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我站1997年3月—1998年4月施行腹式输卵管绝育术1021例,其中剖宫产后绝育术45例,占4%.除1例因粘连较重未能行结扎外,其余44例均顺利完成女扎术,现报道如下.1 临床资料1.1 一般资料 年龄20～40岁,平均30岁.其中2胎43例,3胎2例.剖宫产术后时间最长为5年,最短为4个月,85%是在剖宫产后一年内施行绝育术.均为下腹正中切口.1.2 手术方法 术前小便排空,常规消毒,局部麻醉,耻骨联合三横指,腹直肌旁切口(即原切口疤痕旁),长约3cm.切开皮肤,分离皮下脂肪,显露前鞘,确认腹膜与前鞘没有直接粘连时,切开前鞘,分离腹直肌.45例受术者中有30例分离前鞘后腹直肌不明显;或前鞘打开以后腹膜也随之打开,直接进入腹腔.探查盆腔,详细检查有无腹内脏器损伤.45例中仅发现一例大网膜与子宫切口疤痕处粘连,(即前述未完成手术者).45例手术中,40例为子宫前位,约占88%,有5例盆腔内有粘连带.但均能寻找到空隙提出输卵管.切不可粗暴分离,以免造成出血.对于有粘连带,盆腔没有炎症而影响提出输卵管的,可向上沿长切口,暴露子宫,认准部位、逐步分离粘
From March 1997 to April 1998, we performed 1021 cases of abdominal tubal sterilization, of which 45 cases were cesarean section sterilization, accounting for 4% .Among the cases, one case was unable to carry out ligation because of the heavy adhesion, and the other 44 cases Are successfully completed female ligation, are reported as follows.1 Clinical data 1.1 General information Age 20 to 40 years old, average 30 years of age, of which 2 cases of 43 cases, 3 cases of 2 cases of cesarean section after the longest time of 5 years, The shortest of 4 months, 85% of the cesarean section within one year after the implementation of sterilization .All the lower abdomen incision .1.2 surgical preoperative urine emptying, routine disinfection, local anesthesia, pubic symphysis three horizontal fingers, rectus abdominis muscle Side incision (ie, the original scar incision), about 3cm. Cut the skin, subcutaneous fat, revealing the anterior sheath, to confirm the peritoneum and anterior sheath no direct adhesion, incision of the anterior sheath, the separation of the rectus abdominis .45 cases received surgery 30 cases were separated before the sheath is not obvious rectus abdominis or peritoneum after opening the anterior sheath also will be opened directly into the abdominal cavity to explore the pelvic cavity in detail the presence or absence of intra-abdominal organ injury.Only 45 cases were found in a case of large net Membrane and uterine incision scar adhesions, (ie, the aforementioned unfinished surgery) .45 cases of surgery, 40 cases of anterior uterus, about 88%, 5 cases of pelvic adhesions . But can find the gap to the fallopian tube. Must not be rough separation, so as to avoid bleeding. For adhesions, pelvic inflammation and the impact of the proposed fallopian tube, can be up along the long incision, exposing the uterus, looking for the site, and gradually separation of sticky