Search

输卵管壶腹部造孔法在复孕术中的应用

复孕术中,当输卵管的两个断端管径差异较大时,难以达到满意吻合,从而影响复孕效果。采用在壶腹部育端造一小孔,使远端孔径和近端管径大小一致,以达到满意吻合的改良方法。临床应用32例,随访1年以上,复通率100％,复孕率为93.7％。介绍了手术方法。

输卵管声学造影中发生过度换气的防治和处理

【摘要】　目的　总结输卵管声学造影中发生过度换气综合征的预防及治疗方法。　方法　2008年1月-2010年11月对35例出现过度换气综合征的患者进行临床资料分析。　结果　35例患者通过心理疏导及暗示疗法、面罩或纸袋限制通气、造影剂加温（37~38 ℃）等方法，临床症状得到缓解，治疗后随访症状消失。　结论　输卵管声学造影中发生的过度换气综合征患者，只要采取有效的预防措施，及早诊断，及早治疗，预后效果满意。

Clinical Evidence of Unexplained Infertility

CLINICAL APPLICATION OF TUBAL RECONSTRUCTION AFTER LAPAROSCOPIC TUBAL PREGNANCY OPERATION

ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.

腹腔镜下改良保守手术治疗输卵管妊娠的临床疗效

【摘要】目的 探讨腹腔镜下行保守手术治疗输卵管妊娠的理想方法。方法 2008年9月-2009年10月腹腔镜下对68例输卵管妊娠患者行改良保守性手术,术中采用输卵管系膜血管结扎及垂体后叶素注射止血,从输卵管破口或开窗口负压吸胚,并行妊娠黄体剔除,术后口服米非司酮直至血绒毛膜促性腺激素(βHCG)降至阴性水平。结果 68例流产型、破裂型、陈旧型、未破损型全部成功完成保守手术(包括内出血超过1 000 mL者5例)。发生持续性宫外孕1例,术后3 d加用甲氨喋呤 75 mg,单次静推后治愈;术后第3天血βHCG平均下降率为92%,无手术并发症。术后随访36例,术后1~3个月行宫腔镜下输卵管通液通畅。结论 腹腔镜下保守术式的改进治疗输卵管妊娠安全可行,只要注意手术方法,加强术后监测, 可获得良好效果。

Research of Pituitrin in Reducing Bleeding in Laparoscopy for Interstitial Pregnancy

【摘要】　目的　探讨减少输卵管间质部妊娠腹腔镜术中失血的方法。　方法　选择2007年1月-2010年6月49例诊断为输卵管间质部妊娠的患者随机分成观察组（24例）和对照组（25例）。观察组在腹腔镜切开异位妊娠病灶前于宫角注射垂体后叶素6 U，待子宫收缩后手术；对照组直接切开异位妊娠病灶进行手术。比较两组手术时间、术中出血量、血压、术后肛门排气时间、体温等方面的差异以及随访患者月经恢复时间。　结果　观察组和对照组手术时间分别为（34.29±7.96）、（53.68±10.48） min，术中出血量为（48.04±9.49）、（85.52±15.24） mL，差异有统计学意义（Plt;0.05）；两组在术后肛门排气时间、术后体温、术前血压、妊娠病灶切开后5 min的血压以及观察组使用垂体后叶素前后的血压差异均无统计学意义（Pgt;0.05）。两组患者在术后30～41 d月经复潮。　结论　输卵管间质部妊娠腹腔镜术中使用垂体后叶素能明显缩短手术时间和减少术中出血量，不增加持续性宫外孕的发生。【Abstract】　Objective　To explore the method of reducing bleeding in laparoscopy for interstitial pregnancy. 　Methods　Forty-nine patients diagnosed to have interstitial pregnancy between January 2007 and June 2010 were randomly divided into observation group (24 cases) and control group (25 cases). Patients in the observation group were given an injection of 6 U pituitrin in the horn of uterus before the incision of lesions in laparoscopy, and operation was performed after uterine contraction; while the lesions of patients in the control group were directly incised. The differences between the two groups in operation time, blood loss during the operation, blood pressure, exhaust time and temperature were studied and the recovery time of menstrual period was followed up.　Results　The operation time of the observation group and the control group was (34.29±7.96) minutes and (53.68±10.48) minutes; the blood loss was (48.04±9.49) mL and (85.52±15.24) mL, respectively. The difference in the operation time and blood loss between the two groups was significant (Plt;0.05). The difference in other indexes between the two groups such as the exhaust time, postoperative body temperature, the blood pressure before operation and within five minutes after the incision of the lesion was not statistical (Pgt;0.05). The recovery time of menstrual period in the two groups was 30 to 41 days.　Conclusion　Using pituitrin in laparoscopy for interstitial pregnancy can significantly shorten operation time and reduce blood loss, and will not increase the incidence rate of persistent ectopic pregnancy.

Clinical Analysis of Laparoscopic Operation for 36 Patients with Interstitial Tubal Pregnancy

Objective　To study the clinical value and surgical procedure of laparoscopic operation for interstitial tubal pregnancy. Methods　Clinical data of 36 patients of interstitial tubal pregnancy treated by laparoscopic operation were retrospectively analyzed. Results　All 36 patients were operated successfully, without conversions to laparotomy and intra- or post- operative complications. The operation time was 28-85 min(mean, 41min), and the length of stay in hospital postoperative was 3-6 d (mean, 4-5 d). Conclusion　Laparoscopic operation for interstitial tubal pregnancy is safe and feasible.

Clinical Evidence of Tubal Infertility

输卵管绒癌一例

56例输卵管妊娠治疗方法分析

【摘要】目的探讨输卵管妊娠的病因、诊断及治疗方法。方法回顾性分析2003年10月2007年12月收治的56例输卵管妊娠的临床资料。结果输卵管妊娠的病因有慢性输卵管炎、输卵管手术及IUD等。治疗采用以MTX和(或)米非司酮为主的药物治疗和手术治疗。结论输卵管妊娠的早期诊断为药物治疗和手术的选择提供了有利保证。