输卵管绝育后复通手术十年总评

我们随访１９８２年４月至１９９３年６月在我院行显微输卵管复通手术后的１０２９例妇女，发现宫内妊娠率为９３．２９％（９６０／１０２９），术后第一年受孕率最高，为７３．７８％（７５４／１０２９）；术后第一年内前６个月受孕率５４．８１％（５６４／１０２９）明显高于后６个月者４０．８６％（９０／４６５）；前６个月内的前３个月受孕率３７．４１％（３８５／１０２９）又明显高于后３个月２７．８０％（１７９／６４４）。术后各时期宫外孕的发生率均无明显差别；宫内妊娠率与绝育至复通的时间无关；术后的早期通液反而降低宫内妊娠率；抽芯包埋法及夹绝育后复通的宫内妊娠率较高；输卵管峡部吻合后宫内妊娠率最高。因此，我们认为输卵管峡部的抽芯包埋法或夹绝育在目前不失为一种理想的可逆性绝育方法。     

输卵管绝育术后复育失败妇女再育的研究

输卵管绝育术后复育失败妇女再育的研究孟祥阁李娟田奎武黄真嘉王克华蔡燕叶鑫生江平张梅心张会珍为解决输卵管绝育输卵管吻合后仍长期不孕或无法吻合妇女的再生育问题，我们以体外受精－胚胎移植（ＩＶＦ－ＥＴ）技术治疗３１例输卵管阻塞性不孕（包括绝育术后）患者。现...     

绝育术后显微技术复通输卵管效果研究

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9.94 cm,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≤4 cm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一生理状态是影响效果的重要因素.     

输卵管结扎后传统开腹与腹腔镜下输卵管复通术疗效分析

目的 探析输卵管结扎后传统开腹与腹腔镜下输卵管复通术的临床疗效。方法 选取2015年1月至2022年7月输卵管结扎患者26例。将2015年1月至2019年1月收治的13例患者为参照组,实施传统开腹输卵管复通术。2019年2月至2022年7月收治的13例患者为试验组,实施腹腔镜下输卵管复通术。比较两组患者手术时间、术后首次下床活动时间、住院时间,术后随访2个月记录再次妊娠率。结果 两组患者手术时间比较,差异无统计学意义（P>0.05）。试验组首次下床活动时间、住院时间均短于参照组,差异有统计学意义（P<0.05）。试验组再次妊娠率（84.62%）高于参照组（38.46%）,差异有统计学意义（P<0.05）。结论 输卵管结扎后腹腔镜下输卵管复通术在手术效果和术后妊娠率方面均优于传统开腹输卵管复通术。     

两种输卵管复通术式的临床分析

1975年12月至2003年12月共收治输卵管绝育术后要求复通348例，按照绝育术式分别行输卵管端端吻合术和输卵管宫角植入术，其中1991年以前为肉眼直视下手术，1991年后借助显微镜或手术放大镜进行手术，观察不同术式患者的输卵管复通率及受孕情况，并作临床分析，探讨输卵管绝育术后复通的最佳手术方式。     

药物粘堵输卵管后输卵管植入复通术

药物粘堵输卵管后输卵管植入复通术冯淑芝，曹来英，魏敏，曹秀娟采用药物粘堵输卵管的方法进行绝育，不需要开腹手术，易被育龄妇女接受。但对绝育术后行输卵管复通术，文献报道尚少。我院行药物粘堵输卵管后输卵管植入复通术（输卵管植入术）５例，在手术方法上做了一些...     

输卵管病变对复通术后的影响

随着输卵管绝育后复通术的广泛开展,发现手术的成功率与原绝育方法、结扎部位等因素有关［１,２］,我们认为与绝育术后输卵管病理改变及其病变程度也关系密切。为了进一步提高复通述的成功率,现将复通术中发现的各类输卵管病变进行对照分析。材料与方法一、材料来源自...     

药物粘堵后输卵管复通的探讨

药物粘堵后输卵管复通的探讨山东省立医院妇产科（２５００２１）王育华盛燕输卵管药物粘堵绝育因无痛苦受到很多妇女青睐，但化学药物注入输卵管后，输卵管间质部闭塞，一旦需要再通，子宫角切口与远侧通畅段输卵管的关系较难处理。这是药物粘堵绝育术广泛开展受到限制的...     

输卵管绝育术后复通术的探讨

输卵管绝育术后复通术的探讨许如秀，王佩贞，王育华（山东省立医院）１９８５年１月至１９９２年３月我们对输卵管绝育术后因子女夭折或再婚要求行输卵管复通术者，用显微外科手术分别行输卵管吻合术及于宫角输卵管吻合术，现总结如下。１资料与方法１．１一般资料行输卵...     

体外受精-胚胎移植后宫内妊娠并发输卵管残端出血——2例临床分析

目的:探讨因输卵管积液等行腹腔镜下绝育术后助孕、宫内成功妊娠而并发输卵管残端出血的病因及预治。方法:回顾性分析2例宫内妊娠并发输卵管残端出血患者的临床资料。结果:2例患者经腹腔镜手术止血成功,并保住了宫内胎儿,获得满意的治疗效果。结论:宫内妊娠并发输卵管残端出血原因可能与前次腹腔镜绝育术中不恰当的电凝导致残端组织愈合不良、宫角受损未予成形缝合以及手术器械使用不当等有关,应采用恰当的手术方式加以防范。     

Effect of tubal sterilization on ovarian follicular reserve and function

OBJECTIVE: Tubal ligation may reduce the ovarian blood flow and lead to tissue damage to the ovary. If so, this may also result in a significant decrease of the total follicular pool. We performed a long-term evaluation of ovarian reserve and function after tubal sterilization in a longitudinal prospective comparison cohort. STUDY DESIGN: In an university tertiary-care center, 26 women undergoing laparoscopic tubal sterilization with the use of bipolar coagulation, and 26 matched control subjects underwent measurement of follicle-stimulating hormone, luteinizing hormone, 17beta-estradiol, and inhibin on menstrual cycle day 3 before (baseline) and at 6, 12, 18, 24, and 60 months after the sterilization for ovarian reserve evaluation. At baseline and 12 and 24 months after tubal ligation, women who underwent sterilization were sampled every other day across an entire menstrual cycle for follicle-stimulating hormone, luteinizing hormone, 17beta-estradiol, inhibin, and progesterone determination to evaluate ovarian function. RESULTS: No significant changes were observed either within or between groups for any parameter, despite the fact that a 45% and 30% increase in follicle-stimulating hormone concentration from baseline to the 60-month control was detected in tubal sterilization and control groups of women, respectively. No significant changes were observed in the mean area under the curve of follicle-stimulating hormone, luteinizing hormone, estradiol, inhibin, and progesterone per menstrual cycle at baseline and 12 and 24 months after sterilization. CONCLUSION: This 5-year follow-up study suggests that there is neither an accelerated decline of ovarian follicular reserve nor ovarian dysfunction after tubal sterilization by electrocoagulation.     

Essure: a new device for hysteroscopic tubal sterilization in an outpatient setting

OBJECTIVE: To evaluate the results of hysteroscopic placement of an intratubal device for permanent birth control in 85 women in an outpatient setting. DESIGN: Prospective, observational study. SETTING: Private university hospital. PATIENT(S): Eighty-five premenopausal women who asked for tubal sterilization by hysteroscopy between July 2002 and July 2003. INTERVENTION(S): Hysteroscopic placement of titanium-dacron intratubal devices in an outpatient setting. MAIN OUTCOME MEASURE(S): Procedure feasibility without anesthesia, success rate of device implantation, patient satisfaction, and confirmation of correct placement. RESULT(S): Successful placement was achieved in 81 patients (95%). Mean time elapsed between the start of hysteroscopy, placement of devices, and removal of optics was 9 minutes (range, 1-35 minutes). No intraoperative or postoperative complications were detected. Of 81 patients, 75 (93%) had abdominal x-ray performed at the third month; bilateral correct placement was confirmed in all of them. CONCLUSION(S): Essure is a safe, effective, and minimally aggressive procedure with satisfactory patient acceptance that does not require anesthesia or hospitalization. It seems to be a good alternative to laparoscopic tubal sterilization.     

Hazards of laparoscopic tubal sterilization.

The complications of laparoscopic tubal sterilization found in the literature are summarized, and the inherent risks of the procedure are discussed.     

输卵管绝育术后显微吻合100例病理临床分析

对１００例女性绝育术后要求输卵管吻合者，进行了病理及临床分析，其中绝育后≥５年３５例，＜５年６５例。病理检查发现，输卵管近端积水与粘膜上皮变性占总数的７０％，不同程度的异物反应占４２％；结扎处管壁纤维化占３９％；子宫内膜异位症占２％；卵管峡部炎占４％；卵管内膜息肉占２％。输卵管近端积水及粘膜上皮变性程度与绝育后时间关系密切，≥５年组重于＜５年组（Ｐ＜０．０５）；而异物反应程度＜５年组重于≥５年组（Ｐ＜０．０５）。术后随访３年宫内妊娠率为９１％，≥５年组为８２．８６％，低于＜５年组的９５．３８％（Ｐ＜０．０５）。提示，绝育术后输卵管可发生不同程度的病理变化，与绝育后时间的长短密切相关，绝育≥５年者吻合后成功率低。要进一步提高吻合术后的成功率，就须正确识别病理情况，在输卵管修复术中，既要尽量切除不可逆性的病理组织，又要尽可能保留足够长度的输卵管     

Ectopic pregnancy following tubal sterilization

Over a 5 year period 232 ectopic pregnancies were recorded at Ullevaal Hospital in Oslo, Norway. There had been 10,294 births during this July 1976 to June 1981 period. In 3 cases tubal sterilization had been performed prior to the development of the extrauterine pregnancy. A total of 1047 female tubal sterilizations were performed during these 5 years. Almost all the sterilizations were done by laparoscopy. Different methods of sterilization were used: unipolar diathermy; spring clips according to Hulka; silicone rings; and endotherm coagulation. Each case of the 3 ectopic pregnancies, observed following tubal sterilization, is reviewed. A 36 year old patient became pregnant 3 years after diathermy sterilization. The right tube was found normal, and the pregnancy located in the lateral part of the divided left tube. 14 months following silicone ring sterilization a 26 year old patient had an ectopic pregnancy in the lateral right tube. The silicone ring was in perfect position on the left side. The medial right tube showed fibrous scarring after the ring application, but the ring was located in the mesosalpinx. A 37 year old patient was admitted to the hospital after a tubal pregnancy 10 months after diathermy sterilization. The pregnancy was in the lateral part of the tube. Both tubes had been transected, and there was a diastase of about 2 centimeters. The etiology of ectopic pregnancies is complex. It is only recently that previous sterilization has been recognized as a factor in this condition. Luteal phase pregnancies are because of a failure in the timing of the procedure and are unrelated to the procedure itself. Pregnancies resulting from operative failure range from 0-2.4/1000 sterilizations in different series. Technical failure may be caused by recanalization, fistula formation, and product failure. An important cause of ectopic pregnancy after laparoscopic sterilization is probably fistula formation that allows sperm to pass out of the uterus. Such fistulas have frequently been documented. Thus, if it is considered necessary to confirm tubal occlusion by salpingogram, this should be delayed for at least 12 weeks. As fistula formation probably is a major cause in this entity, division of the tube at the time of sterilization is neither necessary nor desirable. It is important to damage the tube in the isthmic segment and to minimize the involvement of the parametrium in the destructive process.