输卵管吻合术的临床术式探讨(1)
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[摘要] 目的 研究不同输卵管吻合术式的特点和临床效果。方法 研究不同输卵管吻合术式的适应条件及手术要求，并分别分析不同输卵管吻合临床术式的复通率及再孕率。结果 直视下输卵管吻合术手术简单、手术时间短，适合基层医院开展，显微输卵管吻合术的复通率(98.6%)及再孕率最高(95.5%)(P<0.05)，腹腔镜下输卵管吻合术手术损伤小，但对手术设备和器械要求较高，而且对手术医师的操作技巧也有很高的要求。而各种手术方式中，手术中放置支架的术后复通率(74.62%)及再孕率(51.94%)均低于不放置支架手术组(93.97%,81.92%)(P<0.05)。结论 输卵管吻合术的手术方式较多，各种术式的要求及效果有一定差异，应根据医院自身条件及患者要求等选择适当的手术方式。
[关键词] 输卵管吻合术 术式 复通率 再孕率
[中图分类号] R711.76[文献标识码] A[文章编号] 1005-0515(2011)-08-024-01
Clinical Surgical Methods and the Progress of Tubal Anastomosis
[Abstract] Objective To study the characteristics and the latest developments of different surgical methods of tubal anastomosis. Methods The study the conditions and requirements of different tubal anastomosis procedure, and analysis the recanalization rate and the pregnancy rate of different tubal anastomosis surgical. Results Tubal anastomosis surgery under direct vision is simple, shorter operative time for primary Hospital to carry out. The recanalization rate(98.6%)and pregnancy rate(95.5%)of microscopic tubal anastomosis was the highest(P<0.05).Laparoscopic tubal anastomosis surgical injury least, but require a higher surgical equipment and devices, and also have high demands in the surgeon's operating skills. In the variety of surgical procedures, the recanalization rate after(74.62%)and re-pregnancy rate (51.94%)in the surgery of placing stents were lower than non-surgical stent group (93.97%，81.92%)(P<0.05).Conclusion There are variety of surgical procedures in tubal anastomosis, they have different requirements, and results are different, it should be based on hospital conditions and patients requirements when selecting the appropriate surgical approach.
[Keywords] Tubal anastomosis; Surgical approach; Recanalization rate; Pregnancy rate
输卵管吻合术经过多年的发展，出现了各种不同手术方法，包括缝合法、组织粘合技术、导丝再通、气囊再通、输卵管钉合技术、显微技术、腹腔镜技术等[1]。目前缝合术是临床成熟的输卵管吻合术，但是目前临床上有各种条件下的缝合术，从最初的直视下到显微手术、腹腔镜手术等。各种术式的要求及效果不同[2-3]，笔者根据部分输卵管吻合术病例资料及部分研究资料的数据，试研究不同输卵管吻合术式的特点和临床效果，探讨输卵管吻合术的最新进展。现将有关结果汇报如下。
1 资料及方法
1.1 临床资料 总结150例于2001年-2009年在行输卵管吻合术的输卵管绝育术患者，均符合计划生育要求并报上级主管部门批准，150例患者中年龄最小为28岁，年龄最大为36岁。平均年龄33.51±4.31岁。平均绝育时间7.33±2.46岁。结扎方式：银夹法25例，抽管包埋法125例。经检查身体状况良好，月经规律，丈夫精液检查正常 ......
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