改良腹腔镜输卵管吻合术式的临床效果探讨

Clinical effect of laparoscopic tubal anastomosis

摘要:

摘要：目的??探讨腹腔镜输卵管端端吻合术改进临床技能的应用价值。方法?回顾性分析2012年3月-2017年3月对输卵管峡部或壶腹部阻塞致不孕的96例患者不同改良手法腹腔镜输卵管吻合术的临床资料。对比吻合时置入支架（65例）和未置入支架（31例）患者腹腔镜成功率、手术时间、术中吻合通畅率、术后输卵管通畅率和术后妊娠率等。置入支架者术中将硬膜外导管从输卵管伞端逆行插管至接近远侧梗阻位置，微型剪剪开输卵管远端、近端盲端，修整管面硬外导管插入输卵管近侧断端，使其过输卵管间质部，以导管为支架，用5/0可吸收缝合线缝合3或4针，支架置入困难者，则先将管腔对齐，用5/0可吸收线第1针在6点处，缝合两侧管腔肌层，可穿过黏膜层，第2针在12点缝合两侧管腔肌层及黏膜，6点、12点缝好后依次拉紧打结，3点、9点以12点线为中心点缝合浆肌层，不必穿透黏膜层，术中及术后第1次月经干净后3～7?d各通液疏通一次。未置入支架者则仅将硬膜外导管从输卵管伞端插入至壶腹部，其余步骤相同。结果?96例患者术中放置导管支架65例，完成输卵管吻合128条，术中吻合后通畅127条（99.22%），术后第1次月经干净后通液128条，均通畅（100.00%），术后24个月妊娠53例（81.54%）。未放支架31例，完成输卵管吻合62条，术中吻合后通畅60条（96.77%），术后第1次月经干净后通液61条通畅（98.39%），术后24个月妊娠25例（80.65%）。结论?腹腔镜下输卵管吻合手术随着操作技术的成熟及手术方法的改进可达到较好的临床效果。

Abstract:

Abstract: Objective?To explore the application value of laparoscopic tubal terminal anastomosis to improve clinical skills.?Methods?Retrospective analyzed the clinical data of 96 patients with the tubal isthmus, or of periampullary obstruction infertility from March 2012 to March 2017. All the patients were treated by modified laparoscopic tubal end to end anastomosis. Then compare the anastomosis placing stents (65 cases) and not placing stents (31 cases) in patients with laparoscopic success rate, operation time, intraoperative anastomosis patency rate, tubal patency rate after operation, postoperative pregnancy rate and so on. The epidural catheter from the oviduct umbrella end retrograde intubation to near the distal obstruction position, tiny camber of a tubal distal and proximal blind side, trim outside of fallopian tube catheterization tube surface near side end, make it of fallopian tube, catheter for support, with 5/0 absorbable suture suture needle 3-4. When the stent is placed in the victim, the tube is aligned first.With 5/0 absorbable thread 1 in 6 points, stitching on both sides of the tube cavity muscular layer, can be through the mucous membrane layer, 2 needle stitching at 12 o ’clock on both sides of the tube cavity muscular layer, can also through the mucous membrane, after 12 o ’clock sewed up at 6 o ’clock, in turn, taut knot, 3 pm 9 pm to 12 pm line as the center of muscularis suture pulp, need not through mucous membrane layer.intraoperative and postoperative first menstrual clean after 3 to 7 d in hydraulic dredge once.?Results?Intraoperative catheter stents, 65 cases of 96 patients, 128 article of fallopian tube anastomosis, intraoperative after anastomosis patency, 127 (99.22%), postoperative article after the first menstrual clean liquid 128 patency (100.00%), 24 months after pregnancy 53 cases (81.54%). No stents were put in 31 cases, and the tubal anastomosis was performed in 62, with 60 (96.77%) after anastomosis, and 61 unobstructed ventilation (98.39%) after the first period of operation (98.39%), and 25 cases in 24 months after surgery (80.65%).?Conclusion?Laparoscopic oviduct anastomosis can achieve better clinical results with the maturation of operation technique and improvement of surgical method.