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。     

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.     

三种输卵管疏通术治疗后发生输卵管妊娠的临床分析

目的 :了解输卵管疏通术后发生输卵管妊娠的危险因素及其相应对策。方法 :回顾性分析 6 9例输卵管性不孕者分别经三种输卵管疏通术后发生输卵管妊娠 (TP)的患者 ,分成 3组 ,比较 3组疏通术前子宫输卵管碘油造影(HSG)结果和疏通术后通畅与非通畅输卵管的TP发生率。结果 :疏通术前 ,示输卵管柔软 5 7条 (34例 ) ,发生TP 2 1例(6 1.8% ) ,而欠柔软 /僵硬 79条 (5 6例 ) ,发生TP 4 8例 (85 7% ) ,两者差异有显著意义 (P <0 0 5 ) ;输卵管周围有无粘连者TP发生率差异也存在显著意义 (P <0 0 5 )。无论畅与不畅 ,3组术后TP发生率间差异无显著意义 (P >0 0 5 )。结论 :疏通术前HSG提示输卵管欠柔软、僵硬以及存在周围粘连者可能是疏通治疗后输卵管妊娠发生的危险因素。对于此类病变严重的输卵管不宜选择疏通术治疗。     

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.     

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。     

绝育术后显微技术复通输卵管效果研究

目的:探讨显微技巧的改进、结扎方式、吻合部位、输卵管自身的病理-生理状态、术后管理等对显微输卵管复通术后效果的影响.方法:回顾性分析我院1991年5月至2006年5月15年间随访到的900例受术者,术中采用显微镜或眼镜式显微放大镜进行输卵管吻合,一般放大3～4倍,肌层缝合3～6针,浆膜层数针.若两断端口径不一致时,设法将宽大端管腔"部分封闭",使其与另一端对合整齐.术中不放临时支架.输卵管的病理状态应做相应处理.术后输卵管平均长度9.94 cm,随访时间2～5年.结果:受术者平均年龄35.02岁,绝育术距复通术平均间隔时间7.66年.宫内妊娠率91.67%,其中足月分娩95.64%,首次自然流产1.82%,正在妊娠中2.55%,输卵管妊娠0.56%;结扎方法、结扎部位和复通术时年龄大小与术后妊娠率之间差异无统计学意义(P>0.05);术后输卵管长度≤4 cm者效果极差.结论:娴熟掌握显微技巧实施输卵管复通术后有较高的宫内妊娠率.不同部位复通术后妊娠率无明显差异,但以峡部中段施术容易操作.显微技巧和输卵管的病理一生理状态是影响效果的重要因素.     

腹腔镜下治疗休克型输卵管妊娠的临床观察

目的　探讨腹腔镜手术治疗休克型异位妊娠的可行性与安全性。方法　回顾性分析我院 1996年 1月至 2 0 0 1年 1月 5年间收治的经腹腔镜手术治疗的输卵管妊娠病例 2 15例的临床资料。其中有休克症状及腹腔内出血量超过 10 0 0ml的 2 1例为研究组 ,其余 194例为对照组 ,分析两组患者围手术期情况。结果　研究组与对照组的一般情况无明显差异 ;输卵管破裂的发生率分别为 81%(17/2 1)、16% (3 1/194) ,两组比较 ,差异有极显著性 (P <0 0 1) ;腹腔内出血量分别为 (1775± 5 3 1)与(13 3± 176)ml (P <0 0 1) ,自体输血量分别为 (1141± 13 2 7)与 (2 5± 83 )ml (P <0 0 1) ,自体输血率分别为 95 %与 9% ,两组比较 ,差异均有极显著性 (P <0 0 1) ;术中出血量分别为 (40± 2 2 )与 (5 6±5 8)ml,两组比较 ,差异无显著性 (P >0 0 5 )。研究组与对照组输卵管切除术的比例分别为 86%与5 1% ,两组比较 ,差异有极显著性 (P <0 0 1) ;手术时间分别为 (5 0± 2 4)与 (43± 2 4)min ,两组比较 ,差异无显著性 (P >0 0 5 ) ;术后住院时间分别为 (3 0± 0 8)与 (2 3± 0 8)d ,两组比较 ,差异无显著性 (P>0 0 5 )。两组均无腹腔镜操作引起的围手术期并发症。结论　具备熟练的腹腔镜操作技术对休克型输卵管妊娠     

输卵管栓塞术在体外受精-胚胎移植前处理输卵管积水中的应用

目的 探讨输卵管栓塞术在体外受精-胚胎移植(ⅣF-ET)前处理输卵管积水中的应用.方法 选择因输卵管积水行输卵管栓塞术的不孕症患者46例(栓塞组)和同期双侧输卵管阻塞的不孕症患者91例(对照组),栓塞组行输卵管栓塞术,将微弹簧圈通过微导管送入输卵管间质部和峡部,1个月后行子宫输卵管造影术检查栓塞效果.栓塞术后3个月,两组患者行IVF-ET治疗,观察并比较每个周期内的平均获卵数、受精率、临床妊娠率、异位妊娠率、流产率等各项指标.结果 栓塞组共栓塞82条输卵管,插管均1次成功.栓塞效果显著的输卵管有72条,占88%;有效10条,占12%;无效为0.栓塞组患者的平均获卵数(18.9个)、受精率(69%)、临床妊娠率(41%)均高于对照组(分别为17.6个、63%、39%),但差异无统计学意义(P>0.05);输卵管妊娠率(0)、流产率(8%)均低于对照组(分别为8%、16%),差异有统计学意义(P<0.05).结论 输卵管栓塞术应用于IVF-ET前对输卵管积水进行处理,是一种简便、安全、经济的方法,有增加临床妊娠率的趋势,并且能杜绝输卵管妊娠的发生,是一种可行且有效的方法.     

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

目的探讨开腹与腹腔镜下输卵管吻合术的安全性和有效性及影响吻合术后妊娠率的因素。方法回顾性分析2010年3月至2017年10月于郑州大学第一附属医院行输卵管吻合术的356例患者的临床资料,其中开腹组85例,腹腔镜组271例,分析两组围手术期情况、术后妊娠率的差异,并分析术后妊娠率的独立影响因素。结果 (1)两组手术时间、术后发热及术后排气时间比较,差异无统计学意义(P0.05),但腹腔镜组出血更少[(18.1±12.1) ml,(33.4±22.1) ml]、疼痛评分更低[(3.6±0.9)分,(4.5±0.9)分]、住院时间更短[(5.9±0.6) d,(7.1±0.7) d],差异均有统计学意义(P 0.05)。开腹组发生2例腹壁切口感染,腹腔镜组切口均愈合良好。开腹组花费低于腹腔镜组[(9 524±881)元,(12 903±1 162)元],差异有统计学意义(P 0.05)。(2)两组术中吻合成功率、剩余输卵管长度及异位妊娠发生率比较,差异无统计学意义(P0.05),术后2年内腹腔镜组宫内妊娠率(76.4%)高于开腹组(61.2%),差异有统计学意义(P 0.05)。腹腔镜组术后妊娠时间(7.6±4.9)个月,开腹组术后妊娠时间(8.3±5.3)个月,差异无统计学意义(P 0.05)。(3)吻合手术方式(OR=1.847, 95%CI:1.028～3.320, P=0.040)、年龄(OR=3.673, 95%CI:1.690～7.984, P=0.001)、有无多次盆腔手术史(OR=3.092, 95%CI:1.650～5.796, P=0.000)、剩余输卵管长度(OR=4.716, 95%CI:2.552～8.714, P=0.000),是输卵管结扎患者吻合术后妊娠率的独立影响因素(P 0.05),而体质指数、结扎年限、结扎方式、结扎部位与妊娠率无显著相关性(P 0.05)。结论相比于开腹手术,腹腔镜下输卵管吻合术是输卵管结扎患者一个较好的治疗选择。吻合手术方式、年龄、多次盆腔手术史、剩余输卵管长度是吻合术后妊娠率的影响因素。     

选择性输卵管造影术的诊断及治疗意义

目的　探讨选择性输卵管造影术 (SSG)的诊断及治疗效果。方法　 1996年 6月至 2 0 0 2年 10月对 74例经子宫输卵管造影术 (HSG)诊断的输卵管阻塞患者行SSG诊治。结果　经过SSG后希望妊娠且随访 1年以上者 6 4例中妊娠 2 4例 ,妊娠率 37 5 %。其中自然妊娠 18例 ,人工授精 (AIH) 5例 ,配子输卵管内移植 (GIFT) 1例。双侧阻塞组 2 0例中有 3例妊娠占 15 0 % ;单侧阻塞组 4 4例中有 2 1例妊娠占 4 7 7%。即单侧阻塞组妊娠率高 ,与双侧阻塞组比较差异有显著性意义 (P <0 0 1)。结论　SSG因操作简便 ,疗效确实 ,适于临床应用     

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.     

孕早期血清PAPP-A水平与妊娠和围产结局的关系

目的:探讨孕早期血清妊娠相关蛋白-A(pregnancy associatied plasma protein A,PAPP-A)水平对妊娠和围产结局的预测价值。方法:对664例孕4~14周初产妇采用酶联免疫法检测血清PAPP-A水平,并随访该人群至妊娠终止或分娩,分析孕早期血清PAPP-A水平与妊娠和围产结局的关系。结果:①664例初产妇女中,随访到妊娠结局的420例,其中异常妊娠(自然流产、胚胎停止发育)35例(8.33%),建立苏州市围产保健册并成功分娩的385例(91.67%)。②早孕妇女血清PAPP-A水平随孕周的增加而升高。③妊娠结局为异常妊娠的妇女其孕早期血清PAPP-A的中位数倍数值(multiples of the respective normal median,MOM值)水平低于成功分娩者(P<0.05)。④成功分娩孕妇的孕早期血清PAPP-A的MOM值与其早孕期体质量、体质量指数(body mass index,BMI)呈负相关(分别为-0.156,-0.159),与年龄、身高无相关性(P>0.05)。⑤孕早期血清PAPP-A的MOM值与其胎儿性别、出生体质量和分娩方式等无相关性(P>0.05)。结论:孕早期血清PAPP-A水平低常预示早期不良妊娠结局;成功分娩妇女早孕血清PAPP-A水平与其早孕期体质量、BMI呈负相关,但不能预测围产结局。     

Tubal anastomosis for reversal of sterilization with microsurgical technic in 246 women

Tubal anastomosis for reversal of sterilization was performed with microsurgical technique in 246 women, from January 1985 to June 1987. The operation time after tubal sterilization averaged 43.5 months. The patients (99.6%) were followed-up for 3-33 months. Intrauterine pregnancies occurred in 178 cases, the rate being 72.4%. The factors which influence success rate are the tubal length after anastomosis and the mode of original tubal ligation. Postoperative instillation of fluids into fallopian tubes should be performed early to prevent adhesions and early intercourse should also be encouraged.     

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.     

A clinical analysis of 317 cases of salpingo-anastomoses

Influences of various factors on status pregnancy in 317 women having had salpingo-anastomoses were analyzed. All these cases, aged 21 to 45, had end to end operation under direct observation. Through 1-5 years' follow up, two of the 317 women were found to be restricted, 295 were pregnant or already delivered. The re-potent rate was 99.3%, while the re-pregnant rate 93.1%. No statistically obvious disparity in pregnancy rate was found as regard to age, tubal ligation technique site of anastomosis. However, there was influence over the pregnancy rate by the length of the remaining tube and oviduct inflammation. This paper also discussed on the anastomosis method, length of contraception period, observation period and the choice of stents.     

X线下模拟逆行经阴道输卵管插管过程对TV-GIFT插管可靠性的评估

目的 :对在X线下模拟逆行经阴道输卵管插管过程对TV -GIFT插管的可靠性进行评估。方法 :采用KJITS - 50 0 0导管对不孕症 2 1例 (模拟组 ) ,在X线透视下模拟TV -GIFT输卵管插管过程 ,根据荧屏显示金属导丝及注入造影剂判断插管是否成功 ,并与 30例TV -GIFT(TV -GIFT组 )中的判断指标及插管成功率进行比较。结果 :X线下证实经阴道输卵管插管成功率为 4 2 .86% ( 19/ 2 1) ,与采用同类导管行TV -GIFT的插管成功率 ( 70 % ,2 1/ 30 )相比差异无显著性 (P >0 .0 5) ;TV -GIFT过程中置植入管有无阻力 ,导管标记位置是否正确 ,患者感觉及植入管有无扭曲 4项指标与X线下的结果显著相关 ,其中置植入管有无阻力与X线下结果的符合率最高。结论 :TV -GIFT过程中经阴道输卵管插管切实可行 ,但插管成功率有待提高 ;判断插管成功与否的几项指标基本可靠。     

Pregnancy following tubocornual anastomosis

We have reviewed the pregnancy rate and outcome of 25 patients who underwent tubocornual anastomosis for correction of proximal tubal occlusion at Yale-New Haven Hospital between 1977 and 1981. Tubal occlusion was the result of previous tubal sterilization in 17 patients (11 laparoscopic electrocautery and 6 tubal ligation) and previous tubal infection in 8. Fourteen of the patients conceived (56%). Viable pregnancy was achieved in nine patients (36%) and tubal pregnancy in three (12%). No significant difference in pregnancy rates was found between patients with diseased cornua and those previously sterilized by either electrocautery or tubal ligation. Tubal length of greater than or equal to 4 cm following corrective surgery as compared with less than or equal to 4 cm did not influence pregnancy rates. The patients with the shorter oviducts had a higher rate of early pregnancy wastage. All three tubal pregnancies occurred in patients with reoccluded fallopian tubes as demonstrated by a hysterosalpingogram. We conclude that tubocornual anastomosis still remains the treatment of choice for patients with proximal tubal obstruction.     

CC/hMG/IUI、hMG/IUI与IVF-ET治疗多囊卵巢综合征的分析

目的 :探讨利用宫腔内人工受精和体外受精 胚胎移植治疗多囊卵巢综合征的临床效果。方法 :多囊卵巢综合征 5 6例 ,其中CC/hMG/IUI治疗组 2 8例 ,hMG/IUI治疗组 14例 ,IVF ET治疗组 14例。比较 3组患者的年龄、不孕年限、E2 水平、卵泡数及妊娠率。结果 :CC/hMG/IUI、hMG/IUI和IVF ET 3组的年龄及不孕年限无差异 (P >0 .0 5 )。CC/hMG/IUI组与hMG/IUI组的卵泡数无差异 (P >0 .0 5 ) ,两组的E2 水平与妊娠率也无差异 (P >0 .0 5 )。CC/hMG/IUI组的卵泡数明显少于IVF ET组 (P <0 .0 0 1) ,E2 水平也显著低于IVF ET组 (P <0 .0 0 1) ,CC/hMG/IUI组的妊娠率与IVF ET组无差异 (P >0 .0 5 )。hMG/IUI组的卵泡数显著低于IVF ET组 (P <0 .0 1) ,E2 水平也显著低于IVF ET组 (P <0 .0 0 1) ,hMG/IUI组与IVF ET组的妊娠率无差异 (P >0 .0 5 )。结论 :CC/hMG/IUI组与hMG/IUI方案在降低卵巢过激危险和治疗费用的同时可获得较高的妊娠率 ,有可能成为治疗多囊卵巢综合征较理想的治疗方案。     

The changes in ovarian hormone levels and ovarian artery blood flow rate after laparoscopic tubal sterilization.

OBJECTIVE: To investigate the changes in serum ovarian hormone levels and ovarian artery blood flow rate by Doppler ultrasonography following laparoscopic tubal sterilization. METHODS: Laparoscopic tubal sterilization have been performed on 13 voluntary subjects between the sixth and eighth days of the menstrual cycle. Serum ovarian hormone levels and ovarian artery blood flow rate, by Doppler ultrasonography, were determined 3 days before the operation, on the post-operative third day and on the post-operative third month. The results of 10 participants who finished the follow-up period were analyzed. RESULTS: There were no statistically significant changes in serum levels of ovarian hormones after laparoscopic tubal ligation. The end-diastolic blood flow in ovarian artery was found to be decreased following tubal sterilization (8.7+/-2.8 and 7.4+/-1.8m/sec, respectively, P>0.05), while resistivity index (RI) increased after the operation (0.7+/-0.1 and 0.8+/-0.03, respectively, P>0.05). CONCLUSION: There was no change in ovarian hormone levels after laparoscopic tubal sterilization. There is slight but statistically non-significant decrease in ovarian artery blood flow rate following tubal sterilization, signifying a local increase in vascular resistance.