Clinical Application of Transcervical Guidewire or Epidural Catheter in Hysteroscopic Combined with Laparoscopic Oviduct Anastomosis
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摘要:
目的 探讨介入导丝或硬膜外导管在宫、腹腔镜联合输卵管修复手术治疗输卵管性不孕的临床运用价值。 方法 回顾分析2012年6月至2019年8月于云南省第三人民医院因输卵管阻塞引起不孕症74例患者。根据术中是否在输卵管内植入介入导丝或硬膜外导管辅助输卵管吻合，将患者分为导丝辅助缝合组31例与常规缝合组43例。 结果 导丝辅助缝合组与常规缝合组比较，手术缝合时间（16.871±3.052） min vs （19.488±5.795） min（F = 5.256，P = 0.025），输卵管缝合补针数[0（0-0）] vs [0（0-2）]（χ2 = 4.963 ，P = 0.032），美兰液渗漏率[5/31（16.1%）] vs [14/44（31.8%）] (χ2 = 3.938，P = 0.047），术后造影通畅率[70/76(92.1％）] vs [29/37（78.3％）]（Z = 2.409，P = 0.016），导丝辅助缝合组有优势，差异有统计学意义。但两组手术总体时间（130.161±20.584） min vs （122.907±15.053） min （F = 3.070，P = 0.083），3～24个月宫内累计妊娠率[14/31（45.2%） vs 17/43（39.5%）]（F = 0.234，P = 0.628），差异无统计学意义 （P > 0.05）。 结论 宫、腹腔镜联合输卵管吻合术中通过导丝及硬膜外导管辅助缝合输卵管，手术缝合时间短，手术野清楚，缝合相对简单可靠，术后通畅率高的优势。 -
关键词:
- 介入导丝 /
- 硬膜外导管 /
- 输卵管阻塞 /
- 宫、腹腔镜联合输卵管吻合术
Abstract:Objective To explore the clinical value of transcervical guidewire or epidural catheter in surgery of hysteroscopic combined laparoscopic oviduct anastomosis. Methods Seventy-four cases of fallopian tube obstruction from June 2012 to August 2019 were retrospectively analyzed. During laparoscopic combined hysteroscopic oviduct anastomosis surgery, 31 cases underwent oviduct anastomosis assisted by epidural catheter or transcervical guidewire, 43 case underwent conventional oviduct anastomosis. Results The oviduct suture time （16.871±3.052） min vs （19.488±5.795） min （F = 5.256 P = 0.025）; the number of remedial stitches of oviductanastomosis[0（0-0）] vs [0（0-2）] （χ2 = 4.963 P = 0.032）, the leakage rate of Meilan liquid [5/31（16.1%）] vs [14/44（31.8%）] （χ2 = 3.938 P = 0.047）; the postoperative fallopian tube patency rate of hysterosalpingography （HSG） [70/76（92.1%）] vs [29/37（78.3%）] （Z = 2.409 P = 0.016）, the conventional oviduct anastomosis was significantly better than that of the group assisted by epidural catheteror transcervical guidewire （P < 0.05）. The operation time 130.161±20.584） min vs （122.907±15.053） min （F = 3.070 P = 0.083） and intrauterine pregnancy rate of 3-24 months [14/31（45.2%） vs 17/43（39.5%）] （F = 0.234 P = 0.628） had no statistical significance between the two groups. Conclusion The operation of oviduct anastomosis assisted by transcervical guidewire or epidural catheter has the shorter oviduct suture time, better exposure field, more simple and reliable oviduct sutureas compared with those in conventional oviductanastomosis. -
图 1 确认输卵管阻塞及狭窄部位并给予切除
Figure 1. The obstruction and stenosis of fallopian tube were confirmed and resected
图 2 腹腔镜下将由宫腔镜植入输卵管的导丝从输卵管近端断端拉出后再穿入输卵管远端断端管腔内
Figure 2. Under laparoscope, the guide wire implanted into the fallopian tube by hysteroscope was pulled out from the proximal end of the fallopian tube and then penetrated into the distal end of the fallopian tube
图 3 若吻合口美兰液涌出则再次间断补针缝合输卵管
Figure 3. If the Meilan liquid was gushing out of theanastomotic mouth, the fallopian tube was stitched intermittently again
图 4 导丝辅助缝合组与常规缝合组缝合时间比较
*P < 0.05。
Figure 4. The comparison of the suture time between the group assisted by epidural catheteror transcervical guidewire and conventional oviduct anastomosis group
图 5 导丝辅助缝合组与常规缝合组总手术时间比较
Figure 5. The comparison of the operation time between the group assisted by epidural catheteror transcervical guidewire and conventional oviduct anastomosis group
表 1 两组人口学特征及妇科相关疾患资料比较（
$\bar x \pm s$ ）Table 1. Comparison of demographic characteristics and gynecological related diseases between the two groups （
$\bar x \pm s$ ）组别 n 年龄（岁） 既往盆腔粘连及
慢性输卵管炎例数（n）输卵管
结扎例术（n）输卵管妊娠
相关例数（n）单/双侧输卵管
吻合例数（n/n）导丝辅助缝合组 31 37.838 ± 5.398 11 7 13 20/11 常规缝合组 43 36.372 ± 4.825 14 11 19 25/18 t/χ2 1.227 0.069 0.088 0.037 0.307 P 0.223 0.793 0.767 0.847 0.579 
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表 2 导丝辅助缝合组与常规缝合组在手术相关指标比较[
$\bar x \pm s$ /n（%）]Table 2. Comparison of operation-related indexes between the group assisted by epidural catheteror transcervical guidewire and conventional oviduct anastomosis group [
$\bar x \pm s$ /n（%）]组别 n 总手术时间（min） 输卵管缝合时间（min） 美蓝渗漏率 输卵管补针数 导丝辅助缝合组 31 130.161 ± 20.584 16.871 ± 3.052 5（16.1） 0（0-0） 常规缝合组 43 122.907 ± 15.053 19.488 ± 5.795 14（30.2） 0（0-2） χ2/t/Z 3.070 5.256 3.938 2.409 P 0.083 0.025* 0.047* 0.016* 导丝辅助缝合组与常规缝合组比较， *P < 0.05。
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表 3 导丝辅助缝合组与常规缝合组在生育相关指标比较[n（%）]
Table 3. Comparsion of reproduction-related indexes between the group assisted by epidural catheteror transcervical guidewire and conventional oviduct anastomosis group [n（%）]
组别 n 术后3月造影通畅率 3～24个月累计宫内妊娠率 导丝辅助缝合组 31 30（96.7） 14（45.1） 常规缝合组 43 29（62.7） 17（39.5） χ2/t/Z 3.988 0.234 P 0.046* 0.628 导丝辅助缝合组与常规缝合组比较，*P < 0.05。
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