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Chanelles O Ducarme G Sifer C Hugues JN Touboul C Poncelet C 《European journal of obstetrics, gynecology, and reproductive biology》2011,159(1):122-126
Objective
The aim of this study was to assess and validate a management protocol for infertile patients affected by at least one hydrosalpinx.Study design
Eighty-one consecutive infertile normo-ovulatory patients with uni or bilateral hydrosalpinx planed to be surgically managed were included in the protocol from November 2003 to May 2007. During laparoscopy, a systematic evaluation of the tubes was firstly conducted and the local management protocol based on validated tubal prognostic scores was applied. Surgery for hydrosalpinx was either conservative by neosalpingostomy or radical by salpingectomy. The primary end-point was the cumulative clinical pregnancy rate.Results
115 hydrosalpinges out of 153 present tubes were confirmed during laparoscopy. Neosalpingostomy was possible in 35 patients featuring 50 hydrosalpinges (43.2% and 43.5%, respectively). Salpingectomy was necessary for the others (46 patients representing 65 hydrosalpinges). The mean follow-up period was 31.8 ± 12.4 months. The overall cumulative pregnancy rate was 61% per couple who completed the protocol (33/54 patients). The cumulative pregnancy rate was 50% after IVF in patients who underwent bilateral salpingectomy. Among patients with at least one functional tube, the overall cumulative pregnancy rate was 63.3%, with a spontaneous pregnancy rate of 30.4%.Conclusion
Hydrosalpinx management can be conservative with a tubal conservative of 43.5% and fair chances for spontaneous conception. An integrated management of hydrosalpinx including ART actually leads to a cumulative pregnancy rate of 61% per patient. 相似文献62.
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腹腔镜手术治疗输卵管妊娠187例 总被引:3,自引:0,他引:3
目的探讨腹腔镜手术治疗输卵管妊娠的术式选择。方法187例输卵管妊娠根据生育要求及意愿行输卵管切除术102例,输卵管开窗术85例。结果输卵管切除术组手术时间(40.4±9.9)m in,术中出血量(17.7±5.4)m l,术后住院时间(3.8±0.5)d,术后血-βhCG 7~14 d降至正常,无并发症;输卵管开窗术组手术时间(88.8±10.3)m in,术中出血量(80.6±4.4)m l,术后住院时间(7.4±0.9)d,术后血-βhCG 10~33 d降至正常,术后并发症2例(术后腹腔出血和持续异位妊娠各1例)。116例随访6~24个月,平均18个月,输卵管切除术组60例无再次输卵管妊娠;输卵管开窗术组56例,术后行输卵管通液或碘油造影检查,37例通畅,25例宫内妊娠,2例同侧输卵管再次妊娠。结论输卵管切除术手术时间及术后住院时间均短,出血少,并发症少,是治疗输卵管妊娠首选的手术方式。输卵管开窗术仅对有生育要求患者施行,但要警惕持续性异位妊娠的发生,并注意术中如止血效果不满意时,应果断行输卵管切除术或中转开腹止血。 相似文献
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《European journal of obstetrics, gynecology, and reproductive biology》2013,170(1):251-254
ObjectiveSalpingectomy is proposed as a prophylactic measure to reduce the incidence of tubo-ovarian/pelvic serous cancers. We surveyed the attitudes of obstetrician/gynecologists to incorporating salpingectomy opportunistically into surgery for benign conditions, and electively for young BRCA mutation carriers.Study designA questionnaire, designed to assess current standard clinical practice and willingness to perform salpingectomy for female sterilization at abdominal hysterectomy for benign disease (ABH), vaginal benign hysterectomy (VBH) and electively for women with BRCA mutations who wish to postpone oophorectomy was mailed to obstetrician/gynecologists working in Irish hospitals.ResultsIn their current practice of interval female sterilization 96% of gynecologists applied clips at laparoscopy and 4% performed salpingectomy, and 73% were willing to consider salpingectomy. Eighty-one percent were willing to consider salpingectomy for sterilization at cesarean section. Gynecologists performing hysterectomy (without oophorectomy) for benign conditions did salpingectomy in 26% at ABH and 5.4% at VBH, and now 90% would consider salpingectomy at ABH and 66% at VBH. Two-thirds of respondents would consider salpingectomy for women at genetic risk of ovarian cancer who want to postpone oophorectomy.ConclusionChanging general gynecological practice to include more opportunistic salpingectomy has the potential to reduce the incidence of serous cancers. The majority of gynecologists are willing to incorporate more salpingectomies into their surgical practices and consider elective salpingectomy as an interim measure for women with defined genetic risk of pelvic serous cancer. 相似文献
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腹腔镜手术治疗异位妊娠临床分析 总被引:2,自引:0,他引:2
目的探讨电视腹腔镜手术治疗异位妊娠的可能性、安全性及治疗效果。方法对2004年4月~2007年12月收治的48例异位妊娠病例的临床资料进行回顾性分析。按手术方式分为开腹手术组和腹腔镜组,比较两组病例术中出血、住院时间、抗生素应用情况并进行统计学分析。结果腹腔镜组术中出血少、住院时间及抗生素应用天数与开腹组比较差异有显著性(P〈0.05)。结论异位妊娠腹腔镜手术具有安全、微创的特点,值得临床推广。 相似文献
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目的:分析并探讨腹腔镜输卵管切除术对输卵管妊娠患者生殖潜能的影响。方法:选取本院收治的输卵管妊娠患者480例,研究组336例,采用腹腔镜输卵管切除术进行治疗;144例为对照组,采用腹腔镜保留患侧输卵管的保守手术,测定治疗后两组患者的性激素水平、超声测量卵巢体积、窦卵泡数量、排卵率及生育结局,比较两组患者生育状况。结果:同对照组相比,研究组的卵泡刺激素(FSH)、黄体生成素(LH)显著升高(P0.05);雌二醇(E2)、血清抗苗勒管激素(AMH)水平术后1个月、3个月显著降低(P0.05),术后6个月稍有降低(P0.05);卵巢体积及窦卵泡数显著降低(P0.05);术后半年排卵率和术后妊娠率稍有降低,但差异无统计学意义(P0.05);术后异位妊娠率,研究组显著低于对照组(P0.05),尤其是术中保留的患侧输卵管发生再次异位妊娠的可能性更大。结论:输卵管切除术影响患者生殖潜能,但可降低再次异位妊娠的发生率。输卵管妊娠的患者是否行输卵管切除术,取决于输卵管的病变情况及患者的生育要求。 相似文献
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目的探索经自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)在异位妊娠治疗中的可行性、安全性及有效性。
方法中国医学科学院北京协和医院妇产科于2015年6月至2016年5月共完成8例经阴道NOTES异位妊娠患侧输卵管切除术。记录患者年龄、体质量指数、阴道分娩数、停经时间、血β-HCG(人绒毛膜促性腺激素)、肿物大小、子宫直肠窝积血、手术时间、术中出血量等指标。
结果8例患者的手术均成功完成,无中转传统腹腔镜手术或开腹手术,无并发症发生。年龄(33 ± 4.8)岁,体质量指数(24.2 ± 1.8)kg/m2,阴道分娩(1.5 ± 0.8)次,停经时间(52.3 ± 4.9)d,术前血β-HCG(10 280 ± 7 948.6)U/ml,肿物大小(2.75 ± 0.5)cm,子宫直肠窝积血(105 ± 98.3)ml,手术时间(41.9 ± 3.7)min,术中出血量(8.4 ± 5.6)ml。术后随访血β-HCG水平下降理想,阴道伤口愈合良好。
结论经阴道NOTES可安全、有效完成异位妊娠输卵管切除,但需要进一步前瞻性研究来评估其完整临床应用。 相似文献
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