绝育术后显微技术复通输卵管效果研究  

The Effect of Microsurgical Tubal Reanastomosis after Tubal Sterilization

作　　者：王振海[1] 江静[1] 李晓冬[1] 黄向华[1] 阴梅云[1] 

机构地区：[1]河北医科大学第二医院,河北石家庄050000

出　　处：《实用妇产科杂志》2009年第6期370-373,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：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9.94cm,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≤4cm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-生理状态是影响效果的重要因素。Objective-To explore the results of microsurgical tubal reanastomosis affected by elevated microtech- nique, ligation mode, site of anastomosis and pathological and physiological state of oviduct.Methods： From May 1991 to May 2006, 900 cases that had received tubal ligation before and desired new pregnancies were recruited by retrospective review, and microsurgical tubal reanastomosis was performed. The reversal operations were done un- der the 3 to 4 fold＇ s amplification of paired eyepiece or glasses-type operating microscope. Muscular layer of the oviduct was sutured 3 to 6 needles and serosa was demixing sutured. If the caliber of tuba in anastomosis site was imoompatible, the wide caliber was partly closed, which could anastomose the opposite one well. No temporary sup- port was put in during operation. The pathological state of oviducts was treated. The mean length of the oviduct was 9.94 cm after reanastomosis. All the patients were followed up for 2 to 5 years. Results.The mean age of patients was 35.02 years old, and the mean interval between tubal sterilization and reanastornosis was 7.66 years. Intrauter- ine gestatlonal rate was 91.67%, among it the term delivery rate was 95.64%, spontaneous abortion rate was 1.82%, 2.55% was still in pregnancy, tubal pregnancy was 0.56% .There was no statistic significance between the pregnancy rate after operation and ligatlon mode, ligation site, the age of patient.if the length of fallopian tubes ≤ 4 cm after operation, the result was bad.Conclusions. Good microsurgical tubal reanastomosis after ligation has high pregnant rate. The pregnancy rate is no obvious difference among different site of reanastomosis. The easy site for operation is the middle of isthmus. The meticulous microsurgical skills and tubal pathological-physiological state are the key factors in achieving satisfactory pregnancy rate.

关 键 词：显微外科手术 输卵管复通术 绝育术 

分 类 号：R713.7[医药卫生—妇产科学]