输卵管绝育后显微复通手术的效果  

Effects of Microsurgical Tubal Reversal after Tubal Sterilization

作　　者：刘建华[1] 王雪芬[1] 叶香[1] 陈鸣[1] 法韫玉[1] 

机构地区：[1]上海交通大学医学院第九人民医院妇产科,上海200011

出　　处：《上海交通大学学报（医学版）》2006年第12期1369-1372,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨几种常见输卵管绝育手术后，进行显微输卵管复通术的效果及影响因素。方法回顾分析1982～2000年间我院对2001例妇女进行输卵管绝育后复通手术的效果，对不同绝育方法的复通效果及影响因素进行比较。结果2001例接受复通手术的妇女随访1798例，随访率89．85％。复通术后前3个月受孕率最高为37．43％（673／1798）。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）；输卵管粘堵术复通效果最差。各种输卵管吻合方法中以峡-峡部和壶-壶部吻合后的宫内妊娠率较高，均显著高于输卵管峡-壶部吻合及输卵管植入术；峡-壶部吻合术后宫内妊娠率显著高于子宫输卵管植入术。吻合术后输卵管长度〈4cm时宫内妊娠率显著降低，长度〉5cm时宫内妊娠率即不受影响。吻合术后的早期通液不能提高手术成功率，反而可使宫内妊娠率下降和异位妊娠发生率升高。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；粘堵绝育复通效果较差；术后没有必要短期避孕；输卵管吻合术后的早期通液有弊无益。Objective To study the effects of microsurgical tubal reversal in women with various common tubal sterilization techniques, and the factors influencing the reversal. Methods Two thousand and one women who underwent microsurgical tubal reversal after tubal sterilization in our hospital from 1982 to 2000 were followed up to observe the revernal results. The reversal results of different sterilizing techniques and the influencing factors were compared and analyzed. Results One thousand seven hundred and ninety-eight women （89.85%） with tubal reversal were successfully followed up. The pregnancy rate in the first 3 months after tubal reversal was the highest （37.43%, 673/1 798）. The rates of intrauterine pregnancy after tubal reversal in Uchida sterilization technique and clips sterilization were significantly higher than those in other sterilizing techniques （ P 〈 0. 05）. The reversal result of medicinal block of the tubal lumen was the poorest. The tubal anastomosis of isthmus-isthmus and ampulla-ampulla produced the excellent intrauterine pregnancy rates, either of which was significantly higher than the rates of isthmus-to-ampulla anastomosis and hyste than rosalpingostomy. While the intrauterine pregnancy rate of isthmus-ampulla anastomosis was significantly higher that of hysterosalpingostomy. When the tubal length after anastomosis was less than 4 cm, the intrauterine pregnancy rate was very low. When the tubal length was more than 5 cm, the reversal result will not be impaired. The early tubal fluid infusion after anastomosis can not improve the reversal result. On the contrary, it could decrease the chance of intrauterine pregnancy and lead to a higher ectopic pregnancy rate. Conclusion The tubal streilization, at isthmus of salpinx and with a little destruction of salpinx and its mesosalpinx, can be more reversible after microsurgical reanastomosis. The chemical occlusive sterilization is the least reversible of all the sterilizing techniques. The short-term contraception after tubal reversal

关 键 词：输卵管 绝育术 输卵管复通手术 宫内妊娠 显微手术 

分 类 号：R713[医药卫生—妇产科学]