显微输卵管复通手术与异位妊娠关系的探讨

Relationship between microsurgical tubal reversal and ectopic pregnancy

目的探讨显微输卵管复通术与异位妊娠的关系及术中、术后与异位妊娠发生有关的因素。方法随访１０２９例绝育后行显微输卵管复通术的妇女，对其中发生异位妊娠及其相关因素进行分析。结果１０２９例妇女中子宫内妊娠９６０例，异位妊娠１２例（均为输卵管妊娠）。异位妊娠占复通手术妇女的１．１７％，占妊娠妇女的１．２３％，与子宫内妊娠的比例为１８０。手术后第一、二及年两年后复通手术妇女和妊娠妇女中异位妊娠率差异均无显著意义；术后６月内及７～１２月异位妊娠率差异亦无显著意义。手术后进行早期通液者异位妊娠率升高；绝育方法、复通术式、绝育至复通的时间均与异位妊娠无关系。结论复通术中彻底切除绝育部位病变、穿过粘膜缝合及不进行早期通液，可控制异位妊娠率；手术后６个月内避孕并不影响异位妊娠率。

Objective To study the correlation between microsurgical tubal reversal after tubal sterilization and ectopic pregnancy. Methods 1029 women who underwent microsurgical tubal reversal were followed up. The causes of ectopic pregnancy were analysed and discussed. Results 960 intrauterine pregnanciess and 12 ectopic pregnancies occurred. The 12 ectopic pregnancies were all tubal ones, among which 2 had intrauterine pregnancies. The rate of ectopic pregnancy in the 1029 women was 1.17%, and in the pregnant cases was 1.23%. The ratio of intrauterine pregnancy to ectopic pregnancy was 1∶80. The rates of ectopic pregnancy in the 1st, 2nd year and 2 years later after tubal reversal were not significantly different respectively among the tubal reversal and among the pregnant cases. The rates of ectopic pregnancy in the 1st and 2nd 6 months after tubal reversal were not statistically different. The early tubal hydrapertubation could only increase the chance of ectopic pregnancy. The sterilization method, reversal mode, and interval between sterilization and reversal were not related to the ectopic pegnancy. Conclusion When the lesion in the sterilized position is completely removed, the sutures being through the tubal mucosa and the early tubal hydrapertubation not carried out, the chance of ectopic pregnancy can not be increased after tubal reversal. The contraception 6 months after tubal reversal is not related to ectopic pregnancy