The maintenance of tubal patency and the prevention f pelvic adhesion are the major keys for the successful fallopian tube surgery for infertility. Various kinds of tubal splints have been used to maintain tubal patency in clinical and
experiemntal
tuboplasties, but there are still undetermined factors such as the optimum duration of splint indwelling and its effects on tubal healing and patency.
Therefore, authors performed experimental tuboplasty in rabbits and attempted to known the effects of the hylon splint ontubal patency according tot he duration of indwelling and also the effects of the intraperitoneal adjuvants on pelvic
adhesion.
All
results were analyzed clinical and pathologically by using the light and electron microscopes.
The total number of experimental rabbits were 72. Both normal oviducts were obtained from three rabbits as a control group. In sixty nine rabbits experimental reananstomoses were performed at the ampullae of both oviducts and a nylon splint was
inserted
into only one oviduct of each rabbit. Twenty(Group I) of sixty nine rabbits were sacrificed on the 1st week (seven), 2nd week (six) and 4th week (seven rabbits). In the remained forty nine rabbits(Group II), only the splint was removed on the 1st
week(sixteen), 2nd week(seventeen) and 4th week(sixteen rabbits).
And finally, all of these Group II rabbits were sacrificed on the 8th week to obtain oviducts. To evaluate the preventive effect of intraperitoneal adjuvant against adhesion, twenty milliliters of saline, 10% dextran (Reomacrodex(r)), or combined
regimen (saline, solumedrol, ampicillin and heparin) was applied into the pelvic cavity of Group II animals.
@ES The results were as follows:
@EN 1. The restoration of tubal peristalsis in Group II was significantly high(75%) in one week splinted group as compared with other splinted groups(p<0.10), but there was no significant difference compared with unsplinted groups.
2. The incidence of tubal patency in Group II was significantly high(81 %) in one week splinted group as compared with other groups(P<0.10).
3. Inflammatory cell infiltration was increased along the duration of splint indwelling in Group I, but only slight infiltration was noted in Group II without relation to the duration of splinting. Fibrosis was increased at the two and four week
splinted groups compared with the one week splinted group of Group I & Ii.
4. On scanning electron microscopic examination, the tissues adjacent to the anastomotic site were restored at two weeks after operation and the appearance of transformed ciliated and secretory cells was more frequent at the two and four weeks
splinted
groups than the one week splinted group of Groups I & II. Transmission electron microscopic examination for secretory cells of group I showed decrease in microvilli and granules in two weeks splinted group.
5. On scanning electron microscopic filed (x 2000), the ratio of transofmed to normal secretary cells was significantly lower in the week splinted group than in the four weeks splinted group of Group I, and also lower in the unsplinted and one
week
splinted groups than in the two and four weeks splinted groups of Group II(P<0.05).
6. The incidence of pelvic adhesion was significantly lower in the cases in which combined regimen was used than in the cases in which saline or 10% dextran was used as an intraperitoneal adjuvant (P<0.05).
From the above results, it is considered that the retaining of tubal splint for one week and the use of combined regimen as an intraperitoneal adjuvant may improve the results of tubal reanastomosis.
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