输卵管绝育术后并发异位妊娠病因及其防治的探讨

本文总结我院２０年中输卵管绝育术后并发异位妊娠的有关临床资料，主要以陈旧性宫外孕为其临床特征，仍以停经、腹痛、阴道出血为主要症状，对绝育术致宫外孕的有关因素及其预防进行了分析探讨。     

腹腔镜下治疗输卵管妊娠术28例临床分析

目的 :对腹腔镜下治疗输卵管妊娠手术做出评价 ,并与传统剖腹手术方法比较。方法 :在电视腹腔镜下行保守性手术 8例及根治性手术 2 0例 ;对照组 2 8例采用传统剖腹手术方法。结果 :两组手术时间、尿TT恢复正常时间、切口感染差异均无显著性 (P >0 .0 5 ) ,两组术中出血、术后体温、肛门排气时间、下床活动时间、住院天数差异有显著性 (P <0 .0 1)。结论 :腹腔镜下治疗输卵管妊娠术具有创伤小 ,康复快 ,术中出血少 ,术后感染率低等优点 ,有助于提高患者生活质量 ,是临床上的理想手术方式     

子宫阔韧带内静脉的解剖学研究及其临床意义

子宫底和体上部的静脉汇集于子宫角处浅出,应称子宫上静脉。该静脉续为卵巢静脉。子宫上静脉1条者占30%,2条者占56.7%,3条者占13.3%。子宫上静脉与输卵管峡部中点相对处的口径是3.7±0.2mm,卵巢丛与子宫上静脉汇合后的口径为5.0±0.4mm。输卵管峡部中点与子宫上静脉的间距为6.3±0.6mm。在输卵管系膜中见有输卵管静脉汇入子宫上静脉。本文研究结果认为盆腔静脉淤血症的发生,与结扎手术中损伤子宫上静脉和输卵管静脉有关。     

Schistosomiasis: an unusual cause of tubal infertility

A case report of a Nigerian woman having an unusual cause oftubal infertility is presented. On histological examinationof the Fallopian tube, ova of Schistosoma haematobium enclosingliving miracidia were found in the smooth muscle layer of theFallopian tube and its mesosalpinx. Mechanisms of tubal involvementare analysed. The case indicates the need to consider schisto-somiasisas a possible aetiological factor in patients with tubal infertilitycoming from areas where the disease is endemic.     

Interleukin-11 expression: its significance in eutopic and ectopic human implantation

Embryo implantation and subsequent decidualization, trophoblast invasion and formation of a functional placenta are crucial for establishment and maintenance of pregnancy. Interleukin-11 signalling has been shown to be obligatory for adequate decidualization and trophoblast invasion in mice. Defects in IL-11 signalling in mice result in trophoblast over-invasion and fetal loss. The pathological situation of human tubal pregnancy resembles that of IL-11Ralpha(-/-) mice concerning these symptoms. As our interest is focused on the human early pregnancy, we compared IL-11 expression at the implantation site of ectopic tubal pregnancy (EP) to 1st and 2nd trimester of normal intrauterine pregnancies (IP), and to the normal cycling endometrium. The mRNA expression of IL-11 and IL-11Ralpha was analysed by semiquantitative RT-PCR. Protein expression was detected by western blotting and immunohistochemistry. IL-11Ralpha is expressed constitutively in all tissue specimens analysed. IL-11 is expressed predominantly during follicular and early luteal phase of the menstrual cycle. In IP, IL-11 expression peaks during the 1st trimester and declines from the beginning of the 2nd trimester onwards. In tubal abortions, IL-11 expression is reduced in comparison to vital EP and IP. Cultured primary endometrial and decidual epithelial cells were analysed for hormonal regulation of IL-11 by enzyme-linked immunosorbent assay and RT-PCR. IL-11 is up-regulated by estrogen and down-regulated by progesterone. Overall, our results indicate that in humans, IL-11 signalling is significantly involved in regulation of trophoblast invasion. In the case of tubal abortion, inadequate IL-11 signalling may therefore result in dysregulation of trophoblast invasion.     

The role of a single free {beta}-human chorionic gonadotrophin measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability

This prospective controlled study investigated the concentrationsof free -human chorionic gonadotrophin (HCG) subunit in 554women with a singleton intrauterine or tubal pregnancy. Theypresented with vaginal bleeding and/or abdominal pain in thefirst 18 weeks of pregnancy. The control group comprised 156women with musculo-skeletal pain and no vaginal bleeding. Theirpregnancies continued to term. The study group comprised 398women (141 threatened-continuing pregnancies, 37 threatened-miscarriages,185 non-continuing pregnancies and 35 tubal pregnancies). Free-HCG concentrations were significantly lower in the non-continuing,threatened-miscarriage and tubal pregnancy groups [mean 4.62,6.50 and 4.27 ng/ml respectively; 95% confidence interval (CI)3.75–-5.69, 4.46–9.48 and 2.92–6.2 respectively]than in the control and threatened-continuing groups (mean 41.61and 48.22 ng/ml respectively; 95% CI 34.53–50.13 and 42.03–55.32respectively) (P < 0.001 in all cases). A cut-off value at20 ng/ml was found to differentiate between the ‘viable’(control and threatened-continuing) and the ‘abnormal’(non-continuing, threatened-miscarriage and tubal) pregnancies,with 88.3% sensitivity and 82.6% positive predictive value.An excellent diagnostic and prognostic usability of free HCGwas confirmed by a receiver operating characteristic curve plotIn conclusion, a single serum free -HCG measurement taken inearly pregnancy is valuable in the immediate diagnosis of earlypregnancy failure and the long-term prognosis of viability.     

The assessment of tubal functional status by tubal perfusion pressure measurements

The measurement of tubal perfusion pressures (TPP) is a recent advance in the field of gynaecoradiology. Measurement of TPP involves a standardized technique using transcervically placed tubal catheters which is reviewed in detail. TPP assesses the functional status of the Fallopian tubes, i.e. their ability to permit pregnancy. Infertile patients with normal TPP demonstrated a higher pregnancy rate (10 out of 23) than patients with elevated TPP (four out of 24, P < 0.05). Analysis of patients who had undergone a laparoscopy as well as measurement of TPP suggest that elevated TPP are highly indicative of tubal endometriosis. Tubal catheterization with wireguides was successful in reducing mildly elevated TPP. The impact of this procedure on pregnancy rates is not known. The use of the gynaecoradiological techniques discussed in this paper has reduced the need for diagnostic laparoscopy at our centre by >60%. This was achieved without compromise in pregnancy rates and has resulted in a considerable reduction in cost.     

Pregnancy: Combined intra-uterine and extra-uterine pregnancy in the contralateral tube after gamete intra-Fallopian transfer

A case of combined intra-uterine and contralateral tubal pregnancyafter gamete intra-Fallopian transfer (GIFT) is presented. Laparotomywith partial tubal resection was performed after tubal rupture.The intra-uterine pregnancy is still ongoing without complications.Heterotopic pregnancies are dangerous conditions for the patientand should be taken into account after transfer of multipleoocytes. To our knowledge this is the first report of a heterotopicpregnancy in the contralateral tube after GIFT.     

Direct gamete uterine transfer in patients with tubal absence or occlusion

Purpose: Our aim was to examine the potential of the uterine cavity to affect fertilization and early embryo development. Design: A prospective IRB-approved protocol for patients fulfilling study eligibility criteria was used. Methods: Patients studied included those with primary or secondary infertility, aged less than 38 years, with no history of severe male-factor infertility, and with hysterosalpingogram-and laparoscopic-confirmed bilateral proximal tubal occlusion. Superovulation induction was accomplished with a combination of GnRH agonist and menotropins, with serum hormonal and sonographic monitoring. Within 24 hr prior to, and again at the time of, ovulatory hCG administration, progesterone (P4) was given. Sonographic-guided transvaginal retrieval was performed 35 hr after hCG. Between four and six oocytes were returned to the uterine cavity, admixed with sperm, immediately following retrieval. Luteal support consisted of daily P4 administration. Results: Of the 20 patients recruited for the study, all completed the retrieval and transfer procedure. A total of four clinical pregnancies was achieved, with one early first-trimester loss, one late first-trimester loss (Trisomy 14), and two healthy term infants delivered. IVF of surplus oocytes demonstrated a 82.5% fertilization rate and 66.7% cleavage following cryopreservation. Conclusions: Human fertilization can be achieved through direct uterine transfer of gametes. Furthermore, administration of P4 prior to the ovulatory dose of hCG is compatible with in vitro or in vivo fertilization and implantation.     

Does Previous Salpingectomy Improve Implantation and Pregnancy Rates in Patients with Severe Tubal Factor Infertility who are Undergoing In Vitro Fertilization? A Pilot Prospective Randomized Study

Objective: To evaluate the implantation rate and pregnancy rate (PR) in patients with severe tubal factor infertility who were undergoing IVF. Patients who had undergone salpingectomy were compared with those who had not.

Design: A prospective randomized study.

Setting: A department of obstetrics and gynecology at a university hospital.

Patient(s): Thirty patients who previously had undergone salpingectomy and 30 patients who had not undergone salpingectomy before IVF treatment.

Intervention(s): Laparoscopy with or without salpingectomy followed by IVF with the use of combined GnRH agonist and hMG therapy in a long stimulation protocol.

Main Outcome Measure(s): Embryo implantation rate and ongoing PR per transfer. The cumulative PRs were compared for the two groups of patients.

Result(s): After the first IVF attempt, the implantation rate was 10.4% in the group with salpingectomy and 4.6% in the group without salpingectomy. For all IVF attempts, the respective embryo implantation rates in the two groups were 13.4% and 8.6%. The ongoing PR per transfer was 34.2% in the group with salpingectomy compared with 18.7% in the group without salpingectomy. After four IVF attempts, the probability of becoming pregnant was greater in the group of patients with salpingectomy (75%) than in the group without salpingectomy (63%).

Conclusion(s): Previous salpingectomy in patients with severe tubal factor infertility who are undergoing IVF seems to increase the embryo implantation rate and the PR per cycle of IVF. This monocentric study must be followed by other similar studies to allow for a metaanalysis and confirm this clear trend with definitive evidence.