日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

Online ISSN: 2434-2505 Print ISSN: 0917-0324
日本性感染症学会 Japanese Society for Sexually Transmitted Infections
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society for Sexually Transmitted Infections Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Japanese Journal of Sexually Transmitted Infections 32(1): 1-6 (2021)
doi:10.24775/jjsti.O-2020-0006

原著原著

クラミジア感染症が卵管性不妊患者に対する子宮鏡下選択的卵管通水法と腹腔鏡下手術の臨床成績に与える影響Is genital Chlamydia trachomatis infection associated with the outcome of selective hydrotubation under hysterofiberscopy and laparoscopic surgery for tubal infertility?

山形大学産科婦人科学講座Department of Obstetrics & Gynecology, Yamagata University School of Medicine

受付日:2020年5月12日Received: May 12, 2020
受理日:2021年6月30日Accepted: June 30, 2021
発行日:2021年9月24日Published: September 24, 2021
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クラミジア感染は卵管性不妊の主な原因である。卵管閉塞例に対しては、一般的に子宮鏡下選択的卵管通水法や腹腔鏡下手術が施行される。本研究では、それらの疎通率や妊娠成績とクラミジア抗体の有無を検討した。2013年1月から2018年12月までに子宮卵管造影法を施行した患者347例を対象とした。卵管閉塞例は抗体陽性群で30.2%、陰性群で15.0%であり、陽性群で有意に多かった(p=0.010)。いずれかの卵管治療により卵管疎通性を認めた症例は抗体陽性群で90.0%、陰性群で81.5%であり、両群間で差はなかった。卵管疎通性を認め、その後自然妊娠あるいは人工授精により妊娠した症例は、抗体陽性群で33.3%、陰性群で31.8%であり、有意差を認めなかった。クラミジア抗体陰性例のみならず抗体陽性例についても、卵管閉塞例に対して子宮鏡下選択的卵管通水法や腹腔鏡下手術による卵管治療を行う意義はあると考えられた。

Genital Chlamydia trachomatis infection is a major cause of tubal infertility. For cases of tubal occlusion, selective hydrotubation under hysterofiberscopy and laparoscopic surgery are generally performed. In this study, we examined the rate of tubal recanalization and pregnancy outcomes after treatment for tubal occlusion, and the presence or absence of C. trachomatis antibodies. We studied 347 patients who underwent hysterosalpingography between January 2013 and December 2018. The tubal occlusion rates were 30.2% in the antibody-positive group and 15.0% in the antibody-negative group; the rate was significantly higher in the antibody-positive group (p=0.010). The proportions of cases in which tubal recanalization was recognized by any of the tubal treatments were 90.0% in the antibody-positive group and 81.5% in the antibody-negative group, but no significant difference was found. After recanalization by either treatment, the pregnancy rates by natural pregnancy or intrauterine insemination were 33.3% in the antibody-positive group and 31.8% in the antibody-negative group; however, the difference was not statistically significant. We suggest that there is significance in performing tubal treatment by selective hydrotubation under hysterofiberscopy or laparoscopic surgery, not only for C. trachomatis antibody-negative cases, but also for antibody-positive cases.

Key words: tubal infertility; Chlamydia trachomatis antibody; hysterosalpingography; selective hydrotubation under hysterofiberscopy; laparoscopic surgery

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