子宫全切除术后发生输卵管脱垂的临床分析

Clinical analysis of fallopian tube prolapse after hysterectomy

目的探讨子宫全切除术后输卵管脱垂的诊断、处理及预防措施。方法收集1983年1月至2005年8月行各类子宫全切除术7949例患者的资料,其中行开腹子宫全切除术6229例,行阴式子宫全切除术780例,行腹腔镜辅助阴式子宫全切除术940例。结果手术后共发生阴道残端输卵管脱垂9例,发生率为0．11%(9/7949)。其中开腹子宫全切除术后发生5例,发生率为0．08% (5/6229)；阴式子宫全切除术后发生4例,发生率为0．51%(4/780)；腹腔镜辅助阴式子宫全切除术后无一例发生输卵管脱垂。9例患者子宫全切除术后均放置了阴道引流管,其中5例子宫切除后未行阴道残端腹膜化处理。9例患者中,3例无任何症状；6例有症状的患者中,1例出现左侧腰背部痛,5例出现阴道排液。妇科检查,3例阴道残端发现输卵管伞端,6例阴道残端可见类似肉芽样组织。9例患者均经阴道切除,局部烧灼脱垂的输卵管,切除组织经病理检查证实均为输卵管组织。之后随诊1～59个月无异常发现。结论输卵管脱垂是子宫全切除术后的一种少见并发症,输卵管脱垂一般发生于子宫全切除术后放置阴道引流管的患者,经正确的诊断和治疗预后良好。行子宫全切除术时,应将附件固定在骨盆侧壁或行输卵管切除。

Objective To investigate the clinical diagnosis, treatment and prevention of fallopian tube prolapse （FTP） after hysterectomy. Methods A total of 7949 patients received hysterectomy from 1983 to Aug 2005 in Peking Union Medical College Hospital, including 6229 cases of trans-abdominal hysterectomy （TAH）, 780 cases of transvaginal hysterectomy （TVH）, and 940 cases of laparoscopic assisted vaginal hysterectomy （ LAVH ）. Nine cases （ including 1 case from other hospital ） of FTP after hysterectomy were analyzed retrospectively for their symptoms, diagnosis and treatment. All of them were diagnosed according to the results of histology and follow-up. Results The overall incidence of FTP after hysterectomy was 0. 11% （9/7949）. Incidence of FTP after trans-abdominal hysterectomy was 0. 08% （ 5/6229 ）, after vaginal hysterectomy 0. 51% （ 4/780 ） , and after laparoscopic assisted vaginal hysterectomy 0 （0/940）. There were no symptoms in 3 cases, but the other 6 cases had symptoms. The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and red granulation tissue in the other 6 cases. All of them were excised vaginally and cauterized. The results were confirmed by histological examination. No recurrent cases were reported in follow up. Conclusions FTP is a rare complication after hysterectomy. The prognosis is well after proper diagnosis and treatment. Salpingectomy or fixation of accessories into the pelvic wall and complete peritonealisation at the time of hysterectomy are important methods to prevent FTP after hysterectomy.