Search

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。

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.

Chinese Medicinal Herbs for Tubal Subfertility: A Systematic Review

Objective　To assess the effectiveness and safety of traditional Chinese medicinal herbs for subfertility. Method　Databases used including MEDLINE, EMBASE, CBM and the Cochrane Controlled Trial Register (CCTR). Potentially related trials in reference lists of studies were hand searched. Published RCTs in any languages and length whether they were blind or unblind, were included. Treatments were Chinese medicinal herbs (single or compound), and controls were placebo, standard medical intervention, or no intervention. Data were extracted independently by two reviewers and analyzed with Revman 4.2 softeware. Results　7 randomized trials, including 1 042 patients met inclusion criteria. Methodological quality of all trials was poor. Chinese medicinal herbs were effective compared with routine antibiotics [RR 1.49, 95％CI (1.37 to1.62), Plt;0.000 01] and resulted in higher pregnancy rate [RR 1.46, 95%CI (1.09 to,1.96), P=0.01]. There were no adverse events reported in treatment group. Conclusions　Some Chinese medicinal herbs may be effective for subfertility. However, the evidence is too weak to draw a conclusion. More strictly designed, randomized, double-blind, placebo-controlled trials are required.

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.

输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况调查

目的:了解输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况,以指导输卵管妊娠的临床治疗。方法:选择我院2004年至2007年因输卵管妊娠行开腹患侧输卵管切除术患者183例术后的生殖状况进行随访调查,回顾性分析其再次受孕及输卵管妊娠情况。结果: 在有生育要求的107位患者中,总的宫内妊娠率为64.5％(69/107例),8.7％复发输卵管妊娠(6/107例)。宫内受孕率以lt;30岁,术后1～2年最高,中重度贫血及盆腔中重度黏连导致宫内受孕机率下降;复发输卵管妊娠与年龄及术后时间无相关性,随贫血程度及盆腔黏连程度的加重进行性增加。结论: 开腹患侧输卵管切除术后生殖状况与年龄、术后时间、盆腔黏连程度、贫血程度密切相关。及时手术,减轻贫血程度,细致分黏,合理生殖健康指导,能有效提高宫内妊娠,降低复发输卵管妊娠。

Clinical Evidence of Unexplained Infertility

The Short-term Influence of Oviduct Suture after Laparoscopic Embryo Removal Fenestration

目的　探讨腹腔镜下输卵管妊娠开窗取胚术后缝合与否对输卵管再通、宫内妊娠率的近期影响。方法　回顾分析2008年4月－2010年4月112例有保留生育功能意愿且具备随访条件的输卵管妊娠患者行腹腔镜手术的临床资料。根据手术方法将患者分为两组：A组54例，行患侧输卵管开窗取胚术，术后缝合输卵管；B组58例，行患侧输卵管开窗取胚术，术后不予缝合输卵管。两组术毕均予甲氨喋呤20 mg注射于病变输卵管处系膜，并行通液了解患侧输卵管通畅情况（对侧输卵管均通畅）。3个月后比较两组患侧输卵管的再通情况，并随访其近期（12个月内）宫内妊娠率、重复性异位妊娠率情况。 结果　A组54例患者术中患侧输卵管通畅48例，通而不畅6例；术后3个月B型超声监测下通液43例通畅，10例通而不畅，1例不通，通畅率79.63%。B组58例患者术中患侧输卵管通畅54例，4例通而不畅；术后3个月B型超声监测下通液37例通畅，13例通而不畅，8例不通，通畅率63.79%。近期（12个月内）宫内妊娠率、重复性异位妊娠率情况：A组54例，实访42例，宫内妊娠29例，占69.05%；重复性异位妊娠6例，占14.29%。B组58例，实访44例，宫内妊娠18例，占40.91%，重复性异位妊娠12例，占27.27%。A组术后患侧输卵管通畅率、宫内妊娠率高于B组，而重复性异位妊娠率明显降低，两组差异有统计学意义（P＜0.05）。 结论　腹腔镜下输卵管妊娠开窗取胚术后行输卵管缝合，可以减少对患侧输卵管损伤并恢复其正常的解剖结构，从而有效地保留患者生育功能。术后患侧输卵管通畅率、宫内妊娠率明显高于术后不缝合者，而重复性异位妊娠率明显降低。

结扎术后输卵管二次吻合术六例临床分析

目的 总结分析结扎术后输卵管二次吻合术注意事项。 方法 1997年3月~2004年3月，对6例患者行结扎术后输卵管二次吻合术。年龄31～38岁。首次吻合术距二次吻合术时间为1～6年。术后随访输卵管复通及复孕情况。 结果 患者获随访1～7年。术后1个月，输卵管通液检查5例通畅；术后6个月，输卵管通液检查3例通畅， 1例已宫内妊娠；术后1年，宫内妊娠2例，足月分娩；术后2年输卵管妊娠1例。结论 结扎术后输卵管二次吻合术成功率尚不高，术中应用显微外科技术和保留足够长度输卵管是手术成功的关键。

改良式输卵管吻合术疗效观察

目的 总结改良式输卵管吻合术的临床疗效。 方法 2008 年1 月－ 2010 年10 月，对89 例输卵管绝育术后育龄妇女行双侧改良式输卵管吻合术，从输卵管结扎部位浆膜层的分离、管芯的端端对合及吻合方法等方面改进。患者年龄25 ～ 42 岁，平均35 岁。手术时间为月经结束后3 ～ 7 d。术中取切除的输卵管结扎瘢痕组织送病理检查。吻合术后5 d 及第1 次月经结束后3 ～ 7 d 行输卵管通液手术。术后12 个月以上未妊娠者行子宫输卵管碘油造影。 结果 89 例双侧输卵管吻合均成功。术中见慢性盆腔炎8 例，病理检查示慢性输卵管炎17 例。术后5 d 输卵管通液通畅率为100%，第1 次月经结束3 ～ 7 d 通畅率为95.5%。术后避孕4 例。术后2 年内妊娠率为61.2%（52/85），其中术后12 个月内妊娠47 例；12 ～ 18 个月内妊娠5 例，其中2 例为输卵管妊娠。52 例妊娠者中，慢性盆腔炎患病率为3.8%（2/52），与33 例未孕患者慢性盆腔炎患病率42.4%（14/33）比较，差异有统计学意义（χ2=12.261，P=0.000）。术后12 个月以上未孕者中14 例行输卵管碘油造影，有5 例输卵管梗阻。 结论 改良式输卵管吻合术具有吻合口张力小、对合好，缝合针数少，术后输卵管通畅性好等优点。建议对术后1 年以上未孕者尽早施行输卵管通畅性及盆腔炎症的评估。

输卵管绒癌一例