卵巢癌的输卵管起源学说对妇科手术决策的影响

近年来有观点认为卵巢浆液性癌和腹膜浆液性癌可能起源于输卵管。因此,手术方式上的一些简单改变,如对于有基因风险人群行预防性双侧输卵管切除术取代双侧输卵管卵巢切除术,在降低卵巢癌和腹膜癌的发生风险的同时尚可避免卵巢切除术后的一些相关并发症。     

输卵管结扎后传统开腹与腹腔镜下输卵管复通术疗效分析

目的 探析输卵管结扎后传统开腹与腹腔镜下输卵管复通术的临床疗效。方法 选取2015年1月至2022年7月输卵管结扎患者26例。将2015年1月至2019年1月收治的13例患者为参照组,实施传统开腹输卵管复通术。2019年2月至2022年7月收治的13例患者为试验组,实施腹腔镜下输卵管复通术。比较两组患者手术时间、术后首次下床活动时间、住院时间,术后随访2个月记录再次妊娠率。结果 两组患者手术时间比较,差异无统计学意义（P>0.05）。试验组首次下床活动时间、住院时间均短于参照组,差异有统计学意义（P<0.05）。试验组再次妊娠率（84.62%）高于参照组（38.46%）,差异有统计学意义（P<0.05）。结论 输卵管结扎后腹腔镜下输卵管复通术在手术效果和术后妊娠率方面均优于传统开腹输卵管复通术。     

家兔输卵管结扎术后的卵巢功能

<正> 输卵管结扎术是国内外常用的女性绝育手术。但输卵管结扎术是否影响卵巢功能是多年来一直存在的争议:章思驹、Donnez等报道输卵管结扎术后部分妇女卵巢功能不足,认为其原因可能与术时损伤了输卵管与卵巢间的部分血管与神经有关。而Corson和Meldrum等的结论则与前者相反。本文旨在以家兔为模拟动物,探讨输卵管结扎术对卵巢功能的影响及其发生机制。     

输卵管绝育与复孕的关系

<正>实行计划生育是一项重要国策,输卵管结扎术是落实计划生育的重要措施之一.对需再孕者行输卵管复通术,大大解除了绝育者的后顾之忧,使输卵管结扎绝育法易于推广.自1988年2月～1995年12月应用显微外科技术对276例输卵管结扎绝育者进行了输卵管复通术,由于结扎部位和方法不同,复孕的成功率也不相同,本文对输卵管结扎部位、方法和吻合后的输卵管长度与复孕术的关系进行分析,认为于峡部进行结扎绝育术,尽量少切除输卵管组织可提高复孕成功率,现分析如下.     

396例输卵管结扎部位形态学分析

３９６例输卵管结扎部位形态学分析山东省广饶县人民医院妇产科（２５７３００）王桂梅，张冬梅，王晓红我们在１９８３～１９９２年施行的妇科手术中，对已施行输卵管结扎术的３９６例输卵管结扎部位做了形态学观察，以期为防止手术失败提供理论依据，并对绝育术的可复性...     

输卵管感染与癌变及预防性输卵管切除术的价值

临床病理资料提示,输卵管感染可能与输卵管癌、卵巢癌的发生有一定关系,但目前尚无定论。近年来“卵巢癌的输卵管起源学说”使人们日益关注输卵管预防性切除术的价值。目前研究显示,预防性附件切除能有效降低遗传性卵巢癌,尤其是BRCA1/2基因突变携带者的卵巢癌的发病风险,能否降低散发性卵巢癌的发生需进一步探讨。单纯预防性输卵管切除能否降低遗传性及散发性卵巢癌以及其他盆腹腔浆液性腺癌的发病风险也需进一步研究。临床应用预防性附件或输卵管切除时,应慎重评估患者综合情况,权衡手术获益和风险,为患者争取最大手术获益。     

跟踪随访和预防性输卵管卵巢切除术对无症状卵巢癌高危妇女的干预结局

目前，对卵巢癌高危妇女有两种处理方法：跟踪随访或预防性双侧输卯管卵巢切除术．目的是在高危人群中早期发现或预防卵巢癌（和乳腺癌）。但是，跟踪随访是否使卵巢癌发病率降低仍不清楚，并且很少考虑诸如不必要的手术干预和相关的并发症等负面效应。为此，回顺性研究分析了1994-2000年鹿特丹家族性癌症门诊的资料，     

FIGO 2013卵巢癌、输卵管癌、腹膜癌新分期解读

<正>近日,国际妇产科联盟(FIGO)发布了《FIGO 2013卵巢癌、输卵管癌、腹膜癌分期》,新分期提供了很多新的临床信息。为使广大同行尽快了解及熟悉新分期,现做一简要介绍。1新分期的形成过程卵巢癌的FIGO分期为手术和病理分期,最近一版FIGO分期发布于1988年(里约热内卢)。随着科学技术的不断进步、诊断方法的不断改进以及更多更准确的预后信息被我们所掌握,肿瘤分期方法在不断发展。FIGO妇科肿瘤委员会认为,目前已有必要对卵巢癌1988原分期进行修订,以提高其可用性和可重复性。     

输卵管结扎后再通的取舍

绝育术后要求再生育时，可以选择输卵管复通术或者体外受精-胚胎移植（in vitro fertilization-embryo transfer，IVF-ET）助孕。由于年龄、复通术后输卵管长度、绝育方式及复通术式均会影响复通后妊娠率，所以，<35岁、不合并其他不孕因素的患者更适合输卵管复通术；而>40岁、合并电凝绝育等输卵管复通预后不良因素的患者适合IVF助孕。其他条件的患者，尚无确切证据表明复通术和IVF哪种更有效。     

输卵管结扎术对卵巢功能的影响

<正> 输卵管结扎术(以下简称扎管术)是目前世界上最常用的女性绝育方法。但扎管术是否会影响卵巢功能,至今各家报道不一。近年来,用放射免疫分析法对扎管后妇女的卵巢激素水平进行测定,多数结果表明:扎管后有部分妇女卵巢功能受损,主要为雌、孕激素水平不足,术后有月经紊乱者更为明显。但也有一些报道与此相反。本文就这一问题的研究近况做一概述。一、扎管术可能导致卵巢血运改变输卵管、卵巢的血供均来自子宫动脉和卵巢动脉发出的输卵管支和卵巢支,其分支在输卵管系膜内相互吻合形成丰富的血管网,但两     

The cost-effectiveness of opportunistic salpingectomy versus standard tubal ligation at the time of cesarean delivery for ovarian cancer risk reduction

Objectives

Opportunistic salpingectomy is a cost-effective strategy recommended for ovarian cancer (OvCa) risk reduction at the time of gynecologic surgery in women who have completed childbearing. We aimed to evaluate the cost-effectiveness of opportunistic salpingectomy compared to standard tubal ligation (TL) during cesarean delivery.

The effect of tubal ligation scoring and sterilization counseling on the request for tubal reanastomosis

Objective?The aim of this study is to emphasize the role of counseling methods that are meant to decrease the request for tubal ligation reversal, such as tubal ligation scoring.

Method?This study covers 389 patients who were admitted for tubal sterilization to Çukurova University, Faculty of Medicine, Obstetrics and Gynecology Department, between 1 January 1990 and 31 December 1999. We have used the ‘Tubal ligation score’ on these 389 patients. Four hundred and seventeen patients who underwent bilateral Pomeroy type tubal ligation during cesarean section without having undergone tubal ligation scoring in the same time interval, were accepted as the control group.

Results?Laparoscopic tubal ligation (with a Yoon ring) was performed on 368 patients who had a score of 6 or higher. Twenty-one patients who got a score of 6 or lower were recounseled and another family planning method was prescribed to them. None of the 368 patients to whom tubal ligation scoring was done previous to laparoscopic tubal ligation returned to our clinic for tubal reanastomosis. Fifteen of the 417 patients (3.6%) in the control group returned to our clinic for tubal reanastomosis.

ConclusionTubal ligation scoring may decrease the ratio of patients who request a tubal ligation reversal.     

Ectopic tubal pregnancy after hysterectomy and tubal ligation

Posthysterectomy ectopic pregnancy is an unusual condition that may present soon after hysterectomy or several years later. Similarly, although tubal ligation is a widespread method of contraception, tubal pregnancy after tubal ligation is not common either. If any of these conditions are rare, having an ectopic pregnancy after hysterectomy and tubal ligation is even more infrequent and only one of such cases was found in our review of the literature. We describe the case of a 35-year-old patient, with history of bilateral tubal ligation and vaginal hysterectomy that looked for medical attention due to abdominal pain. A pregnancy test was positive and a transvaginal ultrasound demonstrated the presence of a gestational sac at the vaginal cuff, adjacent to the ovary. An exploratory laparotomy showed a ruptured ectopic pregnancy located in the distal portion of the left fallopian tube. The occurrence of an ectopic pregnancy several years following tubal ligation and vaginal hysterectomy is a rare phenomenon that appears to be secondary to a fistulous connection into the peritoneal cavity.     

Tubal ligation frequency in Oklahoma women with cervical cancer

Objective

Infrequent Pap screening is an important risk factor for cervical cancer. We studied the association between contraceptive methods, screening frequency, and cancer.

Methods

Women (n = 2004) enrolled in the cross-sectional Study to Understand Cervical Cancer Endpoints and Determinants (SUCCEED) underwent colposcopy to evaluate an abnormal Pap test. Questionnaire data were compared between those with cervical intraepithelial neoplasia (CIN) 3/adenocarcinoma in situ (AIS) and those with invasive cancer to identify factors associated with cancer. Logistic regression was used to calculate age-stratified measures of association between contraceptive method and Pap frequency as well as tubal ligation (TL) and cancer risk.

Results

In all age groups, women with TL were more likely to have had no Pap screening in the previous 5 years compared to women using other contraception: 26-35 years (OR 4.6, 95% CI 2.4-8.6; p < 0.001), 36-45 years (OR 3.8, 95% CI 2.1-7.0; p < 0.001), and 46-55 years (OR 2.2, 95% CI 1.0-4.9; p = 0.050). Subjects with cancer (n = 163) were more likely to have had a TL (41% vs. 21%, p < 0.001) than those with CIN 3/AIS (n = 370). Age-stratified analyses showed increased odds of tubal ligation in women with cancer versus those with CIN 3/AIS between 25 and 45 years, with a significant increase in women 26 to 35 years old (OR 3.3, 95% CI 1.4-8.1; p = 0.009). Adjusting for Pap frequency changed the effect only slightly, suggesting that increased risk was not fully mediated by lack of screening.

Conclusion

Contraceptive type is associated with Pap screening. Women with TLs obtain less frequent Pap testing and may be at an increased risk for cervical cancer.     

Optimal time interval between laparoscopic tubal ligation for hydrosalpinges and ICSI-ET

ObjectiveTo determine the optimal time interval between performing laparoscopic tubal ligation for hydrosalpinges and an ICSI-ET treatment cycle.DesignA retrospective cohort study.SettingPrivate infertility clinic.Patient(s)The study group included 69 infertile women who had laparoscopic tubal ligation for hydrosalpinges. 41 patients (group A) had an ICSI-ET cycle <10 weeks after laparoscopic tubal surgery, 20 patients (group B) had an ICSI-ET cycle 10 and 16 weeks after surgery, and 20 patients (group C) had an ICSI-ET cycle >16 weeks after surgery.Intervention(s)laparoscopic tubal ligation and ICSI-ET.Main outcome measure(s)Pregnancy rate, clinical pregnancy rate and implantation rate.Result(s)Pregnancy rates were 39%, 50% and 50%, clinical pregnancy rates 31.7%, 45% and 50%, and implantation rates 14.8%, 21.5% and 18% for groups A, B and C respectively.Conclusion(s)Although the reduction in pregnancy rate, clinical pregnancy rate and implantation rate in Group A, as compared Groups B and C, did not reach statistical significance, our results suggest that ICSI-ET treatment cycles be postponed for at least 10 weeks after laparoscopic tubal ligation for hydrosalpinx. A larger prospectively randomized study should be conducted to confirm the minimum delay period required for endometrial receptivity to recover.     

Factors affecting the pregnancy rate after microsurgical reversal of tubal ligation

Objective

To evaluate the factors affecting the pregnancy rate after microsurgical reversal of tubal ligation.

Design

Retrospective clinical study.

Setting

Private practice affiliated with a tertiary care center.

Patient(s)

One hundred twenty-eight consecutive patients who underwent tubal reversal between October 1992 and May 2001.

Intervention(s)

Microsurgical tubal reanastomosis performed by a single surgeon.

Main outcome measure(s)

Subsequent pregnancy rates were evaluated with Fisher’s exact tests and logistic regression according to clinical characteristics of patients.

Result(s)

The pregnancy rate was 85.7% (54 out of 63) in patients ≤35 years of age vs. 45.5% (10 out of 22) in patients >35 years. The odds ratio (OR) between the two age groups was 7.20, with a 95% confidence interval (CI) of 2.41 to 21.55. The pregnancy rate was 85.4% (35 out of 41) in patients with body mass index (BMI) ≤25 compared with 65.9% (29 out of 44) in patients with BMI >25 (OR 3.02; CI 1.04 to 8.77). Patients sterilized ≤8 years had a pregnancy rate of 87.2% (34 out of 39), vs. 65.2% (30 out of 46) in patients sterilized >8 years (OR 3.63; CI 1.19 to 11.09).

Conclusion(s)

Age was the primary statistically significant factor affecting pregnancy rate in tubal reversal patients. Body mass index and duration of sterilization had smaller, but statistically significant, associations with pregnancy rate.     

Safety and acceptability of tubal ligation procedures performed by trained clinical officers in rural Uganda

Objective

To assess safety associated with tubal ligation performed by trained clinical officers (COs) in rural Uganda.

Methods

Between March and June 2012, 518 women in 4 regions of Uganda were recruited into a prospective cohort study and followed at days 3, 7, and 45 after undergoing tubal ligation performed by a trained CO. Intraoperative and postoperative adverse events (minor, moderate, or major), and acceptability were assessed.

Results

Mean age was 36 years (range, 20–49 years) and mean number of living children was 6.7 (range, 0–15). The overall rate of major adverse events was 1.5%: 0.4% intraoperatively; 1.9% at day 3; and 0.2% at day 7. The majority of women who underwent tubal ligation reported a good/very good experience at the facility (range, 94%–99%) and would recommend the health services to a friend (range, 93%–98%).

Conclusion

In the present study, task sharing of tubal ligation to trained COs in private facilities was safe. Women reported high levels of satisfaction with the procedure. Training COs could be an effective strategy for expanding family-planning services to rural Uganda.