摘要
目的 探讨输卵管黏膜桥的临床特点及腹腔镜手术的效果。方法 2019年1~10月我科291例因不孕症行腹腔镜手术治疗,术中发现输卵管黏膜桥68例,采用单极电钩逐一切断输卵管黏膜桥伞端粘连带,恢复伞端外翻舒展,合并Ⅲ~Ⅳ期内异症患者术后应用4~6针促性腺激素释放激素激动剂(GnRH-a)。结果 单侧输卵管黏膜桥42例,双侧输卵管黏膜桥26例,共94条输卵管黏膜桥。合并内异症者输卵管黏膜桥发生率(45.1%,51/113)显著高于无内异症者(9.6%,17/178)(χ^(2)=48.870,P=0.000)。术中行亚甲蓝通液,44条(46.8%)输卵管通畅;29条(30.9%)输卵管亚甲蓝从输卵管弥散入盆腔缓慢,表现为通而不畅,切开黏膜桥伞端整形后,继续通液,亚甲蓝自输卵管伞端顺利流出;10条(10.6%)输卵管伞端粘连,行粘连分离术;6条(6.4%)输卵管近端梗阻,经宫腔镜行COOK导丝输卵管插管疏通;5条(5.3%)输卵管积水,行伞端造口成形术。术后自然妊娠率77.9%(53/68),其中宫内妊娠率96.2%(51/53),足月分娩率90.6%(48/53)。结论 合并内异症患者输卵管黏膜桥发生率相对较高,需在腹腔镜下仔细检查输卵管及伞端。腹腔镜手术及对合并内异症患者术后辅以用药可获得较好的妊娠率。
Objective To investigate the clinical characteristics and efficacy of laparoscopic treatment for fimbrial agglutination.Methods From January 2019 to October 2019,291 cases of infertility underwent laparoscopic surgery in our department.During the operation,fimbrial agglutination was found in 68 cases.The monopolar electric hook was used to sever bridges of fimbria across the ostium and restore the fimbria to an extended state.For patients with stageⅢ-Ⅳendometriosis,a total of 4-6 doses of gonadotropin-releasing hormone agonist(GnRH-a)were given.Results There were 42 cases of unilateral fimbrial agglutination and 26 cases of bilateral fimbrial agglutination(94 fimbrial agglutinations).The incidence of fimbrial agglutination in infertility patients with endometriosis(45.1%,51/113)was significantly higher than that in infertility patients without endometriosis(9.6%,17/178)(χ^(2)=48.870,P=0.000).Methylene blue infusion was performed during the operation.A total of 44(46.8%)fallopian tubes were unobstructed;methylene blue diffused slowly into the pelvic cavity from the fallopian tube in 29 tubes(30.9%),showing that it was unobstructed but not smooth,and after the mucosal bridge fimbria end was cut open for plastic surgery,the fluid continued to flow with methylene blue flowing from the salpingian fimbriae;10(10.6%)fimbriae end of fallopian tube adhesion were given adhesion separation;6(6.4%)proximal fallopian tubes were obstructed,and the COOK guide wires were inserted through hysteroscopy to clear the fallopian tubes;5(5.3%)fallopian tubes of hydrosalpinx were treated with fimbrioplasty.The rate of natural pregnancy after laparoscopic surgery was 77.9%(53/68),including an intrauterine pregnancy rate of 96.2%(51/53)and a full term delivery rate of 90.6%(48/53).Conclusions The incidence of fimbrial agglutination is relatively high in patients with endometriosis,which requires careful examination fimbriae of fallopian tube under laparoscopy.Laparoscopic treatment and use of GnRH-a for endometriosis patients can achieve good pregnancy rate.
作者
黄彦文
李留霞
张莉莉
Huang Yanwen;Li Liuxia;Zhang Lili(Department of Obstetrics and Gynecology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第4期252-256,共5页
Chinese Journal of Minimally Invasive Surgery
基金
河南省医学适宜技术推广项目(SYJS2020107)。
