fallopian tube intrauterine transplantation

Fallopian tube intrauterine transplantation for fallopian tube recanalization. Fallopian tube recanalization is an infertility caused by the fallopian tube factor, and the purpose of gestation is achieved through repair surgery. It is not only to make the lumen unobstructed, but also to consider the functional state of the organ. Therefore, the choice of the case before surgery and the fineness of the surgical technique, as well as careful postoperative treatment are the factors that determine the success or failure of the operation. The cases of recanalization were followed by tubal ligation and tubal obstruction infertility. The recanalization after tubal ligation is different depending on the original ligation procedure. The original ligation is performed by isthoracic entrapment or double-fold ligation, and the site of the ligation is in the fallopian tube. /3 segments for easy anastomosis. Due to the advancement of microscopy technology, the success rate of surgery has been improved. A large number of clinical data have reported that the success rate of microsurgical tubal anastomosis after sterilization is more than 90%. Microsurgery for fallopian tube recanalization, surgeons and assistants must first carry out basic training, familiar with the structure, performance and use of the operating microscope, training the uniformity of eye movements, and the cooperation between the surgeon and the assistant is also successful. The essential. The anastomosis operation is simple, the success rate of surgery and the postoperative pregnancy rate are much higher than those of ostomy and transplantation. Of course, in some cases, when the tube is ligated too much, the tube core is too much or the diameters of the two ends are very different, which will affect the effect of the operation. Infertility caused by obstruction of the fallopian tube accounts for 30% to 40% of infertility cases. Different pathological types have different success rates. Different surgical methods must be chosen depending on the location of the fallopian tube obstruction. The obstructive segment is at the distal end of the isthmus or the ampulla. The obstructive segment can be removed for anastomosis. The obstruction can be used for tubal ostomy in the umbrella or ampulla. The uterine horn (interstitial) or the proximal isthmus is used as the fallopian tube. Intrauterine transplantation, can also be based on the extent of bilateral fallopian tube lesions for their own fallopian tube transplantation. The fallopian tube obstruction caused by infection not only obstructs the lumen but also has inflammatory adhesions around the fallopian tube. The normal anatomy and physiological functions of the fallopian tube are destroyed. The success rate of recanalization is very low, and there is the possibility of ectopic pregnancy. Due to the interference of surgery, re-adhesion and infection can affect the effect of rehabilitation. In recent years, the development of IVF-ET has solved the surgical problem of partial fallopian tube infertility. The value of tubal recanalization is getting smaller and smaller. If the tubal interstitial and isthmus are completely obstructed, the distal fallopian tube is normal, and the fallopian tube anastomosis is not possible, the fallopian tube intrauterine transplantation can be performed selectively; if both sides of the fallopian tube are partially damaged, one side of the lesion is at the distal end, and another One side of the lesion is at the proximal end, the lesion can be removed, and the healthy part is autografted with blood vessels. The fallopian tube and blood vessels are anastomosed by microscopic technique, and the fallopian tube can be restored. The former has a high recanalization rate, but the pregnancy rate is low, about 14% to 27% of the pregnancy rate, the latter technology is more complicated, and the success rate is lower. Treating diseases: female infertility Indication Tubal intrauterine transplantation is suitable for infertility caused by obstruction of the tubal interstitial and isthmus. Contraindications 1. When the age is over 40 years old, the reproductive ability is reduced. There is less chance of conception after re-opening. It is generally not suitable for transplantation. 2, genital tube disease gynecological tumors, genital inflammation, endometriosis and pelvic tuberculous inflammation adhesions are more serious. 3, ovarian dysfunction, no normal ovulation function. 4, the previous surgery for tubal resection or major resection, unipolar electrocoagulation sterilization and drug blocking sterilization, large fallopian tube damage and the previous failure of fallopian tubeplasty caused by tubal is too short, it is not suitable for transplantation. Preoperative preparation 1. Inquire about the medical history and physical examination in detail, understand the general medical history and methods of previous sterilization, whether there is any infection after surgery, and do the whole body and gynecological examination and necessary laboratory tests. 2, uterine tubal iodine oil angiography before surgery to clarify the location of the fallopian tube obstruction and the presence or absence of lesions in the uterine cavity. The operation time should be performed after 3 months of angiography. It has been clarified that no angiography can be performed after sterilization. 3, endoscopy examination suspected pelvic adhesions, endometriosis, tuberculosis or tumors, should be used for laparoscopic or posterior sputum examination, suspected uterine lesions should be hysteroscopy. 4, the husband's semen routine examination. 5, 3 ~ 7d after menstruation, the fallopian tube mucosa is thin, the broken end is easy to match, so early proliferation is the best operation time. There are also advocated oral estrogen to prolong the proliferative phase and increase the chance of fluid. 6, preoperative antibiotics 3d, vaginal washing 3d. 7. Prepare surgical instruments for microsurgery. 8. Prepare a sterile uterine drill, or a sharp blade No. 11. Surgical procedure 1. Abdominal routine disinfection, drape, and removal of the median longitudinal incision of the abdomen, about 8 ~ 10cm long, if you do a transverse incision, you need to cut the rectus abdominis, in order to fully expose the surgical field, cover the skin towel. 2, check the pelvic organs into the abdominal cavity, use a large gauze pad to wrap around the intestine to the upper abdomen, and then use a large gauze pad to block the uterine rectal fossa, so that the uterus and fallopian tubes are exposed to the surgical field. Check the degree of adhesion between the fallopian tube and the surrounding tissue. If there is adhesion, carefully separate the sharp separation with small anatomical scissors to correct the abnormal bending of the fallopian tube. The fine adhesion can also be separated under the microscope. If there is bleeding, use electrocoagulation to stop bleeding. 3, check the obstruction site with a venous incision needle or a thin plastic tube or silicone tube inserted from the end of the fallopian tube, inject physiological saline. Hold the end of the umbrella with your hand to prevent the liquid from overflowing. The proximal end of the fallopian tube is a blocked segment. 4, cut off the fallopian tube on the outside of the obstruction site with a small mosquito clamped the oviduct serosa as a marker, remove the obstruction of the fallopian tube to show the normal mucosa, the smooth distal end of the fallopian tube is cut about 1cm, divided into two front and rear It is in the shape of a "fish mouth". A 3-0 chrome gut is used to cut the two muscles of the sarcoplasmic muscle layer as a lead wire to be fixed in the uterine wall, and the cut end of the fallopian tube is wrapped with heparin saline gauze for transplantation. . 5, uterine corner hole with a uterine drill or a sharp 11th surgical blade close to the uterine horn behind the wall and the palace wall at right angles or wedge-shaped cut to the uterine cavity, where the palace wall is more than the palace corner It is slightly thinner and easy to drill. The implanted fallopian tube is more in line with its physiological position. 6. Implant the fallopian tube and insert one end of the stent into the fallopian tube and the other end into the uterine cavity. The lead wires of the two oviducts of the fallopian tube are respectively inserted into the uterine cavity by the uterus, and the opening of the fallopian tube enters the uterine cavity about 0, 5 cm, and the anterior and posterior walls of the uterus of the fallopian tube are pierced, knotted and fixed. The 3-6 chrome gut is used to suture the fallopian tube and the serosa layer of the uterus, and the root of the fallopian tube is fixed on the uterine wall. In order to determine whether there is a gap in the transplanted part, it is feasible to pass the oviduct through the fluid, and it is found that there is leakage to be sutured until the liquid is not leaked. 7. Keep the bracket. 8. The liquid is built into the abdominal cavity before closing the abdomen. 9. Suture the layers of the abdominal wall. complication There is no major complication of intrauterine transplantation in the fallopian tube, and ectopic pregnancy may occur in the long term.