5种绝育术后腹腔镜复通术的效果分析

目的:探讨几种常见输卵管绝育手术后,进行腹腔镜输卵管复通术的效果及影响因素.方法:回顾分析1999～2008年间我院对89例妇女进行输卵管绝育术后复通手术,对不同绝育方法的复通效果及影响因素进行比较.结果:89例接受复通手术的妇女随访到86例,随访率96.63%.复通术后前6个月妊娠率最高为52.33%(45/86);抽芯包埋法和夹绝育复通术后宫内妊娠率显著高于其他方法(P<0.05);输卵管粘堵术及伞端切除术比较,差异无统计学意义(P>0.05).峡-峡部、壶-壶腹部及峡-壶腹部吻合术后宫内妊娠率比较,差异无统计学意义(P>0.05),均显著高于造口术后及宫腔植入术(P均<0.05),后两者比较差异无统计学意义(P>0.05).结论:在输卵管绝育时应避开血管,减少系膜损伤,可提高术后复通的成功率,使绝育手术更具可逆性;粘堵及伞端切除绝育复通效果较差;复通术后没有必要短期避孕.     

输卵管的解剖和功能

1　输卵管的解剖与超微结构　　输卵管是女性生殖系统的主要组成部分之一 ,具有输送精子、卵子和受精卵以及提供精子贮存、获能、顶体反应和受精场所等生理功能。输卵管长为 6～ 15ｃｍ ,由粘膜和环状平滑肌浆膜构成。分伞部、壶腹部、峡部和间质部 ,壶腹部与峡之间称壶腹 -峡连接 (ＡＩＪ) ,峡部与间质部之间称子宫 -输卵管连接 (ＵＴＪ)。这些连接部位管壁较厚 ,管腔变化大。1 1　输卵管伞部　　输卵管伞部由浆膜、平滑肌和粘膜组成 ,位于壶腹部的远端 ,覆盖于卵巢的表面。伞部肌纤维稀少 ,但粘膜皱折丰富。粘膜上皮由纤毛细胞、分泌细胞…     

宫、腹腔镜联合诊治术在输卵管性不孕中的应用

目的 :探讨宫、腹腔镜联合手术在输卵管性不孕症诊治中的应用价值。方法 :1997年 8月至 2 0 0 0年 9月 ,输卵管性不孕症患者 114例 ,采用宫、腹腔镜联合手术 ,进行粘连分离、输卵管伞端成形术、输卵管造口术、腹腔镜监视下宫腔镜插管通液。结果 :术后≥ 6个月的 67例随访者 ,有 2 8例受孕 ,妊娠率 41. 79% ( 2 8/67)。 2 6例为宫内妊娠 ,2例为宫外妊娠。结论 :宫、腹腔镜联合诊治术是输卵管性不孕的有效诊治方法     

子宫输卵管碘油造影诊断及宫腹腔镜联合下特殊导丝治疗输卵管近端梗阻的疗效

目的比较子宫输卵管碘油造影与宫腹腔镜联合下特殊导丝治疗输卵管近端梗阻性不孕的疗效。方法通过前期子宫碘油造影结果筛选为输卵管近端梗阻性不孕患者30例作为研究对象,在腹腔镜辅助下、宫腔镜下行特殊导丝治疗近端梗阻的输卵管。观察特殊导丝的疗效。结果前期经子宫输卵管碘油造影确诊为输卵管一侧或双侧共60条输卵管有不同程度的宫角、间质部或峡部梗阻,经特殊导丝治疗后,近端已梗阻输卵管通畅54条,疏通率90%(54/60),不通畅6条,不通率10%(6/60)。术后连续观察1年,共计妊娠16例,妊娠率53%。继发不孕20例,妊娠14例,妊娠率为70%(14/20);原发不孕10例,妊娠2例,妊娠率为20%(2/10)。结论宫腹腔镜下联合特殊导丝治疗输卵管近端梗阻具有定位准确、损伤小、风险低、并发症少、输卵管复通率高的特点,是有效治疗输卵管近端梗阻的便捷方法。     

输卵管妊娠保留输卵管手术后综合疗法的宫内妊娠探讨

对输卵管妊娠52例有生育要求者，其中28例行切开输卵管壶腹部取胚胎术，10例行输卵管峡部破裂口修补术，7例行输卵管伞部成形术，5例行输卵管峡部端端吻合术，2例行输卵管子宫角部植入术。术后给MTX与中药等综合治疗2～5个月，对其中45例行输卵管通畅检查，双侧输卵管通畅4O例，通畅率为88.9％；有41例宫内妊娠，妊娠率为78.9％，另有1例再次异位妊娠。提示：对有生育要求的输卵管妊娠尽量根据输卵管的不同情况采用相应的手术方法，并应用有效的术后综合措施，对保留患者的生育功能和提高妊娠率有重要意义。     

腹腔镜监测下宫腔镜输卵管插管术治疗输卵管近端梗阻的疗效分析

目的：分析腹腔镜监测下宫腔镜输卵管插管术（laparoscopy-guided hysteroscopic tubal catheterization,LHTC）治疗输卵管近端梗阻的临床疗效。方法：回顾性分析2010年1月—2012年12月因单纯输卵管近端梗阻在中国人民武装警察部队后勤学院附属医院住院行LHTC的336例患者临床资料。术后随访2年,观察其术后妊娠率及妊娠结局。结果：LHTC术中总的输卵管复通率为54.70%,总的患者复通率为63.10%。术后至少一侧输卵管通畅组和未能复通组的术后2年自然妊娠率分别为43.40%和8.06%,活产率分别为33.96%和7.26%,差异均有统计学意义（P＜0.05）。结论：行LHTC治疗输卵管近端梗阻的疗效确切,该术式可以作为治疗输卵管近端梗阻的首选方法。     

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。     

输卵管妊娠的治疗体会

卵子在输卵管壶腹部受精，受精卵因某些原因在输卵管被阻，而在输卵管的某一部分着床、发育，发生输卵管妊娠。以壶腹部妊娠为最多，占50％～70％；其次为峡部，占30％～40％；伞部、间质部最少见，占1％～2％。     

持续性输卵管妊娠破裂休克1例

1　病例报告　　患者 2 1岁 ,未婚有同居史 1年 ,因腹腔镜下右侧输卵管伞端胚胎挤出术后 8天 ,下腹痛 2小时 ,头晕乏力 2 0分钟于 2 0 0 3年 3月 6日 2 0时急诊入院。患者于 8天前因停经 4 2天 ,下腹痛 2天门诊拟诊为“异位妊娠”收入我院 ,阴道超声检查结果提示右侧输卵管妊娠 ,尚未破裂。遂即行腹腔镜诊治术 ,术中见右侧输卵管壶腹部近伞端增粗膨大约 3cm× 3cm× 2 5cm ,紫蓝色 ,伞端见少量凝血块及胚胎组织堵塞 ,遂自伞端将胚胎组织挤出 ,挤出物中见典型绒毛组织 ,手术顺利 ,病理结果证实右侧输卵管妊娠 ,第 6天痊愈出院。出院后第 2天…     

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。     

输卵管阻塞性不孕症宫、腹腔镜术后治疗方法的探讨

目的:探讨输卵管阻塞性不孕症宫、腹腔镜术后阻止再次粘连和阻塞的诊疗方法。方法:将宫、腹腔镜术后至少一侧输卵管通畅的不孕症患者随机分为治疗组和对照组,治疗组和对照组分别术后第1次月经干净后3~7 d应用欣可聍或注射体积分数20%甲硝唑氯化钠注射液进行彩色B超监测下宫腔镜输卵管插管通液;观察术后1年的妊娠情况,术后1年未孕者,于月经干净后3~7 d行子宫输卵管碘佛醇造影检查,了解输卵管通畅度。结果:术后1年治疗组妊娠率(68.75%)高于对照组(51.25%),差异有统计学意义(χ2=5.104,P=0.024);异位妊娠差异无统计学意义(P0.05);未孕者治疗组双侧输卵管通畅率(40.9%)高于对照组(14.2%),差异有统计学意义(χ2=5.168,P=0.023)。结论:输卵管阻塞性不孕症宫、腹腔镜术后第1次月经干净后3~7 d用欣可聍注射液进行彩色B超监测下宫腔镜输卵管插管通液,可以降低盆腔的再次粘连,维持输卵管的通畅,提高受孕率,值得临床推广应用。     

Diagnosis and treatment of cornual obstruction using a flexible tip guidewire

Proximal tubal obstruction, either unilateral or bilateral, is a frequent finding on hysterosalpingogram (HSG). Approximately two-thirds of the fallopian tubes resected for proximal tubal obstruction reveal an absence of luminal occlusion. The distinction between true pathologic occlusion and either spasm or plugging is crucial in determining therapy. We combined hysteroscopic cannulation of the proximal fallopian tube with laparoscopy in 11 patients with proximal tubal obstruction diagnosed by HSG and confirmed at laparoscopy. Hysteroscopic cannulation was able to be performed in 72% of the fallopian tubes attempted, and there was a postcannulation patency rate by HSG of 73%. Six of the 11 patients became pregnant after tubal cannulation and adjunctive distal tubal surgery. Hysteroscopic cannulation of the fallopian tube is a safe diagnostic procedure that can be used to identify those patients with true proximal occlusion, and may also serve as a therapeutic procedure in some of these patients.     

Outcome of Laparoscopy-Guided Hysteroscopic Tubal Catheterization for Infertility Due to Proximal Tubal Obstruction

Study ObjectiveTo determine pregnancy outcomes after laparoscopy-guided hysteroscopic tubal catheterization and to report its role in the era of in vitro fertilization.DesignClinical cases series (Canadian Task Force classification II-3).SettingReproductive surgery center.PatientsPatients with unilateral or bilateral proximal tubal obstruction as the only cause of infertility were included.InterventionsLaparoscopy-guided hysteroscopic tubal catheterization.Measurements and Main ResultsOnly the first spontaneous conception was considered. Cumulative conception rate (CCR) was calculated using Kaplan-Meier survival analysis. Of 168 women included, 107 (63.7%) had bilateral proximal obstruction and 61 (36.3%) had unilateral obstruction. The successful recanalization rate was 54.2% per tube and 61.9% per patient. In the 93 patients in whom at least 1 fallopian tube was successfully recanalized, 40 spontaneous pregnancies (43.0%) occurred within 24 months, of which 35 (37.6%) were intrauterine pregnancies and 28 (30.1%) resulted in live births. The CCR was 37.6% at 1 year and 43.7% at 2 years. Patients with unilateral obstruction in whom cannulation was successful had the highest CCR (60.7% at 2 years).ConclusionSuccessful tubal cannulation led to significant improvement in the pregnancy rate, which suggests that women with a proximal tubal block could be considered for laparoscopy-guided hysteroscopic cannulation, which is still a viable alternative to in vitro fertilization.     

选择性输卵管造影和再通术1006例随访分析

目的 探讨选择性输卵管造影(SSG)和输卵管再通术(FTR)治疗不孕症的临床疗效和实用价值。方法 对1006例经子宫输卵管造影(HSG)检查诊断为输卵管不同部位、不同程度梗阻的不孕症患者,用自制同轴导管行SSG和FTR,统计1年内的妊娠率和输卵管通畅度治疗的有效率,并结合术前、术后HSG及术中输卵管动态观察结果进行综合分析。结果 输卵管腔完全梗阻315例,共601条输卵管(部分患者曾因各种原因行一侧输卵管切除,完全梗阻组),528条获管腔再通,再通率87．9%．其中35.4％(187条)仅行SSG即获再通,64．6％(341条)在SSG同时行FTR获再通。术后1年内妊娠率为39．9％,异位妊娠发生率2,7％,管腔再闭塞率1．8%;未获再通者中4例为结核性输卵管炎,3例结节性输卵管炎,9例阻塞于峡部,末端呈杵状改变,6例阻塞于壶腹部和伞部,10例输卵管纤维化。管腔不全梗阻691例(不全梗阻组),其中输卵管通而欠畅105例,通而不畅357例,通而极不畅229例,行SSG术后共发现65例术前HSG结果对伞部粘连的诊断有误。1年内妊娠率随访显示,输卵管通而欠畅者为53.6％,通而不畅者为45.7%,通而极不畅者为26,8％,异位妊娠发生率1．4％。术后1年行HSG复查,治疗有效率(管腔通畅度好转)86．9％。两组中经SSG诊断伞端粘连明显或周围包裹形成者共有16例,同时进行了腹腔镜治疗,其手术符合率97．1％。结论 SSG和FTR对输卵管性不孕具有诊断和治疗双重作用,且简便、安全,疗效可靠,值得临床推广。     

经宫腔镜插管术治疗输卵管性不孕症的初步研究

经宫腔镜向子宫输卵管开口插入导管治疗２５２例输卵管梗阻性不孕症患者。本组病例中一侧输卵管插通率为７５％，双侧插通率为１５％，１０例获得宫内妊娠。无宫外孕及其他副反应。据此，作者认为在宫腔镜指引下输卵管插管术为一安全、化费少、有高效的治疗与诊断输卵管梗阻性不孕症的方法。妇科医生均应学习并掌握此项操作。     

Hysteroscopic tubal catheterization under laparoscopy for proximal tubal obstruction

Purpose  

The purpose of this study was to investigate the fertility outcomes of infertile patients having proximal tubal obstruction treated with hysteroscopic tubal catheterization (HCT) for recanalization under diagnostic laparoscopy.     

Digital road mapping image--a novel fluoroscopic real-time guide for selective transcervical catheterization in the treatment of proximal tubal obstruction.

Ten infertile women 20 to 40 years of age, with a standard HSG diagnosis of unilateral proximal tubal obstruction, underwent a transvaginal catheterization and recanalization of the fallopian tubes. To set a fluoroscopic real-time guidance technique for improving the results of transvaginal catheterization and recanalization of the fallopian tubes and to increase its marginal safety, catheterization was performed under digital road mapping guidance. Transcervical catheterization resulted in an immediate patency of the obstructed tube in all 10 women. Three women conceived 2 to 3 months after the procedure. The improved catheterization technique enables good results in the diagnosis and treatment of proximal tubal obstructions.     

A new approach to hysteroscopic cannulation of the fallopian tube

Hysteroscopic cannulation of the fallopian tube has become an essential part of the treatment of interstitial fallopian tube obstruction. This report describes the use of a flexible instrument that can be introduced through a rigid hysteroscope for the purpose of hysteroscopic tubal cannulation.     

Assessment of Tubal Patency: A Prospective Comparison of Diagnostic Hysteroscopy and Laparoscopic Chromopertubation

Study ObjectiveTo evaluate whether the presence of a visualizable “flow” effect in the fallopian tube ostia in hysteroscopy was predictive of tubal patency.DesignA prospective cohort study.SettingIn a prospective study, infertile women who underwent surgery because of infertility between March and November 2018 were included. The main outcome parameter was fallopian tube patency assessed by laparoscopic chromopertubation. The predictive parameter tested was the presence of hysteroscopic tube flow.PatientsSeventy-two infertile women.InterventionsCombined hysteroscopy and laparoscopy with chromopertubation.ResultsOne-hundred forty-four fallopian tubes were evaluated, with 88 (61.1%) patent tubes at laparoscopic chromopertubation. A positive hysteroscopic flow effect was recorded for 94 (65.3%) ostia and was accurate in predicting patency (p < .001), with a sensitivity of 85.3% (95% confidence interval [CI], 76.1–91.9) and a specificity of 66.1% (95% CI, 52.2–78.2). A multivariate binary regression model revealed that the presence of a hydrosalpinx (odds ratio = 8.216; 95% CI, 1.062–63.574; p = .044) and peritubal adhesions (odds ratio = 3.439; 95% CI, 1.142–10.353; p = .028) were associated with a false-normal flow result. A hazy hysteroscopic picture was found in 15 of 21 (71.4%) and 5 of 51 (9.8%) cases with and without bilateral tubal occlusion, respectively (p < .001, sensitivity = 71.4% [95% CI, 47.8–88.7], specificity = 90.2% [95% CI, 78.6–96.7]).ConclusionsThe presence of hysteroscopic tubal flow was a reliable indicator of tubal patency. A hydrosalpinx or peritubal adhesions increase the risk for a false-normal result. A hazy hysteroscopic picture suggests bilateral tubal occlusion. Using the hysteroscopic flow effect, one can provide additional information for the patient.