显微外科技术治疗输卵管性不孕

目的:探讨显微外科技术对输卵管结扎术后复通及输卵管远端阻塞复通的方法及效果.方法:用显微外科技术对输卵管结扎术后进行复通及输卵管远端阻塞进行粘连分离、整形及复通,并随访.结果:输卵管结扎术后复通率100%(28/28),复通术后妊娠率92.9%(26/28).输卵管远端阻塞复通率75%(24/30),术后妊娠率65.6%(21/32),其中伞端成形术复通率83.3%(20/24),妊娠率75%(18/24),输卵管开口复通率50%(4/8),术后妊娠率37.5%(3/8).结论:应用显微外科技术治疗输卵管阻塞性不孕疗效肯定,术后复通率及妊娠率均较普通术式显著提高,但病例选择要适当,术中保证输卵管充足的血液供应及防止手术后再粘连是手术成败的关键.

Treantment of Tubal Infertility with Microsurgical Techniques

Objective:To observe the curative effect of fallopian tubal recanalization combined with microsurgical technique for treatment of tubal ligation and distal fallopian tube obstruction.Methods: This study was designated to analyse the tubal patency rate and pregnancy rate.28 ligated tubes were anastomosed after cutting of the tubal scar.As to the 32 patients with distal fallopian tube obstruction,we peformed salpingolysis,fimbrioplasty and recanalization with microsurgical technique.Results: Postoperative tubal patency rate of tubal ligation was 100%(28/28),as compared with 75%(24/32) for the distal fallopian tube obstruction.Postoperative pregnancy rate of the two group was 92.9%(26/28) and 65.6%(21/32) respectively.(P<0.05).For the patients with distal fallopian tube obstruction,the recanalization rate of fimbrioplasty was 83.3%(20/24) vs 50%(4/8) of salpingostomy.Postoperative pregnancy rate was 75%(18/24)for the group of fimbrioplasty and 37.5%(3/8) for the salpingostomy group,but the different was not statistically different(P>0.05).Conclusions: Our findings suggest that microsurgical recanalization of the occluded tubes is an effective treatment with higher rates of tubal patency and successful pregnancy.Proper selection of candidates,intraoperative surveillance of tubal blood supply and prevention of adhesion are key to a success.