腹腔镜输卵管宫角吻合术的初步研究(附19例报告)

The preliminary study of laparoscopic tubocornual anastomosis:with a report of 19 cases

目的：初步探讨腹腔镜输卵管宫角吻合术的可行性和临床应用价值。方法：2009年4月至2010年2月为19例输卵管近端阻塞的不孕症患者施行腹腔镜输卵管宫角吻合术。结扎患侧输卵管宫角处子宫动脉终末支,垂体后叶素用生理盐水（1：100）稀释后注射于宫角及输卵管系膜处以预防出血。切除输卵管近端闭塞段,行输卵管通液证实输卵管近端和远端通畅后,用2-0可吸收缝线缝合两断端输卵管系膜一针以减张,用5-0可吸收线于12点行过粘膜或不过粘膜的＂一针式＂缝合以准确吻合,再间断缝合两段输卵管浆膜层2~3针。结果：术后随访19例患者共25条输卵管,17条通畅,通畅率68%,7条输卵管经导丝疏通后通畅,占28%;1条因输卵管宫角开口显示不清,插管不成功。结论：输卵管近端闭塞的患者可行腹腔镜输卵管宫角吻合术,术中患者出血少,视野清晰,且创伤小,康复快,是近端输卵管闭塞复通的较好选择。

Objective：To preliminarily investigate the feasibility and clinical appliance value of laparoscopic tubocornual anastomosis.Methods：Nineteen proximal oviduct occlusive infertile women underwent laparoscopic tubocornual anastomosis from Apr.2009 to Feb.2010.The terminal branch of affected tubocornual uterine artery was ligated.Hypophysin,diluted with sodium chloride（1：100）,was injected into cornua uteri and tubal mesenterium in prevention of hemorrhage.After excising the obstruction part of proximal oviduct,oviduct lavage was performed to confirm the patency of remained parts.Then,tubal mesenterium of two sides was sutured to reduce the tension.The one stitch technique（5-0 absorbable thread though mucous membrane or not） was used for accurate anastomosis at 12 o＇clock,and serous membrane was sutured interruptedly.Results：All of the 19 patients were followed up.17 of 25 oviducts were patent（68%）.The other 7 tubes patency was obtained by canalization（28%）.Because the tubocornual orifice was illegible,the rest one was failed in cannula.Conclusions：Laparoscopic tubocornual anastomosis can be performed for infertile patients with proximal oviduct occlusion.With less blood loss and trauma,clearer visual field and quicker recovery,it would be a better choice for proximal oviduct obstruction.