[Gynecological laparoscopy] Fallopian tube clamping

At present, most literature reports that untreated hydrosalpinx has a negative impact on the outcome of IVF-ET, which leads to lower embryo implantation rate, clinical pregnancy rate and higher miscarriage rate.

Possible reasons are: ① Hydrosalpinx can flow back into the uterine cavity and flush the embryo, and the water accumulated on the surface of the endometrium interferes with the interaction between the endometrium and the embryo and inhibits embryo implantation. ② Inflammatory hydrosalpinx impairs endometrial receptivity. ③ Hydrosalpinx is often caused by pathogenic infection. Fallopian tube clamping not only blocks the impact and toxic effects of hydrosalpinx on embryo implantation, but also avoids the possibility of damaging the mesangial blood vessels and affecting the ovarian blood supply when removing the fallopian tube.

Indications

1. Hydrosalpinx before IVF-ET is the main indication for fallopian tube clamping.

2. Patients who voluntarily undergo fallopian tube sterilization.

Surgical steps and techniques

1. Hydrosalpinx before IVF-ET is the main indication for fallopian tube clamping.

2. Patients who voluntarily undergo fallopian tube sterilization.

Surgical steps and techniques

1. Take the lithotomy position of the bladder, perform routine disinfection and draping, establish pneumoperitoneum, and place a microscope.

2. Understand the pelvic condition under laparoscopy and separate pelvic adhesions.

3. Fallopian tube ostomy and falloplasty (the steps are the same as those for falloplasty and ostomy).

4. Fallopian tube clamping surgery exposes the clamping parts of both fallopian tubes, lifts and fixes the wall of the fallopian tube isthmus with non-destructive forceps, implants a titanium clip, and double-clamps the fallopian tube at the proximal end of the left fallopian tube isthmus, and press hard to facilitate the closure of the lumen. . Treat the opposite side in the same way.

Intraoperative risks and prevention

1. Wound bleeding: Wound bleeding may occur during the process of adhesion separation. Try to choose avascular areas to cut with electrocoagulation scissors or separate with bipolar electric hooks. If the adhesions are thick or have blood vessels, electrocoagulation can be used first and then cut off. The severed ends after separation should be carefully inspected and electrocoagulated to stop bleeding.

2. Fallopian tube injury or rupture: During the process of separating adhesions around the fallopian tube, instruments should be used rationally to avoid thermal and electrical damage to the fallopian tube. When reshaping the stoma, try to avoid forced tearing that may cause fallopian tube laceration.

3. The placement of the titanium clip is unsatisfactory or fails. If the adhesion around the fallopian tube is severe or the fallopian tube is obviously thickened and hardened, the titanium clip cannot be placed. It is necessary to change to other methods such as electrocoagulation and dissection of the proximal fallopian tube.

4. Incorrect clamping of the round ligament of the uterus or the intrinsic ovarian ligament. If the anatomical layer of adhesion changes or the exposure of the field of view is unclear, the round ligament of the uterus or the intrinsic ovarian ligament on the same side may be mistakenly clamped. Once the incorrect clamping is discovered, the titanium clip should be removed in time and repositioned.

5. If the titanium clip is displaced, loose or falls off, after performing fallopian tube clamping, the position and clamping effect of the titanium clip should be carefully observed. If the titanium clip is found to be displaced, loose or falling off, it should be replaced in time and the operation should be performed again.

Postoperative precautions

1. After the surgery for re-adhesion in the pelvic and abdominal cavity and around the fallopian tube, the pelvic and abdominal cavity should be flushed with normal saline or dexamethasone saline; sodium hyaluronate gel should be applied to the adhesion wound to prevent recurrence of adhesion; patients can also be encouraged to get out of bed early after surgery. Reduce the risk of re-adhesion.

2. If you have lost your natural fertility and undergo fallopian tube clamping, you should give full informed consent before surgery. After the fallopian tube is clamped, you will lose your natural fertility.

3. Fallopian tube recanalization: If the fallopian tube wall thickens or the titanium clip falls off, the fallopian tube may be recanalized after surgery, and the possibility of fallopian tube interstitial pregnancy or uterine horn pregnancy increases.

4. For chronic pelvic pain, if too much mesosalpinx tissue is clamped, it may affect the ovarian blood supply and cause postoperative pain symptoms.

5. Strengthen education and guide patients on pregnancy methods, and inform them to adopt assisted reproductive methods as soon as possible. However, sexual intercourse is prohibited within 2 weeks after surgery, and heavy physical labor or strenuous exercise are avoided.