输卵管结扎术后并发子宫内膜异位症68例分析

目的探讨输卵管结扎术和子宫内膜异位症的关系.方法我院近8年来输卵管结扎术后腹腔镜检查确诊为子宫内膜异位症的患者68例,回顾性分析输卵管结扎的方法,结扎后的并发症及其临床表现和术后子宫内膜异位症的分期.结果不同的输卵管结扎方法术后均有可能并发子宫内膜异位症,53%的患者有典型的子宫内膜异位症的临床表现,结扎后出现腹腔瘘的患者有14.7%合并子宫内膜异位症.结论输卵管结扎术后有可能并发子宫内膜异位症的发生,若出现腹痛、痛经和盆腔包块时应及时行腹腔镜检查以帮助诊断和治疗.     

输卵管结扎后并发子宫内膜异位症68例报道

目的探讨输卵管结扎术和子宫内膜异位症的关系.方法回顾性分析我院近8年来输卵管结扎术后腹腔镜检查确诊为子宫内膜异位症68例患者的临床资料.结果不同的输卵管结扎方法术后均有可能并发子宫内膜异位症,53%的患者有典型的子宫内膜异位症的临床表现,结扎后出现腹腔瘘的患者14.7%合并子宫内膜异位症.结论输卵管结扎术后出现腹痛、痛经和盆腔包块时应及时行腹腔镜检查以利子宫内膜异位症的早期诊治.     

输卵管结扎术后子宫内膜异位症

结扎术后盆腔痛已被公认,其痛因只是揣测。但是,子宫内膜异位症作为结扎术后能够发生和引起盆腔疼痛的实质一直未加讨论,本研究分析了结扎术后症状性子宫内膜异位症。本文收集1980.1～1982.4期间,Yale-New Haven医院诊断子宫内膜异位症施术治疗后出院患者住院卡,手术发现内膜异位症患者中23例作过绝育术。本文23例平均年龄35.8岁(27～47岁),其中13例腹式Pomeroy法结扎:产后结扎3例,腹腔镜电烧绝育9例,阴道式结扎1例。23例中20例因具有内膜异位症症状,即盆腔痛、痛经、异常出血     

腹腔镜对女性不孕症诊治的评价

目的:探讨腹腔镜检查术对诊治女性不孕症的价值。方法:回顾性分析行腹腔镜检查的706例女性不孕症患者,术后随访2年,对腹腔镜协助诊治的结果进行评价。结果:镜下诊断各种病变692例(98.02%),未发现异常14例(1.98%)。其中输卵管因素442例,子宫内膜异位症132例,卵巢异常78例,子宫异常42例,其他12例。术后随访2年,其妊娠率分别为:输卵管异常38.91%(172/442),子宫内膜异位症39.39%(52/132),卵巢异常23.08%(18/72),子宫异常19.04%(8/42),其他16.67%(2/12)。结论:输卵管因素和子宫内膜异位症是导致女性不孕的主要因素。腹腔镜对诊治输卵管性不孕和子宫内膜异位症,具有快速、准确、可靠及损伤小的特点。     

腹腔镜下输卵管通液对输卵管性不孕的诊断价值

目的:探讨腹腔镜下输卵管通液对输卵管性不孕(TFI)的诊断价值。方法:对168例不孕症女性进行腹腔镜下盆腔探查和输卵管通畅检查,分析盆腔疾病与不孕症的关系,随访2年并记录其妊娠情况。结果:盆腔炎和子宫内膜异位症是引起输卵管不孕的主要盆腔疾病;盆腔炎的输卵管梗阻率为91.35%,显著高于子宫内膜异位症患者(21.05%)和正常盆腔患者(11.11%),差异均有统计学意义(P<0.05);腹腔镜与输卵管通液检查输卵管通畅度符合率为70.24%;术后妊娠86例,妊娠率68.8%。结论:腹腔镜下输卵管通液检查具有评估输卵管通畅度及疏通的双重功效,可作为不孕症患者的首选检查方法。     

腹腔镜输卵管结扎术的弊与利

目的:探究腹腔镜输卵管结扎术的弊与利.方法:选取2013年到2015年在我中心接受落实输卵管结扎术的60例对象,腰硬联合麻醉腹腔镜下行输卵管结扎术,腔镜成功的置入后对盆腔进行探查,没有粘连和子宫异常的情况,采用双点穿刺法对输卵管进行结扎;结果:对60例患者行腔腹镜下输卵管结扎手术,患者手术的成功率为100％,其他的器官也没有出现损伤的情况,对伴随的疾病进行其他手术的治疗:卵巢囊肿、肿瘤剥除术、盆腔粘连松解术、子宫肌瘤挖除术等等;结论:与腹腔镜下输卵管结扎术对患者的创伤小、手术时间段,成功率比较高,容易被患者接受.     

开腹与腹腔镜治疗子宫内膜异位症合并不孕症的效果比较

目的:比较腹腔镜手术与开腹手术治疗子宫内膜异位症合并不孕症的效果。方法:选择89例有手术指征的子宫内膜异位症伴不孕患者,分为腹腔镜与开腹手术两组进行手术治疗,术后肌肉注射诺雷德3个月,随访患者1年内妊娠情况和子宫内膜异位症复发情况,了解两种术式对疾病的治疗效果。结果:子宫内膜异位症伴不孕症患者腹腔镜术后1年内妊娠率为52.38%,复发率9.52%,开腹手术妊娠率51.06%,复发率12.77%,两组妊娠率及复发率均无显著统计学差异(P>0.05)。腹腔镜组术后输卵管不通畅者占术后不孕的50.00%,而开腹组占54.55%,两组之间具有显著统计学差异。结论:治疗子宫内膜异位症伴不孕应选择手术治疗,有条件者首选腹腔镜手术,腹腔镜手术较开腹手术具有损伤少,术中出血少,术后并发症少,住院时间短,病人恢复快等优点,是一种微创、高效、尽量保证器官完整的,具有发展前景的新技术。患者术后再次粘连导致的输卵管输送卵子不畅也是术后不孕的主要原因。     

改良输卵管宫角植入术在结扎术后输卵管近段病理性闭塞复通中的应用探讨

对60例输卵管结扎术后近段闭塞(间质部及峡部)妇女采用改良输卵管子宫角植入术,并对部分病例切除的近段输卵管标本进行病理形态学观察。病理检查发现:①输卵管慢性炎症;②输卵管子宫内膜异位症;③管腔内增生的纤维组织填塞。术后随访50例(83.33％),输卵管通畅46例(92％),宫内妊娠29例(58％),校正妊娠率为63.04％,宫外孕1例,表明宫角植入术用于此类结扎术后输卵管近段闭塞病例的复通有较好疗效。对此术式的关键点及术后宫内妊娠率与绝育年限、年龄、术后输卵管长度的关系作了分析。     

长期不孕的腹腔镜检查及选择性输卵管插管术的治疗效果

作者使用腹腔镜检查之同时,在子宫镜下行选择性输卵管内插管,进行疏通诊断,并注入碘化油,该法获术后早期约40％妊娠的效果。研究5年以上不孕患者用该法妊娠例的输卵管与子宫内膜异位症的情况。     

经腹输卵管绝育术后远期并发症概述

经腹双侧输卵管结扎术后下腹痛等不适是常见术后并发症状,有研究提示,输卵管结扎术后下腹痛患者中,大网膜粘连占47．4％,盆腔粘连占8．5％,肠粘连占8．5％,盆腔静脉淤血症占6．8％,子宫内膜异位症占6．8％,慢性阑尾炎22．0％,陈旧性异位妊娠3．4％,畸胎瘤1．7％。目前认为经腹输卵管结扎术后远期并发症主要包括各种盆腹腔炎症、粘连等,如盆腔炎、大网膜粘连综合征、肠粘连等,以及术后精神神经症状如神经官能症等,现分述如下。     

Utero-ovarian morphology and blood flow after tubal ligation by the Pomeroy technique

OBJECTIVES: The objectives of this study were to evaluate ovarian sonographic morphology and pelvic blood flow in patients who had undergone bilateral tubal ligation by the Pomeroy technique. DESIGN: Twenty women who had undergone bilateral tubal ligation during cesarean section by the Pomeroy techniques were compared to 20 matched controls who had undergone cesarean section alone. Ovarian morphology as well as ovarian and uterine pulsatility index (PI), resistance index and peak systolic velocity were evaluated using transvaginal sonography and Doppler velocimetry. RESULTS: Patients post tubal ligation by the Pomeroy technique were found to have a significantly higher rate of polycystic appearance of the ovaries (60% vs. 5%; p < 0.005). Six patients (30%) had post tubal ligation symptoms, as compared to none of the controls. Five of the six symptomatic tubal ligation patients (83%) had ovarian polycystic appearance, which was not significantly different than asymptomatic patients. Ovarian artery PI was significantly higher in symptomatic patients (2.7 +/- 1.9) compared to asymptomatic patients (1.5 +/- 0.9) (p < 0.05). CONCLUSIONS: We therefore conclude that patients post bilateral tubal ligation by the Pomeroy technique may acquire an ovarian polycystic appearance and increased ovarian PI, which may be associated with a tendency to develop post tubal ligation symptoms.     

异丙酚复合局麻行输卵管结扎术的临床分析

目的 探讨异丙酚麻醉复合局麻减轻小切口输卵管结扎术受术者痛苦的可行性。方法 将260例受术者按自愿随机分成用药组160例,对照组100例。用药组给予静脉注射异丙酚复合1％利多卡因局麻,观察两组受术者的术中反应及手术时间。结果 用药组术中无痛感达100％,全部对手术无回忆;手术时间较对照组明显缩短,无明显副作用。结论 静脉注射异丙酚加局麻行输卵管结扎术是安全可行的。     

腹腔镜手术治疗输卵管结扎术后盆腔淤血综合征的临床研究

目的 探讨腹腔镜下圆韧带悬吊术或缩短术治疗输卵管结扎术后盆腔淤血综合征(PCS)的临床疗效.方法 应用腹腔镜下圆韧带悬吊术或缩短术治疗30例PCS患者,术后3个月开始随访,了解患者症状缓解情况.结果 全部病例术后症状均有不同程度的缓解,治愈率为73.3%(22/30),好转率为20.0%(6/30),无效率为6.7%(2,30),总有效率为93.3%(28/30).结论 腹腔镜可作为PCS的常规和首选诊治手段.腹腔镜下圆韧带悬吊术或缩短术方法简单、手术成功率高,是PCS的一种有效治疗方法.     

Changes in menstrual pattern and ovarian function following bipolar electrocauterization of the fallopian tubes for voluntary surgical contraception

OBJECTIVE: Our aim was to investigate the changes in menstrual pattern, ovarian reserve and presence of dysmenorrhea and ovulation after tubal ligation via bipolar electrocautery. METHODS: Sixty patients requesting voluntary tubal ligation were recruited in the study. Laparoscopic tubal sterilization via bipolar electrocoagulation was performed in all patients in the early follicular phase. Blood samples were collected on day 3, one cycle before the procedure, in the same cycle when the procedure was carried out and on the third cycle following the procedure for determination of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E(2)), and on day 21 for progesterone (P) levels. All patients were followed for 3 months, and changes in menstrual pattern, presence or absence of dysmenorrhea and ovulation were noted. RESULTS: Menstrual changes occurred in six patients (10%), although only one patient had mild dysmenorrhea (1.6%) after the procedure. The incidence of ovulation was 33% preoperatively, rising to 40% in the cycle when surgery was performed and maintained a constant level at 40% 3 months after tubal ligation. There was no statistically significant difference in the serum FSH, LH and estradiol levels in preoperative and postoperative assessments (p > .05). CONCLUSION: Tubal ligation has been blamed for causing luteal phase defect as a result of an effect on ovarian circulation. In our study, the rate of ovulation was slightly improved after the procedure, and ovarian reserve was not negatively affected. Bipolar electrocoagulation of the fallopian tubes did not alter the ovarian reserve and function.     

微型腹腔镜治疗小儿非腹腔型隐睾合并腹股沟斜疝18例体会

目的探讨微型腹腔镜治疗小儿非腹腔型隐睾合并腹股沟斜疝的方法及疗效。方法2009年6月～2010年2月对18例小儿非腹腔型隐睾合并腹股沟斜疝应用微型腹腔镜行隐睾探查、下降固定术及内环口关闭术。结果16例镜下降松解精索、下降固定睾丸,1例转腹股沟切口下降固定睾丸,1例镜下行睾丸切除术。18例均在腹腔镜下行内环口结扎。术后恢复良好,无出现并发症。结论腹腔镜下内环口关闭、隐睾探查及下降固定术治疗小儿非腹腔型隐睾合并腹股沟斜疝疗效肯定,手术创伤小,恢复快,并发症少,值得临床推广应用。     

中隔子宫不孕不育合并子宫内膜异位症的临床诊治

目的:探讨中隔子宫不孕不育患者合并子宫内膜异位症的临床特征、诊断及治疗方法。方法:对2001年2月～2005年8月北京大学深圳医院住院治疗的24例中隔子宫不孕不育合并子宫内膜异位症患者的临床资料进行回顾性分析。结果:24例中隔子宫不孕不育患者全部合并子宫内膜异位症,平均年龄28.5岁,临床表现均为不孕不育,其中不孕不育16例,月经紊乱4例,无症状体检发现4例,全部患者经手术治疗(宫腔镜、腹腔镜联合手术)。手术证实完全中隔7例,不全中隔17例。子宫内膜异位症按(ASF-r)分期,均为Ⅰ～Ⅱ期,多处盆腔异位病灶8例,直肠窝异位病灶6例,子宫骶骨韧带异位病灶10例,所有患者术后均放置宫内节育器,雌激素治疗3～6个月,追踪随访妊娠10例,分娩5例。结论:中隔子宫不孕不育患者易合并子宫内膜异位症,应早期诊断、早期手术治疗,宫腔镜、腹腔镜联合手术治疗是治疗的最佳方法。术后雌激素治疗有利于子宫内膜的修复。但对盆腔子宫内膜异位病灶则不利,必要时需二次腹腔镜手术去除异位病灶,疗效满意。     

盆腔子宫内膜异位症合并不孕患者术后妊娠相关因素分析

目的:通过对盆腔子宫内膜异位症(EMs)合并不孕患者行宫腹腔镜联合手术治疗前后多个因素分析,探讨可能影响其术后妊娠的主要因素,为临床治疗提供科学依据。方法:收集247例EMs合并不孕且进行宫腹腔镜联合手术患者的相关资料,采用χ2检验、t检验、秩和检验、多因素Logistic回归等方法进行分析。结果:术后患者自然试孕157例,直接进入体外受精(IVF)助孕周期90例。最终未妊娠者105例,成功妊娠者142例。术后成功妊娠者和未妊娠者不孕年限、子宫内膜异位症分期(r-AFS分期)、子宫内膜异位症生育指数(EFI)评分比较,差异有统计学意义(均P0.05),而不孕类型、是否合并子宫内膜息肉(EP)和卵巢EMs异位囊肿病灶单双侧比较,差异无统计学意义(P0.05)。术后随着时间延长,自然妊娠率和IVF助孕妊娠率逐渐下降,趋势χ2检验差异有统计学意义(均P0.05)。r-AFS分期、EFI评分与术后妊娠情况密切相关(P0.05),EFI评分高为术后妊娠的保护性因素,而r-AFS分期高为术后妊娠的危险性因素。结论:r-AFS分期、EFI评分和不孕年限是子宫内膜异位症患者术后妊娠的重要影响因素,对此类患者可通过腹腔镜手术探查及治疗,尽早根据相应指标评估病情,积极采取措施指导受孕,可显著提高术后妊娠率。     

Factors related to inflammation of the ovarian epithelium and risk of ovarian cancer

Previous epidemiologic observations consistently suggest that suppression of ovulation, tubal ligation, and hysterectomy reduce the risk of ovarian cancer and that perineal talc use increases the risk. We examined these and other risk factors in the context of a new hypothesis: that inflammation may play a role in ovarian cancer risk. Ovulation entails ovarian epithelial inflammation; talc, endometriosis, cysts, and hyperthyroidism may be associated with inflammatory responses of the ovarian epithelium; gynecologic surgery may preclude irritants from reaching the ovaries via ascension from the lower genital tract. We evaluated these risk factors in a population-based case-control study. Cases 20-69 years of age with a recent diagnosis of epithelial ovarian cancer (767) were compared with community controls (1,367). We found that a number of reproductive and contraceptive factors that suppress ovulation, including gravidity, breast feeding, and oral contraception, reduced the risk of ovarian cancer. Environmental factors and medical conditions that increased risk included talc use, endometriosis, ovarian cysts, and hyperthyroidism. Gynecologic surgery including hysterectomy and tubal ligation were protective. Tubal ligation afforded a risk reduction even 20 or more years after the surgery. The spectrum of associations provides support for the hypothesis that inflammation may mediate ovarian cancer risk.     

子宫内膜异位症患者血清中VEGF和IGF-Ⅰ的表达及其相关性

目的:探讨子宫内膜异位症患者血清中血管内皮生长因子(VEGF)和胰岛素样生长因子-I(IGF-I)的表达水平和有无相关性。方法:选取40例在该院行手术治疗且病理检查证实为子宫内膜异位症的患者(Ⅰ、Ⅱ期19例,Ⅲ、Ⅳ期21例)为病例组,选取40例非子宫内膜异位症患者(包括单纯性卵巢囊肿患者,因不孕症行腹腔镜检查的患者和行输卵管结扎术的患者,均排除内分泌疾病,不合并子宫腺肌症、子宫肌瘤及乳腺增生等激素依赖性疾病,且半年内均未服用激素类药物)为对照组,采用酶联免疫吸附试验(ELISA)方法检测这两组患者血清中VEGF和IGF-I的表达水平,并分析两者在子宫内膜异位症中有无相关性。结果:①子宫内膜异位症组患者血清中VEGF和IGF-I的浓度比对照组浓度均明显增高,且差异具有统计学意义(P<0.05)。②Ⅲ-Ⅳ期患者血清中VEGF和IGF-I的浓度比Ⅰ-Ⅱ期患者均明显增高,且差异具有统计学意义(P<0.05)。③子宫内膜异位症患者IGF-I和VEGF在血清中的表达水平呈正相关(r=0.689,P<0.05)。结论:子宫内膜异位症患者的发生和发展与血清中VEGF和IGF-Ⅰ水平密切相关,且两者在子宫内膜异位症患者血清中的水平都随着病情的加重而升高;VEGF和IGF-Ⅰ在子宫内膜异位症血清中的协同表达可能促进疾病的发生发展。