| BackgroundFemale sterilisation,also called tubal ligation,is a worldwide used contraceptive method.Tubal sterilisation include surgically cutting and tying the fallopian tubes,mechanically blocking the tubes using rings or clips,and electrically coagulating the tubes.Tubal ligation can also be achieved via the vaginal route by means of mechanical or chemicals tubal inserts that block the tubes by producing a fibrotic reaction.Sterilization accounts for 30%of all means of contraception use in women,which corresponds to 200 million women in the world.Effective and affordable contraception reduces physical damage caused by multiple childbirth and abortion and reduces the reproductive burden on women.However,with remarriage,loss of child,family change and other reasons,the demand for re-birth of patients with tubal ligation has alsoincreased accordingly.Tubal anastomosis,also known as tubal resection,is the operation of requiring recovery of reproductive function after previous sterilization.For reversible tubal ligation,the site of the ligation is removed,and the two ends are repaired and re-connected.This may be carried out via laparoscopy or laparotomy.At present,the two methods are widely used in clinic.However,there are few comparative literatures on the safety and effectiveness of the two methods.In addition,pregnancy rate is the most important evaluation index of the effectiveness after tubal anastomosis,however,literatures have different conclusions on the influencing factors of postoperative pregnancy rate,and there is always a lack of comparative study of large samples.Objective1.Compare the perioperative status and postoperative pregnancy rate of patients undergoing laparotomic and laparoscopic sterilization reversal,to provide a theoretical basis for the choice of anastomosis method in clinical work.2.Analyze the influencing factors of pregnancy rate,to provide a theoretical basis for the evaluation of pregnancy rate in clinical work.MethodsThe clinical data of 356 ligation patients who underwent tubal anastomosis in the first affiliated hospital of Zhengzhou University from March 2012 to October 2017 were analyzed retrospectively,including 85 cases of laparotomy and 271 cases of laparoscopy.The differences of operating time,bleeding volume,postoperative fever,and postoperative exhaust time,pain score,wound healing,duration of hospital stay,cost were statistically analyzed.The patency rate of intraoperative anastomosis,uterine pregnancy rate,ectopic pregnancy rate,residual tube length and time to pregnancy were compared.Analysze the effects of anastomotic procedure,age,BMI(body mass index),time from sterilization till reversal,ligating method,ligated site,multiple pelvic operation history and residual tube length on repregnancy.The data were recorded and analyzed using SPSS 25.0.Continuous variables were presented as mean±standard deviation,using t test when two independent samples satisfy normal distribution.Chi-square test was used to evaluate the difference of enumeration data.Logistic test was used for factors analysis.The significance level was set at 0.05.Results1.There was no significant difference in operation time,postoperative fever and exhaust time between the two groups(all P are>0.05),but laparoscopic bleeding volume was less than that in laparotomic group[(18.1 ± 12.1)ml vs(33.4±22.1)ml,P=0.000],and the pain score was lower(3.6±0.9 vs 4.5±0.9,P=0.000),duration of hospital stay was shorter[(5.9±0.6)d vs(7.1 ±0.7)d,P=0.000].The cost of laparotomic group was lower than that in laparoscopic group(9524±881 vs 12903±1162,P=0.000).2 cases of laparotomic group had abdominal wall incision infection,which healed after symptomatic treatment.Cases of laparoscopic group all healed well.There were no complications such as incisional hernia,intestinal obstruction and intraperitoneal hemorrhage in both groups.2.There was no significant difference in the patency rate of intraoperative anastomosis and residual tube length between the two groups(all P are>0.05).The uterine pregnancy rate within 2 years after anastomosis was higher in laparoscopic group than that in laparotomic group(76.4%vs 61.2%),the difference was statistically significant(P=0.006).Laparotomic group was pregnant(8.3±5.3)month after anastomosis and laparoscopic group was pregnant(7.6±4.9)month after anastomosis,the difference was not statistically significant(P=0.375).80.8%of the pregnancies in the laparotomic group occurred within 1 year after operation,and 81.6%of the pregnancies in the laparoscopic group occurred within 1 year after operation,with no significant difference(P=0.885).The incidence of ectopic pregnancy in the laparotomic group was 3.5%,and that in the laparoscopic group was 7.7%,the difference was not statistically significant(P=0.176).3.Anastomotic method(OR=1.847,95%CI 1.028～3.320,P=0.040),age(OR=3.673,95%CI 1.690～7.984,P=0.001),length of residual tube(OR=4.716,95%CI 2.552～8.714,P=0.000),and multiple pelvic operation history(OR=3.092,95%CI 1.650～5.796,P=0.000)were independent factors influencing intrauterine pregnancy rate after anastomosis.In addition,the pregnancy rate of patients with isthmus ligation after anastomosis was higher than those with proximal interstitial ligation(76.9%vs 55.6%,P=0.007).Laparoscopic anastomosis,age ≤40 years,length of both residual tubes≥5 cm,no multiple pelvic surgery are favorable factors for successful pregnancy after anastomosis.There was no significant correlation between pregnancy rate and BMI,time from sterilization till reversal,ligation method,ligated site.Conclusions1.Laparoscopic tubal anastomosis has the advantages of small trauma,high postoperative pregnancy rate and short hospital stay.It is a good treatment choice for patients with tubal ligation.2.Laparoscopic anastomosis,age ≤40 years,length of both residual tubes≥5 cm,no multiple pelvic surgery are favorable factors for successful pregnancy after anastomosis. |
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