Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_207_библиотеки_им_акад_М_И_Перельмана
.pdf
Closure of serosa
With the tube anastomosis in place, the same suture from the mesosalpinx approximation is used to close the tubal serosa. A
separate suture may be used as well. The tubal serosa can be closed in a running fashion starting in the mesosalpinx, going
around the tube, and ending at the other side of the mesosalpinx, where the suture is tied off (Tech Fig. 4.4.7).
Te ch Fig ure 4.4.7. Closure of t ubal serosa with a running suture around the entire t ube.
https://t.me/med1917
Confirmation of patency
After completion, patency of the tubes is confirmed with chromotubation using gentle pressure (Tech Fig. 4.4.8).
Te ch Fig ure 4.4.8. Confirming tubal patency with chromotubation aft er reanastomosis.
https://t.me/med1917
Contralateral procedure
The same procedure is performed on the opposite side. To accomplish chromotubation, the first tube may need to be
occluded at the cornua. A clamp or grasper should not be used to directly close the tube. The blunt end of an instrument can
be used to fold the tube back against the uterus near the cornua, obstructing the open tube.
https://t.me/med1917
PEARLS AND PITFALLS
https://t.me/med1917
POSTOPERATIVE CARE
Patients should be able to go home after the procedure. For a mini-lap reversal, infiltration of the fascia and subcutaneous
tissue with a long-acting local anesthetic (0.25% bupivacaine hydrochloride) can be beneficial.
Patients may try to conceive during their next menstrual cycle.
Patients should be cautioned to seek early evaluation after conceiving due to an increased risk for an ectopic pregnancy.
https://t.me/med1917
OUTCOMES
In a large report of 1,118 cases of microsurgical bilateral tubal reversal, 55% of women had a live birth within 5 years of
follow-up.
1
Delivery rates vary from 42% to 65%, based on patient age and surgical outcomes. Tubal patency rates were
calculated to be 88%. Mean time to conception was approximately 8 months. The ectopic pregnancy rate was
approximately 4%.
https://t.me/med1917
COMPLICATIONS
Postoperative scarring may lead to tubal closure at the anastomosis site or tubo-ovarian adhesions.
https://t.me/med1917
KEY REFERENCE
1. Kim SH, Shin CJ, Kim JG, et al. Microsurgical reversal of tubal sterilization: a report on 1,118 cases. Fertil Steril.
1997;68(5):865–870.
https://t.me/med1917
5
Ovary
https://t.me/med1917
Chapter 5.1
Ovary: Cystectomy
Travis W. M cCoy
https://t.me/med1917
Соседние файлы в папке Библиотека им академика М.И. Перельмана