腹腔镜下输卵管吻合术的临床应用探讨

目的:评价腹腔镜下输卵管吻合术的临床应用价值.方法:对15例输卵管绝育术后或输卵管妊娠行保守性手术处理后输卵管断裂,因生育需要而要求复通者进行输卵管对端吻合术并随访妊娠率.结果:14例术后第1次月经干净后输卵管通液均显示通畅,术后1年半内复孕8例,受孕率57.1%.结论:腹腔镜下输卵管吻合术较开腹有一定优势,亦具有较高成功率,是输卵管堵塞患者的一个较好的治疗选择.     

绝育术后输卵管吻合术601例临床分析

１９８１年３月至１９９３年３月我们行绝育后输卵管吻合术（ｓａｌｐｉｎｇｏａｎａｓｔｏｍｏｓｉｓ，ＳＡ）６０１例，经过随访，探讨了输卵管结扎术（ｔｕｂａｌｌｉｇａｔｉｏｎ，ＴＬ）的可复性及提高复孕率的几个关键问题，现报告如下。１资料与方法６０１例均来自...     

腹腔镜输卵管吻合术

20世纪80年代末已有学者应用腹腔镜进行输卵管吻合手术,但是至今较大样本的报道并不多[1-2].绝大多数要求输卵管吻合复通的患者为输卵管绝育术后要求再生育的妇女,相对于炎症等引起的不孕,这些妇女进行输卵管吻合的条件较为优越,吻合手术时只需切除输卵管的阻塞部位,进行输卵管肌层和浆膜层的吻合即可,所以目前腹腔镜下的输卵管吻合术也主要应用于这些患者.     

输卵管显微吻合术281例临床分析

目的:探讨提高输卵管吻合复通率的可行方法。方法:采用显微外科技术对281例施行输卵管吻合术,并随访观察1-18年。结果:281例施行输卵管显微吻合术后,通畅率达100%,子宫内妊娠263例(94%)。结论:使用显微手术器械,熟练显微操作,对吻合术复通成功率有较明显的提高。     

显微输卵管吻合术89例临床效果分析

目的探讨应用显微外科技术进行输卵管吻合术的效果及影响妊娠的原因。方法对我站1992～2003年应用显微外科技术，开展显微输卵管吻合术89例，进行随访研究并对复通者的绝育方法、年限及输卵管的长度等进行分析。结果随访89例，怀孕81例（91．O％），宫外孕2例（2．2％）。结论绝育方式、输卵管长度、显微外科技术、输卵管有无炎症是决定复孕是否成功的关键。     

输卵管吻合术68例临床分析

目的:探讨输卵管吻合术后的临床妊娠效果及影响因素.方法:回顾分析我院妇科2009年2月至2011年12月经审批符合再育、无手术禁忌证,经腹行直视下输卵管吻合术68例患者临床资料,观察术后妊娠情况.结果:①术后3年内妊娠27例,36例未受孕,5例失访;②68例妇女的宫内妊娠率为42.9％ (27/63),无异位妊娠发生;③输卵管吻合术后妊娠与年龄、吻合输卵管长度、合并输卵管炎、术后通液通畅情况有关(P＜0.05).结论:在术前排除输卵管因素以外的不孕因素后,临床研究证明经腹直视下输卵管吻合术是可行的,妊娠率较高.但术后的妊娠率与患者年龄、吻合输卵管长度、术后通液等因素密切相关.     

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?     

Laparoscopic tubal anastomosis: fertility outcome in 202 cases

Objective: To evaluate the fertility outcome after laparoscopic tubal anastomosis for reversal of sterilization.

Design: Retrospective clinical study.

Setting: A private practice affiliated with a university medical school.

Patient(s): Two hundred two women who desired reversal of tubal sterilization.

Intervention(s): Laparoscopic tubal anastomosis.

Main Outcome Measure(s): The cumulative pregnancy rate (PR) and factors that influenced the fertility outcome.

Result(s): The cumulative PR in the 186 patients for whom follow-up data were available was 60.3%, 79.4%, and 83.3% at 6, 12, and 18 months after operation, respectively. Five patients (3.2%) had ectopic pregnancies; one of these patients subsequently conceived normally. There were no statistically significant differences in the PR according to the sterilization method used, the site of the tubal anastomosis, or the length of the fallopian tube after surgery. The intrauterine PR was 87.1% (149/171) with bilateral anastomosis and 60% (9/15) with unilateral anastomosis. The PR decreased with increasing patient age (mean [±SD], 35 ± 3.6 years) but was still 70.6% (12/17) in patients aged 40–45 years.

Conclusion(s): Our findings suggest that laparoscopic tubal anastomosis is a highly successful procedure. This less invasive approach could be considered the procedure of choice in patients who desire reversal of tubal sterilization.     

An unusual complication of tubal anastomosis

OBJECTIVE: To report an unusual complication associated with the use of a long-term intrafallopian stent during microsurgical tubal anastomosis. DESIGN: Case report. SETTING: Tertiary academic center. PATIENT(S): A 36-year-old woman in whom an intrafallopian stent used during a sterilization reversal procedure could not be transcervically retrieved in the office. INTERVENTION(S): Hysteroscopic evaluation for removal of intrafallopian stent, followed by operative laparoscopy for postoperative abdominal pain. MAIN OUTCOME MEASURE(S): Patient symptoms, potential for morbidity, and review of the literature. RESULT(S): Hysteroscopic view of the uterine cavity failed to identify the intrafallopian stent. Laporoscopic evaluation of postoperative abdominal pain revealed significant formation of pelvic and abdominal adhesions. The 2-0 nylon suture used as an intrafallopian stent was seen sitting freely on top of the liver serosa. Adhesiolysis and successful retrieval of the stent resolved the patient's symptoms. CONCLUSION(S): To our knowledge, this is the first report describing complete dislodgment and cephalad migration of an intrafallopian stent. Patient morbidity and health care costs may increase when long-term stents are used for sterilization reversal.     

A report on 387 cases of microsurgical tubal reversals

Objective: To survey what factors influence the pregnancy outcome in an effort to improve the pregnancy rate (PR) after microsurgical reversal of tubal sterilization.Design: Retrospective clinical study.Patient(s): Three hundred eighty-seven patients who had microsurgical tubal reversal between March 1982 and January 1994.Intervention(s): Postoperative pregnancy outcomes were determined by telephone, letters, and direct interviews.Result(s): Pregnancy outcomes were identified in 94.1% of the total patients. The overall PR was 91.6%, of which 3.9% spontaneously aborted and 1.7% were ectopic. The probability that pregnancy occurred within the first 12 months was 0.80. The median interval from tubal reversal to pregnancy was 5.34 months. The pregnancy success rate after reversal of Falope ring sterilization was statistically significantly higher than in the other groups. Patients with reversed tubal length ≥7 cm had a statistically significantly higher PR than those with <7 cm.Conclusion(s): The overall probability of pregnancy was 0.89. The tubal length reconstructed after tubal reversal and the type of sterilization performed previously were the important factors affecting the PR.     

Laparoscopic tubal anastomosis.

OBJECTIVES: To evaluate the pregnancy outcome after laparoscopic tubal anastomosis. METHODS: From December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients' age varied from 28 to 37 years. RESULTS: Laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was possible in all but two patients. The operation time ranged from 95 to 155 min and all patients were discharged in the following morning after surgery. After 3 months, tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. The average time from tubal reversal and pregnancy was 6 months. CONCLUSIONS: In selected cases, laparoscopic tubal reversal can be offered to patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.     

Microsurgical reversal of tubal sterilization: a report on 1,118 cases

Objective: To review and evaluate a series of patients who underwent microsurgical anastomosis of previously sterilized fallopian tubes.Design: Retrospective clinical study.Setting: Tertiary care academic center.Patient(s): In the 134–month span from January 1980 to February 1991, 1,118 women were evaluated for microsurgical reversal of previous tubal sterilization.Main Outcome Measure(s): Clinical characteristics of patients, pregnancy rates (PRs), and factors influencing the outcome.Result(s): Of 1,118 patients, 633 (56.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. Nine hundred twenty-two (82.5%) patients were followed up for > 5 years. The overall PR after microsurgical tubal anastomosis was 54.8% (505 of 922) with a delivery rate of 72.5% (366 of 505), and the estimated anatomical success rate was 88.2% (814 of 922). There was no statistically significant difference in the PR or in the interval from tubal reversal to conception among the different operative procedure groups. In addition, no statistically significant difference in the PR was observed regardless of the postoperative tubal length. However, the interval from operation to pregnancy decreased significantly as the postoperative tubal length increased. The pregnant patients (n = 505) were younger and had a longer postoperative tube than the nonpregnant patients (n = 417); these differences were statistically significant.Conclusion(s): The pregnancy rate after microsurgical reversal of tubal sterilization was not significantly correlated with the method and duration of sterilization, the operative procedure, or the postoperative tubal length.     

开腹与腹腔镜下输卵管吻合术回顾性队列研究及术后妊娠影响因素分析#br#

【Abstract】?Objective?To evaluate the safety and effectiveness of laparotomic and laparoscopic tubal anastomosis, and evaluate the influencing factors of pregnancy rate. Methods?The clinical data of 356 ligation patients who underwent tubal anastomosis in the First Affiliated Hospital of Zhengzhou University from March 2012 to October 2017 were analyzed retrospectively, including 85 cases of laparotomy and 271 cases of laparoscopy. The differences of perioperative status and postoperative pregnancy rate between the two groups were analyzed, and the independent influencing factors of postoperative pregnancy rate were analyzed. Results?①There was no significant difference in operation time, postoperative fever and exhaust time between the two groups (P>0.05), but laparoscopic bleeding was less[(18.1±12.1) ml, (33.4±22.1) ml], and the pain score was lower[(3.6±0.9), (4.5±0.9) score], duration of hospital stay was shorter[(5.9±0.6) d, (7.1±0.7) d](P<0.05). 2 cases of laparotomic group had abdominal wall incision infection, cases of laparoscopic group all healed well. The cost of laparotomic group was lower than that in laparoscopic group[(9 524±881), (12 903±1 162) yuan](P<0.05).② There was no significant difference in the patency rate of intraoperative anastomosis, residual tube length and ectopic pregnancy rate between the two groups (P>0.05). The uterine pregnancy rate two years after anastomosis was higher in laparoscopic group (76.4%) than in laparotomic group(61.2%)(P<0.05). The postoperative gestation time of the laparoscopic group was (7.6±4.9) months, and the postoperative gestation time of the open group was (8.3±5.3) months, with no statistically significant difference(P>0.05).③ Anastomotic procedure (OR=1.847, 95%CI: 1.028~3.320, P=0.040), age (OR=3.673, 95%CI: 1.690~7.984, P=0.001), multiple pelvic operation history (OR=3.092, 95%CI: 1.650~5.796, P=0.000), and length of residual tube (OR=4.716, 95%CI: 2.552~8.714, P=0.000) were independent factors influencing intrauterine pregnancy rate after anastomosis. There was no significant correlation between body mass index (BMI), length of ligation, method of ligation and site of ligation and pregnancy rate. Conclusion?Compared with open surgery, laparoscopic tubal anastomosis is a better treatment option for patients with tubal ligation. Anastomosis mode, age, history of multiple pelvic surgeries and length of remaining fallopian tubes were the influencing factors of pregnancy rate after anastomosis.     

First and subsequent pregnancies after tubal microsurgery: evaluation of the fertility index

Objective: To determine the number of children born after a tubal microsurgical operation and to evaluate the fertility index, a long-term measure of reproductive potential.

Design: A case series involving a follow-up questionnaire.

Setting: A tertiary care university hospital.

Patient(s): Three hundred twelve women undergoing microsurgery for tubal disease.

Interventions: A range of open microsurgical procedures including reversal of sterilizations.

Main Outcome Measure(s): Cumulative pregnancy rates to the first and second normal pregnancies and calculation of the fertility index.

Result(s): The 2-year cumulative pregnancy rates (probability ± SE) for a first normal pregnancy for proximal disease, distal disease, tubal reanastomoses, and tubal adhesions were 0.51 ± 0.05, 0.29 ± 0.06, 0.47 ± 0.06, and 0.30 ± 0.07, respectively. Of the 288 (92%) women responding to the questionnaire, 142 women had at least one child. Of the 100 women who wanted a second child, 68 succeeded, the proportions being similar in each surgery category. The fertility index described restoration of normal fertility in 30%, 12%, 34%, and 23% for women with proximal disease, distal disease, anastomotic procedures, and adhesion disease, respectively.

Conclusion(s): The fertility index is a useful measure of long-term reproductive potential. The high recurrent pregnancy rate emphasizes the value of microsurgery in restoring normal fertility to some women.