electric coagulation forceps, then separate ovary envelope from cysts’ wall. \nAt last, we remove the cysts’ wall from ovary tissue entirely. The residual ovary tissue will be seamed by means \nof 2/0 absorbable suture, then a new ovary will be formed. \nC. Salpingostomy \nAccording to fimbriated extremity of fallopian adherence, we firstly loosen the adherence between fallopian \ntube and it’s around tissue, which can restore the normal position. Then we inject water into fallopian tube, \nwhich can exp and it. And the fimbriated extremity of fallopian can be restored by separating after being \npressured. If the surgery has been failed, we can use electrode to cut the end of fimbriated extremity of fallopian. \nThe incision should be big, and it is necessary  to cut the end, which forms a artificial fimbriated extremity of \nfallopian. \nD. Ovary punching surgery \nMulticystic ovary can be cured by means of peritoneoscope. The number of punching shouldn’t be too much. \nUsually, every side of ovary should have four holes  in accordance with the patients’ ovary size. The power of \nelectric coagulation shouldn’t be big, and 30W can meet well. The operation is very easy. [8] \nIn all 188 cases patients with disease of sterility, the initial reason is fallopian tube factor, the s econd is \nendometriosis and the third is ovary benign cyst. The total pregnancy of those 188 cases patients is 48.9%. The \npatients’ pregnancy which caused by endometriosis is 68.6%, and it is the fast. The second is 66.7% which \ncaused by ovary benign cyst. Peritoneoscope surgery is a kind of easy, rapid and exact method when it is used to \nexamine the reason of sterility. With the development of instrument of peritoneoscope device and the gather of \nclinic experience, this kind of technology is more and more i mportant to diagnose and cure the disease of \nsterility. \nReferences \n[1] Afaf F,Seang LT,Tulandi T.Lapamscopic treatment of polycystic ovaries with insulated needle cautery: a \nreappraisal. Fertll. Steril,2000,73:266-269. \n[2] Franks S,Gharani N, Warerwozth D,et al.Th e genetic basis of polycystic ovary syndrome. Hum Reprod, \n1997, 12: 2641-26482. \n[3] Morita M. Prostaglandins in peritoneal fluid of women with minimal  and mild endometriosis. Nippon \nSanka Fujinka Gakkai Zasshi, 1991,43(7): 741. \n\n Analysis of 188 Cases of Laparoscopic Diagnosis of Infertility 7 \n[4] Berube  S,  Marcoux  S, Langev in  M, et a1. Fecundity of  infertile  women with minimal or mild \nendometriosis and women with unexplained infertility. Fertil Steril, 1998, 69(6): 1034.  \n[5] Matorras R，Rodriguez F, Ignacio J, et a1. Are there any clinical  signs and symptoms that are related to \nendometriosis in infertile  women. Am J Obstet Gynecol, 1996, 174(2): 620. \n[6] Chapron C, Fritel X, Dubuisson JB. Fertility after laparoscopic  management Of deep endometriosis \ninfiltrating the uterosacral ligaments. HumReprod, 1999, 14(2): 329. \n[7] Leng JH,Lan g JH,Huang RL, et al.C omplications in Laparoscopic Gynecologic Surgery[J].Chinese \nMedical Sciences Journal,2000,15(4:222-226). \n[8] Korttila K,Clergue F,Leeser J, et al.Intravenous dolasetron and ondansetron in prevention of postoperative \nnausea and vomiting: a multicenter, double -blind, placebo -controlled study[J].Acta Anaesthesiologica \nScandinavica,1997,41(7):914-922. \n \n \n \nHow to cite this paper:  Minhua Gao,\"Analysis of 188 Cases of Laparoscopic Diagnosis of Infertility\", IJEME, \nvol.3, no.2, pp.1-7, 2013.","source_license":"CC0","license_restricted":false}