Rock J A, Parmley T H, King T M, Laufe L E, Su B S
Fertil Steril. 1981 Jan;35(1):16-20. doi: 10.1016/s0015-0282(16)45251-9.
The present study details gross and histologic findings of 79 previously ligated fallopian tubes from 3 groups of patients. Of 20 oviducts removed after documented sterilization failure (group I), 6 revealed a process compatible with endometriosis. Four of nine previously ligated fallopian tubes removed at the Johns Hopkins Hospital (group II) were successfully injected with India ink. In two patients histologic examination demonstrated the India ink in epithelium-lined spaces that lay beyond the muscle of the tubal wall extending from the tubal lumen to the serosal surface. Fifty oviducts were studied in twenty-five patients requesting reversal of their sterilizations (group III). A higher percentage of fistulas was demonstrated in patients with less than 4 cm of remaining proximal tubal segment. Furthermore, most of these fistulas were demonstrated in patients for whom 3 years had elapsed since the original sterilization procedure. Patients sterilzed by laparoscopic cautery methods were observed to have a higher percentage of fistula formation and histologic documentation of endometriosis at the sterilization site as compared with patients sterilized by other methods. Our observations suggest that ligation of the oviduct within 4 cm of the uterine cornu may predispose to the development of endometriosis and subsequent fistula formation in the tip of the ligated oviduct.
本研究详细描述了来自3组患者的79条先前已结扎输卵管的大体和组织学发现。在记录到绝育失败后切除的20条输卵管（I组）中，6条显示出与子宫内膜异位症相符的病变过程。在约翰霍普金斯医院切除的9条先前已结扎的输卵管（II组）中，有4条成功注射了印度墨汁。在两名患者中，组织学检查显示印度墨汁存在于上皮衬里的间隙中，这些间隙位于输卵管壁肌肉之外，从输卵管腔延伸至浆膜表面。对25名要求输卵管复通的患者的50条输卵管进行了研究（III组）。剩余近端输卵管段小于4 cm的患者中，瘘管的发生率更高。此外，这些瘘管大多出现在距最初绝育手术已过去3年的患者中。与采用其他方法绝育的患者相比，观察到采用腹腔镜烧灼法绝育的患者在绝育部位形成瘘管的比例更高，且有子宫内膜异位症的组织学证据。我们的观察结果表明，在子宫角4 cm范围内结扎输卵管可能易导致结扎输卵管末端发生子宫内膜异位症及随后的瘘管形成。
