腹腔镜输卵管宫角植入术治疗42例输卵管近端阻塞的临床观察

Clinical observation of laparoscopic tubal cornual implantation in the treatment of 42 cases of proximal tubal obstruction

目的：探讨腹腔镜输卵管宫角植入术治疗输卵管近端阻塞的手术方法及临床疗效。方法：回顾分析2007年12月至2010年12月为42例输卵管近端阻塞致不孕患者行腹腔镜输卵管宫角植入术的临床资料。腹腔镜下切除阻塞部输卵管,将通畅部输卵管植入宫角,输卵管内放置支架管并保留14 d。结果：双侧植入39例,单侧植入3例,无一例中转开腹及发生副损伤,术后6~12个月行子宫输卵管碘油造影,均显示输卵管通畅,除1例合并子宫腹膜瘘形成外,无一例发生输卵管闭锁。术后3年随访,继发性腹腔妊娠1例,宫内受孕30例,11例未受孕。结论：腹腔镜输卵管宫角植入术治疗输卵管近端阻塞所致的不孕疗效满意,借助支架子宫角部与输卵管吻合处愈合良好,保持输卵管与子宫通畅,重新恢复了输卵管的拾卵与运输功能。

Objective：To study the operative method and clinical effect of laparoscopic tubal cornual implantation in the treatment of proximal tubal obstruction. Methods：Retrospective analysis was made on the clinical data of 42 patients who suffered from infertility caused by proximal tubal obstruction and underwent laparoscopic tubal cornual implantation from Dec. 2007 to Dec. 2010. Obstructed fallopian tube was resected under laparoscopy,unobstructed fallopian tube was implanted into the cornua uteri,the stent was placed in fallopian tube and kept for 14 d. Results：Thirty nine cases of oviduct were bilaterally implanted,3 cases of oviduct were unilaterally implanted,no conversion to laparotomy or vice injury occurred,uterus oviduct iodine oil radiography was performed in postoperative 6-12 months,all oviducts were unobstructed,no tubal atresia was found except 1 case combined with uterine peritoneal fistula formation. During the follow-up of 3 years,there were 1 case of secondary abdominal pregnancy,30 cases of intrauterine pregnancy,11 cases were not pregnant. Conclusions：Laparoscopic tubal cornual implantation obtains satisfactory curative effect in the treatment of infertility caused by proximal tubal obstruction,tubal cornual anastomosis heals well with stent. This procedure keeps oviduct and uterus unobstructed,restores tubal function of picking up the egg and the transportation.