Tubal anastomosis is a common surgical method to treat tubal infertility. The fallopian tube originated from the differentiation and evolution of the middle part of the accessory mesonephric duct (Mullerian duct) in embryonic stage. The time of tubal anastomosis should be chosen within 3 ~ 7 days after menstruation is clean, and should not be arranged in menstrual period and middle menstrual period.
Operation steps of tubal anastomosis
1. Routine patients are taken to supine position, disinfected in the operating field and covered with towels;
2. Generally, a transverse incision about 5cm long on the pubic symphysis of the lower abdomen is selected, and the skin, subcutaneous tissue, fascia and muscle are cut in turn to open the peritoneum;
3. After pelvic exploration, the right fallopian tube anastomosis was performed first;
4. Lift the right fallopian tube to the surgical incision, and find the site to be anastomosed. Clamp the left and right sides of the obstruction with two tissue forceps. Firstly, normal saline was injected into the serosa surface to make it swell locally. Gently cut the film on the surface of fallopian tube with small scissors, then cut off the blocked fallopian tube with scissors, which can exceed the normal fallopian tube by about 2-3mm, and then use No.5-6 absorbable catgut at 4 o'clock on 3.6.912.
5. You can inject Meilan liquid from the liquid tube placed in the vagina, and observe whether there is liquid flowing out from the umbrella-shaped end of the right fallopian tube after anastomosis, and you can see that it flows out normally and smoothly;
6. Treat the left fallopian tube the same way, but pay attention to clamping the right fallopian tube when passing fluid;
7. After checking that the gauze equipment is normal, sew the layers of the abdominal wall in turn.
Matters needing attention in tubal anastomosis
Preoperative attention
1. Ask about the medical history in detail, focusing on the menstrual history, birth history, sterilization time, sterilization technical level and postoperative conditions, such as fever and abdominal pain.
2. When remarried, if the man is newly married or has never given birth, he should have a routine examination of semen and reproductive organs.
3. Determine the blocked part of fallopian tube, and make hysterosalpingography or laparoscopy if necessary.
4. Explain the success rate of recanalization and various possible complications to patients and their families, especially some pregnancies are ectopic.
5. Surgery is usually performed within 3 to 7 days after menstruation.
Postoperative attention
1, encourage getting out of bed early: 12 ~ 24h later, the catheter can be pulled out to get out of bed.
2. Because of the rapid recovery of intestinal peristalsis, a milk-free liquid diet was given immediately after the recovery of intestinal peristalsis, and soft food was eaten to general food the next day.
3. Preventive or therapeutic use of antibiotics. The types and compatibility of antibiotics can be determined according to the intraoperative situation, postoperative temperature and hemogram changes. Antibiotics are usually used 5 ~ 7 days after operation.
4. Early postoperative drainage: About 5 days after tubal recanalization, it is feasible to perform 1 ~ 2 drainage on the premise that the routine examination of leucorrhea is normal. Attention should be paid to aseptic operation and the speed and pressure of liquid injection when draining liquid.
5. Before leaving the hospital, we should explain to the patients and their families the matters needing attention and health care contents after leaving the hospital, such as rest, diet, nutrition, hygiene, sexual life and post-pregnancy knowledge, especially the importance of regular inspection and follow-up.