腹腔镜下环形缝扎切开取胚法治疗输卵管间质部妊娠

目的 探讨腹腔镜下环形缝扎切开取胚法治疗输卵管间质部妊娠的手术方法及效果.方法 选择腹腔镜下确诊包块型未破裂的输卵管间质部妊娠要求保留生育功能患者共112例,按手术时间及手术方法分为研究组65例、对照组47例.研究组行腹腔镜下输卵管间质部妊娠环形缝扎切开取胚术,对照组行腹腔镜下垂体后叶素注射后行输卵管间质部妊娠切开取胚术.比较两种手术成功率、手术时间、术中出血量、术后持续性异位妊娠发生率、术后输卵管通畅率及术后妊娠情况.结果 研究组在手术成功率、术后输卵管通畅率均高于对照组;研究组手术时间、术中出血量均短于对照组.研究组无持续性异位妊娠发生,对照组有4例持续性异位妊娠.结论 腹腔镜下环形缝扎切开取胚法治疗输卵管间质部妊娠是安全、有效的治疗方法.     

不同治疗方式在输卵管妊娠中的应用

目的探讨腹腔镜输卵管开窗取胚术加局部甲氨蝶呤（MTX）注射在输卵管妊娠治疗中的价值。方法选取149例输卵管妊娠病例,分为3组,A组和B组有生育要求,A组43例行腹腔镜输卵管开窗取胚术加局部MTX注射,B组39例行输卵管开窗取胚术,C组67例无生育要求行腹腔镜输卵管切除术,比较3组术后血pHCG下降情况。结果A组血β-HCG转阴时间与C组血β—HCG转阴时间相近,且均较B组时间明显缩短,无持续性异位妊娠发生。结论腹腔镜下输卵管开窗取胚术加局部MTX注射,术后血β-HCG转阴快,减少了持续性异位妊娠发生,增加了患者的生育机会。     

腹腔镜输卵管切开取胚术后输卵管通畅率及其影响因素分析

目的：探讨腹腔镜输卵管切开取胚术后输卵管畅通率及其影响因素。方法选取2014年9月—2015年9月在我院妇科采取腹腔镜输卵管切开取胚术治疗的60例输卵管异位妊娠患者,术后第6个月对其进行X线子宫输卵管碘油造影检查,观察输卵管通畅情况。结果输卵管通畅率受输卵管异位妊娠部位、术中出血量及盆腔粘连程度等因素影响。输卵管峡部异位妊娠患者的输卵管通畅率明显低于壶腹部异位妊娠患者（P<0.05）,术中出血量大（出血量>49 mL）的患者其通畅率低于术中出血量小（出血量<49 mL）的患者（P<0.05）,盆腔无粘连或轻度粘连的患者其通畅率明显高于盆腔中度或者重度粘连的患者（P<0.05）。结论腹腔镜下输卵管切开取胚术是一种有效、安全的保留输卵管手术,有利于患者的再生育。     

腹腔镜下水压分离治疗输卵管妊娠保留生育功能疗效观察

目的探讨腹腔镜下输卵管妊娠水压分离加间断缝合法在输卵管妊娠切开取胚术中的应用,是否增加术后宫内妊娠率。方法选择符合纳入标准的输卵管妊娠患者90例,随机分成治疗组和对照组各45例。治疗组患者行输卵管保守术中使用水压分离法清除胚胎组织,间断缝合浆膜止血;对照组患者行常规保守手术,即使用吸管吸引或钳夹法清除胚胎组织,电凝止血,不缝合。两组患者均于术后第1次月经干净后3～7d行子宫输卵管造影术观察两组患者的输卵管通畅率,并随访两组患者的宫内妊娠率及继发性不孕、再次异位妊娠的发生率。结果本组90例腹腔镜输卵管切开取胚术,45例采用水压分离法,子宫输卵管造影输卵管通畅率高,宫内妊娠率高,而再次异位妊娠率低。结论腹腔镜下输卵管水压分离切开取胚术安全、有效、损伤小、出血少,宫内妊娠率高,再次异位妊娠的发生率低,值得临床推广应用。     

腹腔镜下取胚术治疗输卵管妊娠62例

目的观察腹腔镜下切开取胚术治疗输卵管妊娠的疗效。方法将本院125例输卵管妊娠患者分别行腹腔镜手术62例（腹腔镜组）,开腹手术63例（开腹组）,比较两组手术时间、术中出血量、术后排气时间、术后发热率、住院天数、术后持续性宫外孕发生率、输卵管通畅率及再次宫外孕发生率。结果两组手术时间、腹腔出血量、术后持续性宫外孕发生率及再次宫外孕发生率比较差异无显著性（P〉0.05）;术后排气时间、发热比率及住院天数,腹腔镜组明显低于开腹组（P〈0.05）。术后输卵管通畅率腹腔镜组高于开腹组（P〈0.05）。结论输卵管妊娠腹腔镜下切开取胚术具有创伤小、疼痛轻和恢复快、住院时间短、切口美观,术后输卵管通畅率高等优点,更适合于有生育要求的输卵管妊娠患者。     

小剂量垂体后叶素在腹腔镜下输卵管妊娠保守性手术中的应用价值

目的：探讨小剂量垂体后叶素在腹腔镜下输卵管妊娠保守手术中的应用价值。方法：回顾性分析在金华市妇幼保健院确诊为输卵管妊娠并行腹腔镜下切开取胚术的124例患者,根据手术方法的不同分为2组：研究组63例,术中行输卵管切开前于着床部位输卵管系膜处注射垂体后叶素2 U;对照组61例,术中行常规腹腔镜下输卵管切开取胚术。观察2组手术时间、术中出血量、术后持续性异位妊娠发生率、术后患侧输卵管通畅率、术后妊娠率及术后异位妊娠率。结果：研究组手术时间为（47.0±7.5）min,短于对照组的（58.7±7.9）min（P＜0.01）;术中出血量为（17.3±7.3）mL,少于对照组的（41.0±9.1）mL（P＜0.01）;持续性异位妊娠发生率为1.5%,低于对照组的3.3%（P＜0.05）;术后输卵管通畅率为55.6%,高于对照组的34.4%（P＜0.05）;术后不避孕1年内的妊娠率为46.6%,高于对照组的31.6%（P＜0.01）;异位妊娠率为1.7%,低于对照组的7.0%（P＜0.05）。结论：输卵管妊娠着床部位输卵管系膜处小剂量垂体后叶素注射后行腹腔镜下输卵管切开取胚术能显著减少术中出血,降低持续性异位妊娠的发生,保护术后患侧输卵管功能,提高术后妊娠率。     

腹腔镜下经腹壁小切口输卵管切开缝合术治疗输卵管妊娠对输卵管通畅度的影响

目的比较腹腔镜辅助下经腹壁小切口输卵管切开缝合术和腹腔镜下输卵管切开内凝术治疗输卵管妊娠对术后输卵管通畅度的影响。方法回顾性地分析了我院2006年01月～2009年12月98例有生育要求的腹腔镜下输卵管妊娠保守性手术患者的临床资料和随访结果,其中研究组患者53例,行腹腔镜辅助下经腹壁小切口输卵管切开缝合术,对照组患者45例,行腹腔镜下输卵管内凝缝合术。比较二组患者术后子宫输卵管碘油造影（HSG）结果的差异。结果术后6个月未妊娠者,研究组中有38例行HSG检查,31例患侧输卵管通畅,对照组中有36例行HSG检查,19例通畅（P〈0.05）。结论腹腔镜辅助下经腹壁小切口输卵管切开缝合术治疗输卵管妊娠有利于输卵管通畅度的恢复。     

腹腔镜输卵管妊娠60例保守手术两种止血方式对输卵管功能的影响

目的 探讨腹腔镜输卵管妊娠保守手术不同止血方式对输卵管功能的影响.方法 将输卵管妊娠且要求保留输卵管患者60例,随机分为两组:垂体后叶素止血组(A组,n=32)在术中于患侧输卵管系膜内两点注射垂体后叶素进行预处理后再行输卵管切开取胚术;电凝止血组(B组,n=28)直接电凝止血.比较两组手术时间、术中出血量、血压变化、持续性异位妊娠率和输卵管通畅率等的差异.结果 A组手术时间长于B组、出血量明显少于B组、输卵管通畅率明显高于B组,两组比较差异有统计学意义(P＜0.05);两组持续性异位妊娠率差异无统计学意义(P>0.05).结论 在腹腔镜输卵管切开取胚术中预先应用垂体后叶素止血效果显著,减少术中出血量及避免电凝对输卵管的进一步损伤,有利于保护患者的生育功能,值得推广.     

腹腔镜下输卵管开窗取胚和输卵管切除术对血hCG影响分析

目的:探讨腹腔镜下输卵管开窗取胚和输卵管切除术对血β-hCG的影响。方法:选取120例输卵管妊娠病例,分为两组,甲组87例(有生育要求)行腹腔镜输卵管开窗取胚术,乙组33例行腹腔镜下输卵管切除术,比较两组术后血β-hCG下降情况。结果:甲组血β-hCG转阴时间与乙组血β-hCG转阴时间相近,差异无统计学意义(P0.05),无持续性异位妊娠发生。结论:腹腔镜下输卵管开窗取胚术,术后血β-hCG转阴稍快,不增加持续性异位妊娠发生,保留了患者的生育能力,对于有生育要求的患者具有临床推广价值。     

腹腔镜输卵管切开取胚术对输卵管异位妊娠的疗效分析

目的 探讨腹腔镜输卵管切开取胚术对输卵管异位妊娠患者的疗效.方法 选择2017-02/2019-10月作者医院收治的82例输卵管异位妊娠患者,以随机数字表法均分为两组.A组行腹腔镜下输卵管切开取胚术(n=41),B组行腹腔镜下输卵管切除术(n=41).比较两组患者手术一般情况、卵巢功能指标、应激指标、炎症因子、术后妊娠...     

Ruptured tubal pregnancy following tubal sterilization

Prior tubal sterilization should be regarded as a possible etiologic factor in the pathogenesis of ectopic pregnancy. The authors present the case of a 32-year-old woman, para 4, who presented to Kenyatta National Hospital in October 1985 with complaints of lower abdominal pain and vomiting. She had undergone tubal ligation in February 1985. Examination revealed a ruptured ectopic pregnancy in the lateral part of the left tube. There was active bleeding from the rupture. The right distal stump was intact, and the right proximal stump had no obvious defect. There was a corpus luteum in the left ovary. Ectopic gestation after tubal sterilization apparently occurs when there is recanalization and formation of a proximal tuboperitoneal fistula, allowing sperm passage and fertilization of the ovum in the peritoneal cavity, on the ovarian surface or within the ductal tubal lumen. Although the technical details of this patient's sterilization were not available, laparotomy indicated that a modified Pomeroy procedure using absorbable sutures had been performed. The failure rate for the Pomeroy procedure is estimated at 0.25-2%. Since the incidence of ectopic pregnancy following tubal sterilization is about 1 in 13 in some parts of the world, potential sterilization acceptors should be counseled about this complication and a diagnosis of ectopic gestation should be considered whenever a patient with a previous history of tubal ligation presents with signs or symptoms of pregnancy.     

未破裂输卵管妊娠的非血管介入治疗

目的探讨经输卵管途径治疗输卵管妊娠的可行性及临床疗效。方法采用介入输卵管插管方法,插管成功后注入甲氨喋呤60mg治疗16例输卵管妊娠。结果14例获得成功,2例中转手术,未出现严重并发症。结论经输卵管插管治疗输卵管妊娠是简单、安全、迅速有效的方法。     

腹腔镜下输卵管逆行插管治疗输卵管性不孕

目的 研究腹腔镜下输卵管逆行插管治疗输卵管性不孕的效果.方法 选择我院92例疑似输卵管性不孕患者,采用腹腔镜下输卵管逆行插管治疗,同时选择常规治疗的62例患者作为对照组,随访6-30个月,观察输卵管阻塞率及宫内妊娠率.结果 观察组与对照组疏通率分别为90.18％、91.78％;差异无显著性（P＞0.05）.随访6～30个月,观察组12个月、30个月妊娠率明显高于对照组,再阻塞率明显低于对照组（P＜0.05）.结论 输卵管逆行插管有利于患者壶腹部、输卵管伞端梗阻的疏通,提高宫内妊娠率.     

B超监导下宫腔镜输卵管插管治疗输卵管性不孕症的临床分析

目的：探讨在B超监导、宫腔镜下行输卵管加压疏通术的效果。方法：2007年3月～2009年9月100例患者共185条输卵管,均经子宫输卵管碘油造影（HSG）证实单侧或双侧输卵管梗阻,100例患者均行宫腔镜直视下输卵管插管加压注药术,并采用腹部B超监导评定治疗效果。结果：经1次注药后,有132条输卵管完全通畅,占71.35%。经1次注药通畅38条输卵管,有11例妊娠;经2次注药通畅94条,有51例受孕。结论：B超监导下行宫腔镜输卵管注药术准确性高,具有安全、简便、创伤小、可反复操作等优点.,术后近期疗效较好,且受孕率随注药次数的增加而有所提高。     

宫腔镜注入氨甲喋呤治疗早期输卵管妊娠疗效分析

目的探讨宫腔镜下输卵管插管注入氨甲喋呤辅以口服米非司酮治疗早期输卵管妊娠的临床效果。方法选择110例早期输卵管妊娠患者作为研究对象,按入院先后随机分为观察组及对照组,每组55例,观察组在宫腔镜引导下行输卵管插管注入氨甲喋呤,同时辅以口服米非司酮治疗;对照组肌注氨甲喋呤,同时辅以口服米非司酮。比较两组的临床治疗指标。结果观察组的成功率明显高于对照组,而血β-hCG恢复至正常的时间、附件包块消失时间短于对照组,不良反应发生率少于对照组,差异有统计学意义(P0.05)。结论输卵管注入氨甲喋呤辅以口服米非司酮治疗早期输卵管妊娠疗效显著,优于肌肉注入氨甲喋呤辅以口服米非司酮,值得临床推广应用。     

Regrets after tubal sterilization

The tendency to categorize tubal sterilization as an almost trivial procedure may contribute, at least in part, to the fact that a significant minority of women undergo an elective surgical intervention that subsequently they come to regret. These cases may represent a small percentage of the many sterilization operations that are performed each year, yet the fact that tubal sterilization is performed primarily on fit young women for "nonmedical" reasons makes it all the more important that women who will come to regret the procedure are identified and advised against it. It is equally important to remember that such regret after a tubal sterilization will lead increasingly to requests for reversal operations. Sometimes the bases for subsequent regret are almost impossible to predict. It is unrealistic in the extreme to attempt to screen potential candidates for tubal sterilization by asking, "Would you regret this operation if your husband and 3 children were killed in a car crash next month?" Yet, it is possible to anticipate some situations in which subsequent regret may be strong enough to drive a woman to seek sterilization reversal. Abraham et al. have sought differences between 2 groups of women who had either requested a tubal sterilization reversal or else had apparently been satisfied with the procedure. They correctly point out the inherent dangers of interpreting "retrospective data" in 2 basically self-selected groups. Yet, the apparent absence of any longterm followup study of women who have undergone tubal sterilization means that such data provide a valid starting point for debate. Of particular interest is the finding by Abraham et al. that even in their control group 24% of 53 women who had undergone tubal sterilization but not sought a reversal had experienced some regrets at the procedure. The women who sought reversal were more likely at the time of the sterilization operation to have been younger, to have undergone sterilization close to delivery, or to have experienced major life changes after sterilization. 34% of the 32 women in the reversal group did not feel that they had had the major role in the decision to terminate their own reproductive capacity. Abraham et al. conclude that with the development of less traumatic methods of tubal occlusion there is no longer any justification for a hasty decision to sterilize at the time of operative delivery or gynecological surgery, simply to "avoid another operation." The decision to undergo what should still be viewed as a "permanent" loss of reproductive ability requires more leisurely consideration that is afforded during the stresses of childbirth, miscarriage, or abortion.