Department of Obstetrics and Gynecology, University of British Columbia, Women's Hospital, Vancouver, British Columbia, Canada.
Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Gasthuisberg, Leuven, Belgium.
Fertil Steril. 2016 Oct;106(5):1025-1031. doi: 10.1016/j.fertnstert.2016.08.040.
"Microsurgery" is a set of principles developed to improve fertility surgery outcomes. These principles were developed progressively based on common sense and available evidence, under control of clinical feedback obtained with the use of second-look laparoscopy. Fertility outcome was the end point; significant improvement in fertility rates validated the concept clinically. Postoperative adhesion formation being a major cause of failure in fertility surgery, the concept of microsurgery predominantly addresses prevention of postoperative adhesions. In this concept, magnification with a microscope or laparoscope plays a minor role as technical facilitator. Not surprisingly, the principles to prevent adhesion formation are strikingly similar to our actual understanding: gentle tissue handling, avoiding desiccation, irrigation at room temperature, shielding abdominal contents from ambient air, meticulous hemostasis and lavage, avoiding foreign body contamination and infection, administration of dexamethasone postoperatively, and even the concept of keeping denuded areas separated by temporary adnexal or ovarian suspension. The actual concepts of peritoneal conditioning during surgery and use of dexamethasone and a barrier at the end of surgery thus confirm without exception the tenets of microsurgery. Although recent research helped to clarify the pathophysiology of adhesion formation, refined its prevention and the relative importance of each factor, the clinical end point of improvement of fertility rates remains demonstrated for only the microsurgical tenets as a whole. In conclusion, the principles of microsurgery remain fully valid as the cornerstones of reproductive microsurgery, whether performed by means of open access or laparoscopy.
“显微外科”是一套旨在提高生育手术效果的原则。这些原则是基于常识和现有证据逐步发展起来的，并在使用腹腔镜进行二次探查获得的临床反馈的控制下进行。生育结果是终点；生育成功率的显著提高在临床上验证了这一概念。术后粘连是生育手术失败的主要原因，因此显微外科的概念主要针对预防术后粘连。在这个概念中，显微镜或腹腔镜的放大作用只是作为技术促进剂。毫不奇怪，预防粘连形成的原则与我们的实际理解惊人地相似：轻柔的组织处理、避免干燥、室温冲洗、将腹部内容物与外界空气隔离、细致的止血和灌洗、避免异物污染和感染、术后给予地塞米松、甚至保持裸露区域分离的临时附件或卵巢悬吊的概念。因此，术中腹膜处理、地塞米松和手术结束时屏障的实际概念无一例外地证实了显微外科的原则。尽管最近的研究有助于阐明粘连形成的病理生理学，细化了其预防措施和每个因素的相对重要性，但只有作为一个整体的显微外科原则才能证明生育成功率的提高。总之，显微外科的原则仍然是生殖显微外科的基石，无论是通过开放手术还是腹腔镜手术进行。
