宫喜双?金惠敏?赵振?余晓玲?韩文丽

【摘要】目的 探讨腹腔镜输卵管吻合术中非置入支架法的临床应用价值。方法 收集84例行腹腔镜输卵管吻合术患者的临床资料，根据其输卵管吻合术后管芯是否置入硬膜外支架分为置入支架组38例（76条输卵管）和未置入支架组46例（92条输卵管）。比较2组患者手术时间、术中出血量、术中吻合通畅率、术后输卵管通畅率和术后1年妊娠率。结果 2组均全部完成输卵管吻合术。置入支架组的术中输卵管吻合通畅率和术后输卵管通畅率分别为99%和96%，术后1年妊娠率为82%，未置入支架组相应分别为99%、98%和87%，2组的术中输卵管吻合通畅率、术后输卵管通畅率和术后1年妊娠率比较差异均无统计学意义（P均> 0.05）。未置入支架组的手术时间短于置入支架组、术中出血量少于置入支架组（P均< 0.05）。结论 腹腔镜输卵管吻合术中非置入支架法与置入支架法的效果相同，但操作相对简单，手术时间短，安全性更高。

【关键词】输卵管阻塞;输卵管吻合术;腹腔镜;支架

Clinical application value of non-stent placement in laparoscopic fallopian tube anastomosis Gong Xishuang， Jin Huimin， Zhao Zhen， Yu Xiaoling， Han Wenli. Department of Obstetrics and Gynecology， Anyang Maternal and Child Health Hospital， Anyang 455000， China

Corresponding author， Gong Xishuang， E-mail： 15836345777@ 163. com

【Abstract】Objective To evaluate the clinical application value of non-stent placement in the modified laparoscopic fallopian tube anastomosis. Methods Clinical data of 84 patients undergoing modified laparoscopic fallopian tube anastomosis were retrospectively analyzed. According to whether the epidural stent was placed into the tube core after fallopian tube anastomosis， 38 patients were divided into the stent placement group （76 fallopian tubes） and 46 cases into the non-stent placement group （92 fallopian tubes）. The operation time， intraoperative blood loss， intraoperative anastomosis patency rate， postoperative fallopian tube patency rate， and postoperative 1-year pregnancy rate were statistically compared between two groups. Results All patients completed fallopian tube anastomosis. In the stent placement group， intraoperative anastomosis patency rate， postoperative fallopian tube patency rate and postoperative 1-year pregnancy rate were 99%， 96% and 82%， which did not significantly differ from 99%， 98% and 87% in the non-stent placement group （all P > 0.05）. In the non-stent placement group， the operation time was significantly shorter and intraoperative blood loss was significantly less than those in the stent placement group （both P < 0.05）. Conclusion During laparoscopic fallopian tube anastomosis， the application of non-stent placement yields equivalent efficacy to stent placement， whereas it is simple， shortens operation time and increases safety.

【Key words】Fallopian tube obstruction;Fallopian tube anastomosis;Laparoscopy;Stent

隨着腹腔镜技术的广泛应用，腹腔镜在不孕症等疾病诊治中发挥重要作用，加之我国近年二孩政策的开放，使有输卵管绝育术史又要求行输卵管复通的女性患者逐渐增多[1]。输卵管复通是针对输卵管结扎术后导致的输卵管因素不孕症所进行的修复疏通手术方式，一般使用端端吻合术，手术目的是疏通阻塞的输卵管，提高女性成功自然受孕的机会[2]。传统的输卵管复通术中常使用输卵管支架（硬膜外导管），便于引导输卵管闭锁处的切开和缝合，但容易损伤输卵管黏膜，增加输卵管粘连和穿孔的机会。我院……