Mettler L, Giesel H, Semm K
Fertil Steril. 1979 Oct;32(4):384-8. doi: 10.1016/s0015-0282(16)44290-1.
The advent in recent years of safe endocoagulation (thermocoagulation within the abdomen) has permitted operative laparoscopic treatment of the tubal factor in infertility in selected cases. This paper reviews the results of operative laparoscopy in 223 cases treated for infertility between 1971 and 1976. Tubal occlusion was present in 133 patients before surgical intervention. Following operative laparoscopy, tubal patency was demonstrated in 67% on testing at the time of operation and in 12% at the first postoperative hydrotubation. In only 21% of cases was tubal patency not achieved by these methods. Those cases requiring isthmic salpingostomy, ampullary or isthmic-tubal implantation, or end-to-end anastomosis were further treated by laparotomy and microsurgery. Ninety cases of pelvic endometriosis were treated by a combination treatment of thermocoagulation, ovarian cyst resection, and the antigonadotropin agent, danazol. Ovariolysis, salpingolysis, fimbrioplasty, and salpingostomy can easily be performed using operative laparoscopy as the method of choice with a minimum of complications, shortened hospitalization time (2 days), and the potential for a repeat procedure or a follow-up laparotomy should this be necessary. The pregnancy rate following laparoscopic treatment for the correction of distal tubal occlusion was 30.5% and for endometriosis genitalis externa, 40%. These rates compare favorably with the rates following procedures involving laparotomy and microsurgery for correction of similar lesions.
近年来，安全的体内凝固法（腹腔内热凝固）的出现，使得在某些特定病例中能够通过腹腔镜手术治疗不孕症的输卵管因素。本文回顾了1971年至1976年间对223例不孕症患者进行腹腔镜手术的结果。在手术干预前，133例患者存在输卵管阻塞。腹腔镜手术后，术中测试显示67%的患者输卵管通畅，术后首次输卵管通液时12%的患者通畅。仅21%的病例通过这些方法未能实现输卵管通畅。那些需要进行峡部输卵管造口术、壶腹部或峡部输卵管植入术或端端吻合术的病例，进一步通过剖腹手术和显微外科手术进行治疗。90例盆腔子宫内膜异位症患者采用热凝固、卵巢囊肿切除术和抗促性腺激素药物达那唑联合治疗。卵巢松解术、输卵管松解术、伞端成形术和输卵管造口术可轻松通过腹腔镜手术进行，这是首选方法，并发症最少，住院时间缩短（2天），如有必要，还可进行重复手术或后续剖腹手术。腹腔镜治疗远端输卵管阻塞后的妊娠率为30.5%，治疗外阴子宫内膜异位症后的妊娠率为40%。与涉及剖腹手术和显微外科手术治疗类似病变后的妊娠率相比，这些比率具有优势。
