Karayalcin Rana, Ozcan Sarp, Tokmak Aytekin, Gürlek Beril, Yenicesu Okan, Timur Hakan
1 Acibadem Ankara Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
2 Zekai Tahir Burak Women's Health Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
J Int Med Res. 2017 Jun;45(3):1245-1252. doi: 10.1177/0300060517709815. Epub 2017 May 23.
Objective Tubal sterilization is a widespread method of contraception. Post-sterilization regret is encountered, despite careful consideration prior to the procedure. Two treatment options are available for women after having had tubal sterilization: microsurgical reversal and IVF treatment. Recent improvements in laparoscopy have allowed tubal reanastomosis to be performed. This study aimed to evaluate the reproductive outcome after laparoscopic tubal reanastomosis and surgical features of the patients. Methods From June 2007 to January 2010, 27 patients with bilateral tubal ligation who underwent laparoscopic tubal reanastomosis were evaluated retrospectively. Tubal sterilization was performed by Pomeroy's technique during caesarean section in all of the patients. Before surgery, all of the patients were evaluated for possible other causes of infertility and the results of the evaluation were normal. Results The mean age of the patients was 31.8 years (range, 27-38 years). The mean interval between sterilization and reversal was 5.1 years (range, 1-14 years). Bilateral reversal was achieved in 24 patients. The operation time ranged from 85 to 140 minutes with a mean time of 105 minutes. All of the patients were discharged on the next day. There were no postoperative complications. Overall pregnancy, intrauterine pregnancy, and ectopic pregnancy rates were 55.5% (15/27), 51.8% (14/27), and 3.7% (1/27), respectively. Of the 14 intrauterine pregnancies, one ended with abortion at 6 weeks' gestation (1/14). The mean interval from surgery to pregnancy was 270 days (range, 147-420 days). Conclusion Laparoscopic tubal reanastomosis has the advantages of fewer complications, less postoperative discomfort, a smaller incisional scar, a shorter recovery time, and earlier resumption of normal activities. This technique has a satisfactory pregnancy rate in selected patients who desire reversal of tubal sterilization.
目的 输卵管绝育术是一种广泛应用的避孕方法。尽管在手术前已仔细考虑,但绝育术后仍会出现后悔情绪。输卵管绝育术后的女性有两种治疗选择:显微外科复通术和体外受精治疗。腹腔镜技术的最新进展使得输卵管再吻合术得以开展。本研究旨在评估腹腔镜输卵管再吻合术后的生殖结局及患者的手术特征。
方法 回顾性分析2007年6月至2010年1月期间27例行腹腔镜输卵管再吻合术的双侧输卵管结扎患者。所有患者均在剖宫产术中采用波默罗伊氏法进行输卵管绝育。术前,对所有患者进行了可能导致不孕的其他原因评估,评估结果均正常。
结果 患者的平均年龄为31.8岁(范围27 - 38岁)。绝育与复通之间的平均间隔时间为5.1年(范围1 - 14年)。24例患者实现了双侧复通。手术时间为85至140分钟,平均时间为105分钟。所有患者均于次日出院。无术后并发症。总体妊娠率(15/27)、宫内妊娠率(14/27)和异位妊娠率(1/27)分别为55.5%、51.8%和3.7%。在14例宫内妊娠中,1例在妊娠6周时流产(1/14)。从手术到妊娠的平均间隔时间为270天(范围147 - 420天)。
结论 腹腔镜输卵管再吻合术具有并发症少、术后不适轻、切口瘢痕小、恢复时间短以及能更早恢复正常活动等优点。对于希望逆转输卵管绝育的特定患者,该技术具有令人满意的妊娠率。