腹腔镜绝育术14年评估

The evaluation of fourteen years′ laparoscopic stcrilization

为了解腹腔镜绝育术（简称镜式绝育）的安全性、有效性及可行性，总结本院自１９７９～１９９３年１４年中所作镜式绝育的病例，以供今后作女性绝育手术之参考。共１８０６例，分为两组：第一组（农村组）为我们赴农村集中手术，共１７９例。第一组（城市组）为门诊收住院手术，共１６２８例。手术全部采用局部麻醉、脐部单切口下手术。镜式绝育方法：硅胶环法１５８８例，金属夹法１２６例，双极电凝法１５例，单极电凝法７７例。对术中反应，术中所见异常情况，术后近期随诊和半年以上为远期随诊等进行了分析。认为除了国内外沿用的腹部小切口绝育方法外，镜式绝育术是一种安全、有效、方便、可行的绝育方法，如果掌握技术操作及仪器性能，在有条件的基层医院可以逐步开展，以方便患者就医。

Laparoscopic sterilization is currently a populary method of female sterilization aborad,but not in China. In order to clarify the safety, effectiveness and feasibility, we analysed 1 806 cnses oflaparoscopic sterilization performed in the Peking Union Medical College Hospital in the last l4 yeursfrom February 1979 to May 1993. The total cases were divided into two groups,the cases in the firstgroup were performed in the countryside(the village group),whereas those in the second group were ope-rated in the hospital(the city group).All operations were performed under local anasthesia and With asingle-incision in the umbilical region,among which Fallops ring was applied in 1 588 cases, Hulka clipin 126 cases,bipolar electric coagulation in 15 cases,and unipolar electric coagulation in 77 cases.There-actions,at the time of operation,abnormal findings in the operation and data of short term and over6-months long term follow-ups postoperative were analyzed.During the long term follow-ups, theeffact of laporoscopic sterilization on body weight,emotion,labor,menstruation and sexual life were in-vestigated. Postoperative abdominal pain,pregnancy due to sterilization failure or in case of accidentaldeath of the child,the possibility of recanalization and pregnancy were the main concerns investigated.With the analysis of the follow-up data,these concerns were relieved.The following points were dis-cussed in this paper:(1)the safety of laparocopic sterilization,(2) pregnancy due to failure of sterilization,(3) postoperative abdominaL pain,and(4) tubal reanastomosis after laparoscopic sterilization. In conclu-sion, in addition to the minilaparotomy of tubal ligation method,lapnroscopic sterilization is also a safe.effective, convenient and feasible new method,which could be popularized in a small country hospital.provided there are the facilities and the clinician can master the technique of laparoscopy.