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56例输卵管妊娠治疗方法分析

【摘要】目的探讨输卵管妊娠的病因、诊断及治疗方法。方法回顾性分析2003年10月2007年12月收治的56例输卵管妊娠的临床资料。结果输卵管妊娠的病因有慢性输卵管炎、输卵管手术及IUD等。治疗采用以MTX和(或)米非司酮为主的药物治疗和手术治疗。结论输卵管妊娠的早期诊断为药物治疗和手术的选择提供了有利保证。

输卵管声学造影中发生过度换气的防治和处理

【摘要】　目的　总结输卵管声学造影中发生过度换气综合征的预防及治疗方法。　方法　2008年1月-2010年11月对35例出现过度换气综合征的患者进行临床资料分析。　结果　35例患者通过心理疏导及暗示疗法、面罩或纸袋限制通气、造影剂加温（37~38 ℃）等方法，临床症状得到缓解，治疗后随访症状消失。　结论　输卵管声学造影中发生的过度换气综合征患者，只要采取有效的预防措施，及早诊断，及早治疗，预后效果满意。

改良式输卵管吻合术疗效观察

目的 总结改良式输卵管吻合术的临床疗效。 方法 2008 年1 月－ 2010 年10 月，对89 例输卵管绝育术后育龄妇女行双侧改良式输卵管吻合术，从输卵管结扎部位浆膜层的分离、管芯的端端对合及吻合方法等方面改进。患者年龄25 ～ 42 岁，平均35 岁。手术时间为月经结束后3 ～ 7 d。术中取切除的输卵管结扎瘢痕组织送病理检查。吻合术后5 d 及第1 次月经结束后3 ～ 7 d 行输卵管通液手术。术后12 个月以上未妊娠者行子宫输卵管碘油造影。 结果 89 例双侧输卵管吻合均成功。术中见慢性盆腔炎8 例，病理检查示慢性输卵管炎17 例。术后5 d 输卵管通液通畅率为100%，第1 次月经结束3 ～ 7 d 通畅率为95.5%。术后避孕4 例。术后2 年内妊娠率为61.2%（52/85），其中术后12 个月内妊娠47 例；12 ～ 18 个月内妊娠5 例，其中2 例为输卵管妊娠。52 例妊娠者中，慢性盆腔炎患病率为3.8%（2/52），与33 例未孕患者慢性盆腔炎患病率42.4%（14/33）比较，差异有统计学意义（χ2=12.261，P=0.000）。术后12 个月以上未孕者中14 例行输卵管碘油造影，有5 例输卵管梗阻。 结论 改良式输卵管吻合术具有吻合口张力小、对合好，缝合针数少，术后输卵管通畅性好等优点。建议对术后1 年以上未孕者尽早施行输卵管通畅性及盆腔炎症的评估。

输卵管绒癌一例

Clinical Evidence of Tubal Infertility

CLINICAL APPLICATION OF TUBAL RECONSTRUCTION AFTER LAPAROSCOPIC TUBAL PREGNANCY OPERATION

ObjectiveTo investigate the effectiveness of the tubal reconstruction after laparoscopic tubal pregnancy operation by comparing with simple laparoscopic tubal pregnancy operation. MethodsBetween May 2007 and May 2010, 63 patients with tubal pregnancy underwent laparoscopic tubal pregnancy operation and tubal reconstruction in 30 cases (trial group) or simple laparoscopic tubal pregnancy operation in 33 cases (control group). There was no significant difference in age, pregnancy time, and position between 2 groups (P gt; 0.05). The tube patency test and hysterosalpingography (HSG) were carried out to evaluate the efficacy. ResultsThe operation was successfully completed in 29 cases of trial group; 1 case had too severe adhesion to receive re-anastomosis and was excluded. The tube patency test showed that the tube was patency in 26 cases of trial group and in 2 cases of control group during operation, showing significant difference (Z=5.86, P=0.00); it was patency in 25 cases of trial group and in 26 cases of control group at 1 month after operation, showing no significant difference (Z=0.48, P=0.63). HSG examination showed tube was patency in 25 cases of trial group and in 2 cases of control group at 2 months after operation, showing significant difference (Z=5.35, P=0.00). After 24 months, intrauterine pregnancy of trial group (n=25, 86.20%) was significantly higher than that of control group (n=19, 57.58%) (χ2=7.72, P=0.01). ConclusionThe reconstruction after laparoscopic tubal pregnancy operation can significantly increase the intrauterine pregnancy rate, and it is better than simple laparoscopic tubal pregnancy operation.

Chinese Medicinal Herbs for Tubal Subfertility: A Systematic Review

Objective　To assess the effectiveness and safety of traditional Chinese medicinal herbs for subfertility. Method　Databases used including MEDLINE, EMBASE, CBM and the Cochrane Controlled Trial Register (CCTR). Potentially related trials in reference lists of studies were hand searched. Published RCTs in any languages and length whether they were blind or unblind, were included. Treatments were Chinese medicinal herbs (single or compound), and controls were placebo, standard medical intervention, or no intervention. Data were extracted independently by two reviewers and analyzed with Revman 4.2 softeware. Results　7 randomized trials, including 1 042 patients met inclusion criteria. Methodological quality of all trials was poor. Chinese medicinal herbs were effective compared with routine antibiotics [RR 1.49, 95％CI (1.37 to1.62), Plt;0.000 01] and resulted in higher pregnancy rate [RR 1.46, 95%CI (1.09 to,1.96), P=0.01]. There were no adverse events reported in treatment group. Conclusions　Some Chinese medicinal herbs may be effective for subfertility. However, the evidence is too weak to draw a conclusion. More strictly designed, randomized, double-blind, placebo-controlled trials are required.

输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况调查

目的:了解输卵管妊娠患者开腹行患侧输卵管切除术后生殖状况,以指导输卵管妊娠的临床治疗。方法:选择我院2004年至2007年因输卵管妊娠行开腹患侧输卵管切除术患者183例术后的生殖状况进行随访调查,回顾性分析其再次受孕及输卵管妊娠情况。结果: 在有生育要求的107位患者中,总的宫内妊娠率为64.5％(69/107例),8.7％复发输卵管妊娠(6/107例)。宫内受孕率以lt;30岁,术后1～2年最高,中重度贫血及盆腔中重度黏连导致宫内受孕机率下降;复发输卵管妊娠与年龄及术后时间无相关性,随贫血程度及盆腔黏连程度的加重进行性增加。结论: 开腹患侧输卵管切除术后生殖状况与年龄、术后时间、盆腔黏连程度、贫血程度密切相关。及时手术,减轻贫血程度,细致分黏,合理生殖健康指导,能有效提高宫内妊娠,降低复发输卵管妊娠。

腹腔镜下改良保守手术治疗输卵管妊娠的临床疗效

【摘要】目的 探讨腹腔镜下行保守手术治疗输卵管妊娠的理想方法。方法 2008年9月-2009年10月腹腔镜下对68例输卵管妊娠患者行改良保守性手术,术中采用输卵管系膜血管结扎及垂体后叶素注射止血,从输卵管破口或开窗口负压吸胚,并行妊娠黄体剔除,术后口服米非司酮直至血绒毛膜促性腺激素(βHCG)降至阴性水平。结果 68例流产型、破裂型、陈旧型、未破损型全部成功完成保守手术(包括内出血超过1 000 mL者5例)。发生持续性宫外孕1例,术后3 d加用甲氨喋呤 75 mg,单次静推后治愈;术后第3天血βHCG平均下降率为92%,无手术并发症。术后随访36例,术后1~3个月行宫腔镜下输卵管通液通畅。结论 腹腔镜下保守术式的改进治疗输卵管妊娠安全可行,只要注意手术方法,加强术后监测, 可获得良好效果。

Clinical Evidence of Unexplained Infertility