Interstitial tubal pregnancy: past, present, future. Excision of the tube from the angle of the uterus with its resection or removal consists of a wedge-shaped excision of the inter

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Excision of the tube from the angle of the uterus with its resection or removal consists of a wedge-shaped excision of the interstitial portion of the tube. In this case, the distal section of the pipe is either peritonized (Sergeev, Kiparsky methods). The most common method is Braude. A hole is made in the mesentery of the fallopian tube at a distance of 2 cm from the angle of the uterus with a clamp and a ligature is passed through it. The tube is ligated and crossed. The uterine end of the tube is cut off from the mesentery towards the uterus, and a wedge-shaped tube is cut out from the corner of the uterus so as not to open its cavity. The uterus is sutured with catgut sutures. The distal end of the tube is peritonized using the same ligature with which it was tied. One end of the ligature is passed through the broad ligament. When tying the ligature, the stump of the pipe is immersed under the fold of the peritoneum. The advantage of this method is the possibility of further restoration of the fallopian tubes by implanting them into the uterus. The disadvantage of this method of sterilization is the formation of a scar on the uterus.

Resection of the ampullary section of the tube is performed according to Mermann and has limited use. Its essence is as follows: the tube is separated from the mesentery along its entire length, the ampullary section is cut off and the tubes are sutured to the anterior surface of the uterus. The author performed sterilization vaginally through the posterior vaginal fornix.

The method of immersion of the ampullary section of the pipe is currently of no practical importance.

The listed methods of sterilization are performed, as a rule, during laparotomy as an additional surgical intervention, as independent operation sterilization can be performed with minilaparotomy. The choice of sterilization method depends on the skill of the surgeon. It is most advisable to use the Dutzmann method. All of these sterilization methods are intended for the permanent sterilization of women. But it should be noted that at present it is always possible in further recovery patency of the fallopian tubes through surgery using microsurgical techniques.

Methods surgical sterilization women performed during endoscopy

Sterilization is carried out during laparoscopy or hysteroscopy.

Laparoscopic sterilization

I. Electrocoagulation of the fallopian tube.

II. Mechanical occlusion of the fallopian tubes.

Each of these methods has its own positive and negative sides and complications. The choice of one method or another depends on the equipment available to the surgeon, own experience, topographic-anatomical relationships in the pelvis.

Electrocautery methods include:

1) unipolar diathermy,

2) bipolar cauterization,

3) terminal coagulation,

4) laser evaporation and photocoagulation.

Unipolar diathermy can be performed for surgical sterilization in the absence of other technical means, but it is fraught with complications associated with sudden and significant overheating of tissues. The local temperature of the coagulated fallopian tube can reach 300 - 400°, which is extremely dangerous in terms of causing burns to adjacent tissues or organs (intestines, Bladder, peritoneum), as well as distal damage. Prevention of these complications can be pneumoperitoneum of at least 5 liters and lavage abdominal cavity in order to cool the coagulation zone. If other options are available, unipolar tubal coagulation for sterilization should be avoided.

Bipolar cauterization, for which forceps are offered by Rioux and Kleppingen, eliminates the occurrence of distal burns and injuries, but assumes an equally high local temperature response, what should be feared when performing it.

The method works as follows.

M.: Medical Information Agency, 2005. - 615 p.
ISBN 5-89481-319-0
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Dissection of the uterine angle is performed when localizing ovum in the interstitial section of the tube.
Salpingectomy. Indications:
content (3-subunits of hCG > 15 thousand IU/ml;
history of ectopic pregnancy;
ovum size > 5 cm.
With significant pathological changes of the other tube (hydrosalpinx, sactosalpinx), bilateral salpingectomy is recommended. The possibility of its implementation must be discussed in advance with the patient, and written consent to the specified volume must be obtained. surgical intervention. Coagulation is performed with a bipolar coagulator at the mouth of the tube, then the mesosalpinx is coagulated at the distal edge of the tube and it is crossed. Particular attention is paid to the branches of the arcuate anastomoses of the ovarian and uterine vessels. Sutures or endoloops are placed or staplers are used to prevent bleeding. The resected section of the tube with the fertilized egg is removed in a plastic bag.
The uterine horn is strengthened with an additional suture to prevent myometrial rupture. Laparoscopic resection of the uterine angle requires significant surgeon experience.
In the postoperative period, discharge from the genital tract is possible for 24-36 hours. It is advisable to prescribe antibiotics. On
2nd day after surgery the level is determined)