输卵管妊娠保守性手术96例手术

目的：探讨输卵管妊娠保守性手术及不同手术方式的近期效果及妊娠结局。方法：对96例未破裂型输卵管妊娠中77例行输卵管线型切开术，19例行输卵管伞端胚囊挤出术。绒毛肿植部位注射甲氨蝶呤20－30mg。结果：2．4％的患者发生持续性异位妊娠，均为行伞端挤出术患者。宫内妊娠率为41．5％，重复异位妊娠率为25．6％。对侧输卵管正常者，宫内妊娠率及重复异位妊娠率分别为70．5％和22．8％；当时侧输卵管异常或已被切除者，宫内妊娠率又重复异位妊娠率为7．9％和28．8％。结论：绒毛种植部位注射甲氨蝶呤可降低持续性异位妊娠率，而伞端绒毛挤出术后发生持续性异位妊娠的可能性较大，应尽量避免。     

输卵管妊娠后再次妊娠的探讨

对输卵管妊娠后有生育要求的５８例行输卵管切除术，１５例行输卵管开窗术，３０例应用药物保守治疗。结果：１０３例治疗后６７例宫内妊娠，９例再次异位妊娠。     

36例输卵管妊娠保留功能性手术分析

目的研究各类型输卵管妊娠行显微技术保留功能性手术方法.方法对36例输卵管妊娠患者,以显微技术行输卵管切开、开窗、伞端整形进行手术.结果显微技术保留输卵管功能性手术,术后输卵管通畅率100%,宫内妊娠率83.33%.无1例再发生输卵管妊娠.结论对输卵管妊娠的未产妇,生育功能低及需要保留生育功能的妇女.保留功能性输卵管修复整形术,以采用显微技术为最好.     

腹腔镜输卵管妊娠挤压取胚术中垂体后叶素的应用

目的：探讨腹腔镜输卵管妊娠挤压取胚保守性手术中垂体后叶素的应用效果。方法：2010年1月—2011年12月广西钦州市妇幼保健院妇科确诊为未破裂型输卵管妊娠（除外输卵管间质部妊娠）、有生育要求、具有保留输卵管条件的100例患者,行腹腔镜输卵管妊娠保守性手术。随机分为2组,在输卵管妊娠挤压取胚保守性手术中应用垂体后叶素者为观察组（５０例）,未使用垂体后叶素者为对照组（５０例）。比较２组手术时间、术中出血量、输卵管保留成功率、术后输卵管通畅率及持续性异位妊娠发生率情况。结果：观察组手术时间、术中出血量少于对照组（P＜0.01）,输卵管保留成功率及术后输卵管通畅率高于对照组（P＜0.01）。2组术后持续性异位妊娠发生率比较差异无统计学意义（P＞0.05）。结论：输卵管妊娠挤压取胚保守性手术中,使用垂体后叶素能减少术中出血量、缩短手术时间、提高输卵管保留成功率及术后输卵管通畅率,手术安全可靠,不良反应少,值得推广。     

腹腔镜输卵管吻合术:附32例临床分析

目的评价腹腔镜输卵管吻合术的输卵管通畅率及妊娠结局。方法对32位输卵管堵塞的患者行腹腔镜下显微输卵管吻合术并统计妊娠率（PR），以及影响妊娠结局的因素。结果32例中，术后通畅率为90.2%（55/61），术后宫内妊娠率为50.0%（16/32），无1例宫外孕发生。累积妊娠率，术后6个月为15.6%，12个月为43.8%，18个月为50.0%。96%的妊娠发生在术后一年内。峡部～峡部吻合妊娠率（55.0%）高于壶腹部～壶腹部妊娠率（41.7%）但无统计学差异。大于40岁患者妊娠率为（0/3），小于40岁患者妊娠率为55.2%（16/29）。结论腹腔镜输卵管吻合术具有较高成功率，是输卵管堵塞患者的一个较好的治疗选择。     

宫-腹腔镜联合输卵管复通术再通输卵管的效果评价

目的：评价宫-腹腔镜联合输卵管复通术的术后输卵管复通率及输卵管不同部位的复通率。方法：对2008年1月—2009年12月880例不孕症患者共1 760条输卵管进行宫-腹腔镜联合输卵管复通术,观察其术后的输卵管复通率。结果：宫-腹腔镜联合输卵管复通术的复通率为74.5%。其中,间质部为65.8%,峡部为56.5%,壶腹部为36.7%,伞端为86.0%。术后随访2年自然妊娠率39.6%。结论：输卵管伞端复通率最高,间质部次之,壶腹部复通率最低。     

输卵管妊娠应用腹腔镜3种保守手术治疗后的妊娠结局比较

目的:比较3种腹腔镜保守手术治疗输卵管妊娠患者术后的妊娠结局。方法:初次、未破裂输卵管妊娠且有生育要求的患者268例,均符合腹腔镜保守治疗标准并能够配合随访,腹腔镜下保守手术术式包括输卵管切开取胚术(n=147)、修补术(n=85)和挤压术(n=36),术后随访2年,比较输卵管通畅率及妊娠率。结果:应用输卵管修补术后患侧输卵管通畅率和妊娠率均显著高于切开取胚术及挤压术(P<0.05)。结论:对于合适的输卵管妊娠者应用输卵管修补术治疗能够保留患侧输卵管并获得较好的妊娠结局。     

药物黏堵绝育术后近端输卵管闭塞的手术复通效果分析

目的探讨药物黏堵绝育术后近端输卵管闭塞的手术复通效果。方法对1986年8月至2004年4月间,在中山大学附属第二医院住院的曾接受药物黏堵绝育术,后因各种原因而再行输卵管复通术——输卵管子宫角移植术患者208例的临床资料进行回顾性分析。结果（1）术中检查输卵管闭塞部位均发生在间质部及峡部。（2）65例盆腔有不同程度粘连,其中57例为轻度疏松粘连,7例为中度粘连,仅1例为重度粘连。（3）输卵管复通术后随访6个月以上者共199例,随访率95．7％。术后第2个月进行输卵管通液检查者共193例,其中185例通畅,通畅率为95．8％（185／193）。（4）获得宫内妊娠143例,宫内妊娠率为71．9％（143／199）,其中已足月分娩125例,占87．4％（125／143）,足月尚未分娩2例;目前正在早期妊娠3例,中期妊娠2例。（5）自然流产11例,自然流产率为7．7％（11／143）。输卵管壶腹部妊娠2例,占1．0％（2／199）。随访的199例中均未发现有子宫内膜异位的征象。结论药物黏堵绝育术后,近端输卵管闭塞患者行输卵管子宫角移植术的治疗效果肯定,是值得推荐的一种方法。     

输卵管妊娠保守性手术96例分析

目的探讨输卵管妊娠保守性手术及不同手术方式的近期效果及妊娠结局.方法对96例未破裂型输卵管妊娠中的77例行输卵管线型切开术,19例行输卵管伞端胚囊挤出术.绒毛种植部位注射甲氨蝶呤20～30rng.结果2.4%的患者发生持续性异位妊娠,均为行伞端挤出术患者.宫内妊娠率为41.5%,重复异位妊娠率为25.6%.对侧输卵管正常者,宫内妊娠率及重复异位妊娠率分别为70.5%和22.8%;当对侧输卵管异常或已被切除者,宫内妊娠率及重复异位妊娠率为7.9%和28.8%.结论绒毛种植部位注射甲氨蝶呤可降低持续性异位妊娠率,而伞端绒毛挤出术后发生持续性异位妊娠的可能性较大,应尽量避免.     

影响输卵管吻合术成功因素的分析

目的 :研究影响输卵管结扎后吻合成功的因素。方法 :随访 1991年 1月至 1999年 6月行输卵管结扎术后吻合术 (PTLA)的 198例 ,分析影响PTLA成功的因素。结果 :随访 175例 ( 88 38% ) 1年以上 ,其中PTLA成功 170例 ( 97 14% ) ;妊娠141例 ( 80 57% ) ,包括 1例宫外孕 ,术后 1年内妊娠 116例 ( 82 2 7% )。影响PTLA成功的因素有 ( 1)从输卵管结扎至吻合术的时间 :<5年妊娠率为 79 76% ,≥ 5年妊娠率 81 32 % ,差异无显著性 (P >0 0 5) ;( 2 )输卵管结扎方式 :采用抽芯包埋法结扎者妊娠率为 82 14% ,采用Pomeroy改良法者妊娠率为 79 12 % ,差异无显著性 (P >0 0 5) ;( 3)输卵管吻合方式 :峡部 -峡部吻合者妊娠率为 92 96% ,壶腹部 -壶腹部吻合者妊娠率为 71 4 3% ,峡部 -壶腹部吻合者妊娠率为 71 4 3% ,前者与后两者差异有显著性 (P <0 0 5) ;( 4 )吻合术后输卵管长度 :两侧输卵管≥ 5cm者妊娠率为82 76% ,其中一侧输卵管≥ 5cm者妊娠率为 81 92 % ,两侧输卵管均 <5cm者妊娠率为 37 5% ,前两者差异无显著性 ,前两者与后者差异有显著性 (P <0 0 5) ;( 5)吻合术者输卵管有无异常 :术前输卵管有异常者妊娠率为 70 9% ,无异常者为 89 89% ,差异有显著性 (P <0 0 5) ;( 6)吻合术后是否放支架 ,术后未?     

Pathological observations on fallopian tubes after sterilization]

From animal experiments and clinical observation of 130 cases of tubal anastomosis, it has shown that the dilatation of salpinx and adhesion of pelvic organs may occur after ligation of oviduct tube. The present study showed that: (1) tubal dilatation is the result of simple hydrosalpinx and is related to inadequate location of tubal ligation; (2) the mechanical stimulus caused by rough ligation end and large scar is an important factor in producing adhesion of pelvic organs; (3) delicate and gentle operation and choosing isthmus portion to ligate is helpful in prevention of the above changes.     

输卵管绝育后复通手术十年总评

我们随访１９８２年４月至１９９３年６月在我院行显微输卵管复通手术后的１０２９例妇女，发现宫内妊娠率为９３．２９％（９６０／１０２９），术后第一年受孕率最高，为７３．７８％（７５４／１０２９）；术后第一年内前６个月受孕率５４．８１％（５６４／１０２９）明显高于后６个月者４０．８６％（９０／４６５）；前６个月内的前３个月受孕率３７．４１％（３８５／１０２９）又明显高于后３个月２７．８０％（１７９／６４４）。术后各时期宫外孕的发生率均无明显差别；宫内妊娠率与绝育至复通的时间无关；术后的早期通液反而降低宫内妊娠率；抽芯包埋法及夹绝育后复通的宫内妊娠率较高；输卵管峡部吻合后宫内妊娠率最高。因此，我们认为输卵管峡部的抽芯包埋法或夹绝育在目前不失为一种理想的可逆性绝育方法。     

A clinical analysis of 317 cases of salpingo-anastomoses

Influences of various factors on status pregnancy in 317 women having had salpingo-anastomoses were analyzed. All these cases, aged 21 to 45, had end to end operation under direct observation. Through 1-5 years' follow up, two of the 317 women were found to be restricted, 295 were pregnant or already delivered. The re-potent rate was 99.3%, while the re-pregnant rate 93.1%. No statistically obvious disparity in pregnancy rate was found as regard to age, tubal ligation technique site of anastomosis. However, there was influence over the pregnancy rate by the length of the remaining tube and oviduct inflammation. This paper also discussed on the anastomosis method, length of contraception period, observation period and the choice of stents.     

Ovum transport after microsurgical anastomosis of the rabbit oviduct

From experimental work in rabbits it is known that pregnancy outcome is influenced unfavorably by tubal resection anastomosis in spite of the preservation of tubal patency. In 104 Dutch belted rabbits the impact of microsurgical resection anastomoses on ovum transport during the first 24 hours after ovulation was examined. In oviducts in which the ampulla had been operated on, ovum transport was delayed. Mucosal irregularities that interfere with normal ampullary transport by cilia activity may account for the delay noted. Alterations in the duration of ovum transport in the oviduct may influence pregnancy outcome by creating an inappropriate tubal environment for the early embryo or by creating asynchrony between the embryo and the endometrium. No changes were observed in transport in oviducts in which the isthmus had been operated on: even a small segment of isthmus seems to act as a physiologic sphincter and to prevent premature ovum entrance into the uterus.     

The influence of fallopian tube length on fertility in the rabbit.

The correlation between the length of the oviduct and degree of fertility was studied in 16 New Zealand White rabbits subjected to microsurgical resection of differing lengths of fallopian tube involving the isthmus in each case. A highly significant (P less than 0.005) linear correlation was found, suggesting that more than 47% of an oviduct must remain distally before fertility can be anticipated. Absence of the isthmic segment of the fallopian tube was found to be associated with supracervical fetal implantations in the uterus. The importance of the assessment of tubal length as a prelude to reconstructive surgery, especially for reversal of sterilization, is emphasized.     

不同防粘连剂在输卵管介入再通术中预防术后再粘连的对比研究

目的 探讨不同防粘连剂在输卵管介入再通术中预防术后再粘连的临床价值.方法 将508例输卵管阻塞患者随机分为对照组(245例)、几丁糖组(108例)、透明质酸钠组(113例)、碘油组(42例).对照组输卵管介入再通术后输卵管内灌注松解液,其他组输卵管介入再通术后输卵管内分别注入几丁糖、透明质酸钠、碘油,每侧输卵管注入量均为2～3 ml.术中观察输卵管阻塞的部位、介入再通率,术后3个月随访各组患者输卵管通水通畅率,术后12个月随访妊娠率.结果 508例共计1016条输卵管,其中峡部阻塞输卵管330条,间质部阻塞输卵管563条,因异位妊娠切除输卵管37条,输卵管通畅86条.(1)介入再通率:几丁糖组、透明质酸钠组、碘油组及对照组输卵管介入再通率分别为95.7%(179/187),97.9%(191/195),98.7%(75176)和97.7%(425/435),各组分别比较,差异均无统计学意义(P＞0.05);(2)术后3个月输卵管通水通畅率:术后3个月输卵管通水通畅率几丁糖组(91.7%,99/108)、透明质酸钠组(88.5%,100/113)通畅率明显高于碘油组(71.4%,30/42)和对照组(74.3%,182/245),差异有统计学意义(P＜0.05);(3)术后12个月妊娠率:术后12个月内妊娠率几丁糖组(48.1%,52/108)、透明质酸钠组(41.6%,47/113)高于碘油组(23.8%,10/42)和对照组(24.1%,59/245),差异也有统计学意义(P＜0.05).结论 几丁糖和透明质酸钠均能有效地减少输卵管介入再通术后输卵管再粘连的发生,提高妊娠率.     

Observations on the mode of action of an intratubal device, the P-block

A hydrogelic intratubal device, called P-block, Mark 9, was inserted hysteroscopically with local anesthesia in the intramural part of the fallopian tube of 25 women referred for the procedure as an alternative to abdominal sterilization. Hysterosalpingography revealing bilateral oviductal patency was followed by hysteroscopic checkup verifying bilateral presence of P-blocks, except in three patients who had expulsion of the P-blocks on one side. All of the 22 patients had retention of the P-blocks 6 to 7 months after insertion. None became pregnant. Thus it is suggested that an intratubal device in the isthmic part of the human fallopian tube acts as an intrauterine contraceptive device, preventing intratubal and intrauterine pregnancies. Endeavors to explain the contraceptive effect of a nonocclusive intratubal device are discussed on the basis of our present knowledge of tubal physiology. Distension of part of the human isthmus is likely to disturb normal gamete transport through the isthmus.     

Cesarean delivery on maternal request in southeast China

OBJECTIVE: To estimate the incidence of overall cesarean delivery and cesarean delivery on maternal request in southeast China in the past decade. METHODS: We used data from a population-based maternal and child health surveillance system, which covers 21 cities and counties in two provinces in southeast China. We examined the rate of cesarean delivery and cesarean delivery on maternal request in 1.1 million singleton births from 1994 to early 2006. Cesarean delivery on maternal request was defined as a prelabor cesarean delivery for a singleton gestation without contraindications for vaginal delivery at 38 weeks of gestation or later. RESULTS: During the 13-year study period, the percentage of women who had high school or higher education increased from 13% to 46%. The overall cesarean rate increased from 22% in 1994 to 60% in 2003 and moderated to 56% in 2006. The corresponding rates of cesarean delivery on maternal request (per 100 all deliveries) were 0.8%, 22%, and 20%, respectively. The rates varied enormously among cities and counties. In some areas, cesarean delivery on maternal request accounted for half of all cesarean births. The patterns of rate change were diverse and uneven, and the pattern of risk factors changed substantially between 1994 and 2006. Nulliparity, higher education, older maternal age, having been delivered at provincial or county hospitals, and women's occupations were previously associated with rate of cesarean delivery on maternal request. The rate of cesarean delivery on maternal request no longer varies by age, hospital level, or occupation. CONCLUSION: The rate of cesarean delivery increased dramatically in southeast China in the past decade. Cesarean delivery on maternal request was the predominant contributor to the increase. LEVEL OF EVIDENCE: III.     

Histochemical and histological investigations on the human fallopian tube under different hormonal influences. I. Demonstration of ATPase with special reference to reactive ciliated cells (author's transl)]

The localization of the Mg++-activated adenosine triphosphatase (ATPase) in the human Fallopian tube has been studied by means of histochemical methods. The samples were obtained from 18 women in the age from 23--62 years. Some of them were treated by various steroid hormones. Endosalpinx ciliary ATPase-activity represents dynein and is therefore an indicator of ciliary motility. Estrogens and gestagens have a different influence on the ATPase-activity. All cilia of one ciliated cell react in the same manner and may be regarded as a reaction unit. The relation of negative to positive ciliary borders differs characteristically in the tubal isthmus, ampulls and infundibulum and coincides with commonly known phenomena of egg transport through the oviduct. Postovulatory, reaction units increase in ampulla and infundibulum compared with the proliferative phase. The oviducts of postmenopausal women possess but a scanty outfit of reaction units. Short-time treatment with estrogen in the early secretory phase results in a great number of reaction units in all tubal segments; a similar treatment in the proliferative phase diminishes the reaction units in the ampulla. Midcycle progesterone treatment activates the ciliary ATPase in the isthmus. Low doses of lynestrenol (minipill) in the proliferative phase leads to a decrease of reaction units in all tubal segments; the pattern of ciliary reaction under low doses of lynestrenol at the time of ovulation coincides with that of the proliferative phase. Treatment with a contraceptive steroid (0,05 mg ethinylestradiol and 0,25 d-norgestrel) causes a considerable activation of the ciliary ATPase in all portions of the oviduct.