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目的探讨子宫全切除术后输卵管脱垂的诊断、处理及预防措施。方法收集1983年1月至2005年8月行各类子宫全切除术7949例患者的资料,其中行开腹子宫全切除术6229例,行阴式子宫全切除术780例,行腹腔镜辅助阴式子宫全切除术940例。结果手术后共发生阴道残端输卵管脱垂9例,发生率为0．11%(9/7949)。其中开腹子宫全切除术后发生5例,发生率为0．08% (5/6229)；阴式子宫全切除术后发生4例,发生率为0．51%(4/780)；腹腔镜辅助阴式子宫全切除术后无一例发生输卵管脱垂。9例患者子宫全切除术后均放置了阴道引流管,其中5例子宫切除后未行阴道残端腹膜化处理。9例患者中,3例无任何症状；6例有症状的患者中,1例出现左侧腰背部痛,5例出现阴道排液。妇科检查,3例阴道残端发现输卵管伞端,6例阴道残端可见类似肉芽样组织。9例患者均经阴道切除,局部烧灼脱垂的输卵管,切除组织经病理检查证实均为输卵管组织。之后随诊1～59个月无异常发现。结论输卵管脱垂是子宫全切除术后的一种少见并发症,输卵管脱垂一般发生于子宫全切除术后放置阴道引流管的患者,经正确的诊断和治疗预后良好。行子宫全切除术时,应将附件固定在骨盆侧壁或行输卵管切除。
Objective To investigate the diagnosis, treatment and prevention of tubal prolapse after total hysterectomy. Methods The data of 7949 patients undergoing total hysterectomy from January 1983 to August 2005 were collected. Among them, 6229 cases underwent total hysterectomy, 780 cases underwent vaginal hysterectomy, 940 cases of hysterectomy. Results There were 9 cases of vaginal tubal prolapse after operation, the incidence was 0.11% (9/7949). Among them, 5 cases occurred after total hysterectomy, the incidence was 0.08% (5/6229); 4 cases occurred after hysterectomy, the incidence was 0.51% (4/780); the abdominal cavity Mirror assisted vaginal hysterectomy without tubal prolapse. Nine patients underwent hysterectomy were placed vaginal drainage tube, of which 5 cases after hysterectomy without vaginal stump peritoneal treatment. Of the 9 patients, 3 had no symptoms; 6 of the 6 symptomatic patients had a left lower back pain and 5 had vaginal discharge. Gynecological examination, 3 cases of vaginal tubal end of the fallopian tube found, 6 cases of vaginal stump visible like granulation tissue. All 9 patients underwent vaginal resection and partial cauterization of the oviduct. The resected tissues were confirmed by pathological examination as fallopian tube tissues. Followed up 1 to 59 months without abnormal findings. Conclusions Tubal prolapse is a rare complication after total hysterectomy. Tubal prolapse usually occurs in patients with vaginal drainage tubes after total hysterectomy. The correct diagnosis and treatment have a good prognosis. Line hysterectomy, the attachment should be fixed in the pelvic wall or line tubal resection.