介人性输卵管再通术联合腹腔镜治疗输卵管阻塞性不孕症的临床价值

目的 探讨介入性输卵管再通术联合腹腔镜治疗输卵管多发阻塞性不孕症的临床价值.方法 回顾性分析67例127条输卵管近段阻塞合并同侧伞端粘连不孕患者资料,行选择性输卵管再通术后2～3 d利用腹腔镜对粘连伞端行分离及造口术.分析输卵管近三段再通率、完全再通率,随访1年观察妊娠率及相关并发症等.对术后1年未妊娠者行输卵管造影复查.结果 67例均成功实施输卵管再通术,近三段再通率为97.6%(124/127);联合腹腔镜对近三段再通的124条输卵管行伞端微创手术治疗,完全再通率为98.4%(122/124).术后1年妊娠率为58.2%(39/67),异位妊娠发生率为4.5%(3/67),未妊娠率为37.3%(25/67),其中输卵管再阻塞未妊娠率为25.4%(17/67),输卵管通畅未妊娠率为11.9%(8/67).结论 介入性输卵管再通术联合腹腔镜是治疗输卵管多发阻塞性不孕症的有效方法,可有效提高妊娠率.     

输卵管再通术与电视腹腔镜联合治疗输卵管阻塞所致不孕症的临床分析

目的 分析输卵管再通术与电视腹腔镜联合治疗输卵管(多段)阻塞所致不孕症的临床应用价值.方法 经输卵管造影或/和选择性输卵管造影选择单侧或双侧输卵管伞端粘连合并同侧输卵管其它段阻塞患者67例作为研究对象,一般选择输卵管再通术后2～3 d行电视腹腔镜对伞端粘连分离,必要时行输卵管成形、造口术.准确统计输卵管再通率、联合再通率、妊娠率以及宫外孕、输卵管再次阻塞并发症的发生率. 结果本组67例127条输卵管阻塞均成功实施输卵管再通术与电视腹腔镜联合治疗微创手术,其中,单纯输卵管再通率(前三段)97.6%(124/127),再通术与电视腹腔镜联合治疗再通率为96.0%(122/127),术后1年内妊娠率为58.2%(39/67),宫外孕发生率4.5%(3/67).术后1年未受孕患者28例,其中27例患者再次行普通输卵管造影,10例输卵管各段通畅,占14.9%(10/67);17例输卵管再次阻塞,再次阻塞率25.4%(17/67),其中伞端粘连积水13例,占19.4%(13/67),输卵管其它各段阻塞4例,占6.0%(4/67).另外1例因确诊生殖道结核而放弃该治疗.结论 输卵管再通术与电视腹腔镜联合治疗对输卵管阻塞所致不孕症的治疗是一种有效治疗手段.     

双氧水在输卵管阻塞介入治疗中的应用价值

目的 探讨双氧水在输卵管阻塞介入治疗中的应用价值.方法 150例患者经常规子宫输卵管造影发现264条输卵管近段梗阻,对其应用1.5%双氧水5 ml保留冲洗2 min后造影,对其中210条近段仍阻塞的输卵管作选择性造影及再通术,术后抗炎及定期输卵管通液治疗.结果 54条输卵管近端阻塞行双氧水冲洗后复通,复通率为20%;30条输卵管近段阻塞行选择性冲洗、造影后复通,156条输卵管经同轴导管、微导丝疏通后复通,插管再通成功率为86.6%,无严重并发症.结论 双氧水保留冲洗可使20%输卵管近端阻塞患者复通,免受介入再通术.     

腹腔镜治疗输卵管远端积水疗效分析

为探讨应用腹腔镜治疗远端输卵管积水临床疗效。我们对我科2008年3月～2010年5月输卵管碘油造影诊断为输卵管远端积水的53例患者进行腹腔镜下远端输卵管造口伞端成型术。随访1年,成功随访49例,总受孕20例,受孕率40.82%。结果表明应用腹腔镜治疗输卵管远端积水具有直观性,术后妊娠率较高,现将具体做法报告如下。     

选择性输卵管造影和再通术（附820例分析）

目的探讨选择性输卵管造影和再通术在治疗输卵管不孕症患者中的临床应用价值。方法对经子宫输卵管造影证实820例患者,共1481条输卵管近端阻塞或通畅度不佳,将导管至于输卵管口,实用导丝疏通后造影,对比手术前后的输卵管通畅程度,并对患者进行12个月妊娠率统计。结果本组820例患者均成功地进行了SSG及FTR,插管成功率为100．00％。1481条输卵管,近段堵塞及通而不畅的1283条疏通成功,再通成功率为86．63％。其中356例输卵管完全性梗阻（完全性梗阻组）患者的625条输卵管中496条获得管腔再通,疏通率达79．63％;其中135条输卵管仅进行SSG即可获管腔再通,占27．22％,其余患者均行SSG后再行FTR获得再通,占72．78％。在464例输卵管不完全性梗阻（不完全性梗阻组）患者的856条不同程度梗阻的输卵管中819条获得疏通,疏通率达95．68％;经统计学分析发现不完全性梗阻组的疏通率明显高于完全性梗阻组,且差异具有统计学意义（x^2=6．32,P＜05）。结论选择性输卵管造影及再通术诊断输卵管阻塞准确、简便、安全,再通率高,患者易接受治疗,是输卵管性不孕症尤其是输卵管近端阻塞患者首选的一种快捷、有效的诊疗方法。     

介入性输卵管再通术结合中医治疗输卵管阻塞性不孕症的临床研究

目的探讨介入性输卵管再通术结合中医治疗输卵管阻塞性不孕症的临床应用价值.材料和方法对200例337条输卵管阻塞性不孕症患者,在电视透视下,用改进的导管、导丝进行输卵管再通术,其中120例再通术后行口服中药、中药灌肠及热敷治疗.结果337条阻塞输卵管中,再通276条,再通率为81.9%.2个月后子宫输卵管造影显示,单纯再通术的127条再通后的输卵管,68条再通良好,有效率为53.5%;配合中药治疗组的149条经再通后的输卵管,保持通畅良好112条,有效率为75.2%.术后随访1年,单纯再通术组受孕率为33.8%(27/80),配合中药治疗组的受孕率为56.7%(68/120).结论输卵管再通术结合中医治疗不孕症,方法简单安全,再通的有效率、受孕率均高于单纯输卵管再通术.     

输卵管阻塞不孕症的介入治疗回顾性分析

目的:探讨选择性输卵管造影和输卵管再通术治疗输卵管阻塞不孕症的临床疗效以及临床价值.方法:对4260例输卵管阻塞的患者进行选择性输卵管造影和再通术,采用球茎端导管应用微导管导丝对输卵管阻塞进行治疗,回顾性分析其再通率和受孕率.结果:4260例患者中,完全性输卵管阻塞者再通率为58.41％,其中近端、壶腹部和伞端阻塞的再通率分别为58.41％、64.41％、52.50％.输卵管不完全阻塞者再通率为96.17％.其中不畅和极不畅的再通率100.00％、90.04％.完全性输卵管阻塞者的妊娠率为29.78％,不完全性输卵管阻塞者妊娠率60.01％.结论:选择性输卵管造影和输卵管再通术成本低,操作简便、安全、损伤小、无明显并发症,其疗效高,在门诊即可治疗,适合基层医院的推广使用.     

输卵管性不孕症的放射介入治疗评价

目的:评价放射介入再通术对输卵管性不孕症的疗效。方法:随访102例接受选择性输卵管造影(SSG)和介入性输卵管再通术(FTR)治疗的输卵管阻塞不孕症患者,统计术后1年内妊娠率、异位妊娠率及输卵管再阻塞率,并进行综合分析。结果:完全梗阻患者1年妊娠率为40.7%,其中近端(间质部、峡部)阻塞妊娠率为60%,中远端(壶腹部、伞端)阻塞妊娠率为16.67%,两者比较差异有显著性(χ2=5.19,P<0.05);不完全阻塞患者1年妊娠率分别为通而欠畅60.9%、通而不畅43.2%、通而极不畅13.3%。三者比较差异有显著性(χ2=8.40,P<0.05)。结论:SSG和FTR是治疗输卵管性不孕症的有效方法,输卵管近端阻塞为SSG和FTR首选。     

用自制器械行选择性输卵管造影和再通术

报告用自制器械行子宫输卵管选择性造影及再通术45例,插管成功率95.5%。近端输卵管阻塞再通率80%。随访结果:15例患者正常受孕,受孕率33.3%,其中继发不孕症受孕率50%,原发不孕症受孕率17.4%。近端阻塞再通术后受孕率54.5%,远端积水或阻塞患者受孕率15%。显示选择性输卵管造影及再通术是治疗女性不孕症的有效方法;本手术最佳适应证为继发不孕、近端输卵管阻塞患者;自制器械价廉、安全。     

经导管液体加压法治疗输卵管梗阻性不孕(附157例报告)

目的:探讨液体加压法治疗输卵管梗阻性不孕的临床效果。方法:使用Cook公司生产的输卵管再通同轴导管,微导管引入输卵管后以液体加压的方法行再通术。结果:157例患者共306条梗阻输卵管,再通286条,成功率93.5%,术后6~9个月随访96例,49例受孕,受孕率为51%。结论:液体加压法治疗输卵管梗阻性不孕创伤小,受孕率高,临床疗效明显。     

子宫显著屈曲患者的输卵管再通术

目的：探讨利用自制装置对子宫显著屈曲合并输卵管梗阻的不孕患者进行输卵管再通术的插管方法并分析其疗效。方法：经子宫输卵管造影证实子宫显著屈曲伴单侧或双侧输卵管阻塞患者48例,共66争输卵管阻塞,应用自制装置,配合使用各种手术器械,施行选择性输卵管造影及再通术。采用复通率及妊娠率（随访2年）评价输卵管再通术的治疗效果,并将其与子宫位置正常患者进行比较。结果：48例患者均插管成功,施行再通术后,有56条输卵管复通,复通率为84．8％,随访2年后9例妊娠,妊娠率18．8％,妊娠率低于子宫位置正常患者,而复通率与子宫位置正常患者相近。结论：使用自制装置能够较方便完成显著屈曲子宫的输卵管再通术,各种手术器械的配合使用有利于成功插管。     

Salpingitis Isthmica Nodosa: Technical Success and Outcome of Fluoroscopic Transcervical Fallopian Tube Recanalization

Purpose: To evaluate the technical success and outcome of fallopian tube recanalization (FTR) in salpingitis isthmica nodosa (SIN). Methods: SIN is a well-recognized pathological condition affecting the proximal fallopian tube and is associated with infertility and ectopic pregnancy. We reviewed the presentations, films, and case records of all patients attending for FTR for infertility from 1990 to 1994. Technical success and total, intrauterine, and ectopic pregnancy rates at follow-up were determined. Results: SIN was observed in 22 of 349 (6%) patients. FTR was attempted in 34 tubes in these 22 patients. Technical success was achieved in 23 of 34 (68%) tubes affected by SIN. In 5 of the 11 failed recanalizations, failure was due to distal obstruction. At least one tube was patent on selective postprocedural salpingography in 17 of 22 (77%) patients. There were no recorded perforations or complications. At follow-up (mean 14 months), total, intrauterine, and ectopic pregnancy rates were 23%, 18%, and 4.5%, respectively. Conclusion: FTR in SIN is technically successful and, compared with previously reported results in unselected infertility patients, is associated with only a slightly less favorable intrauterine pregnancy rate and a comparable ectopic pregnancy rate. The findings of SIN at FTR should not discourage attempted fluoroscopic transcervical recanalization. Received: 0/00/00/Accepted: 0/00/00     

液体加压冲击法联合导丝技术介入治疗输卵管阻塞性不孕症的临床研究(附36例报告)

目的:探讨液体加压冲击法联合导丝技术介入治疗输卵管阻塞性不孕的价值.方法:在DSA引导下利用液体加压冲击法以及导丝技术对36例(54条输卵管)输卵管阻塞性不孕症患者进行输卵管再通治疗,记录输卵管再通率、患者的不良反应等.结果:采用液体加压冲击法达到复通的输卵管共29条,采用液体加压冲击法及导丝技术达到复通的输卵管为24条.液体加压冲击法联合导丝技术介入治疗输卵管阻塞再通成功率可达100%.结论:液体加压冲击法联合导丝技术治疗输卵管阻塞,在DSA直视下完成操作,准确性和成功率高,疗效确切,是一种可行的手术方式.     

Fluoroscopically guided transcervical fallopian tube recanalization of post-sterilization reversal mid-tubal obstructions

Purpose: To assess the technical success and early outcome of fluoroscopically guided transcervical fallopian tube recanalization (FTR) in mid-tubal occlusion following sterilization reversal surgery. Methods: From July 1995 to January 1998, patients with greater than 12 months secondary infertility underwent hysterosalpingography (HSG). FTR was performed in proximal or mid-tubal occlusion. Cases of FTR in mid-tubal occlusion were included in this study. Technical success (defined as complete tubal patency) using a standard guidewire and hydrophilic glidewire, the number of patients with at least one patent tube, and the intrauterine and ectopic pregnancy rates were determined. Results: Twenty-six infertile patients with previous sterilization reversal underwent HSG. Eight of 26 (31%) patients (mean age 32 years, range 23–37 years), had attempted FTR for mid-tubal occlusion at the site of surgical anastomosis. Fourteen tubes were attempted as there were two previous salpingectomies. Technical success was achieved in eight of 14 (57%) tubes attempted, resulting in five of eight (62%) patients having at least one patent tube. At follow-up (mean 18 months, range 12–28 months) in these five patients there was one intrauterine pregnancy. There were no ectopic pregnancies. Conclusions: FTR in mid-tubal obstruction in infertile patients following sterilization reversal surgery is technically feasible and may result in intrauterine pregnancy. In this small group there was a lower technical success rate and lower pregnancy rate than in unselected proximal tubal occlusion.     

Fallopian tube obstruction: selective salpingography and recanalization. Work in progress

Seven infertile women, in whom interstitial fallopian tube obstruction (IFTO) was suspected at hysterosalpingography and who were recommended for surgical evaluation and treatment, were treated with catheterization techniques. Selective salpingography with ostial injection demonstrated tubal patency in two patients; direct intratubal salpingography demonstrated patency in another patient. Four patients with a true IFTO underwent fallopian tube recanalization: in the first two, a small soft-tipped guide wire was used, and in the other two, a guide wire and 3-F catheter were used. The suggested catheterization techniques have the potential to make evaluation and treatment of IFTO more efficient, safer, and less expensive than presently used methods.     

改良双腔球囊导管在插管失败的输卵管阻塞介入再通术中的应用价值

目的探讨改良双腔球囊导管在插管失败的输卵管阻塞介入再通术中的应用价值。方法回顾45例输卵管阻塞性不孕患者,应用常规法行介入再通术,其中输卵管开口插管失败采用改良双腔球囊导管行介入再通,统计分析常规法组与联合改良双腔球囊导管法组(联合法组)的输卵管开口插管成功率、输卵管阻塞的开通率。结果输卵管阻塞性不孕患者45例,共阻塞输卵管90条,采用常规法输卵管开口插管成功32条,其中开通成功31条,插管成功率为35.56%,开通率96.88%。采用联合法输卵管开口插管成功90条,输卵管开通83条,插管成功率为100%,开通率92.22%,7条输卵管因阻塞病情严重无法开通,其中双侧均未能开通1例。所有患者术中均无严重并发症发生。随访12个月,妊娠率48.65%。常规法组与联合法组输卵管开口插管成功率差异具有统计学意义(χ^2=85.574,P=0.000),而输卵管开通率差异无统计学意义(χ^2=0.248,P=0.619)。结论对于常规法输卵管开口插管失败者,采用联合改良双腔球囊导管可提高输卵管开口插管成功率。采用改良双腔球囊导管介入再通与常规法开通效果相当,可作为常规介入再通输卵管开口插管失败的备选方案。     

Efficacy of Salpingography and Transcervical Recanalization in Diagnosis, Categorization, and Treatment of Fallopian Tube Obstruction

Purpose: The efficacy of selective salpingography (SS) and transcervical recanalization (TCR) in diagnosis, categorization, and determination of optimal treatment modality for fallopian tube obstruction was investigated. Methods: SS and, in some patients, TCR was performed in 430 patients with a diagnosis of obstruction of one or both fallopian tubes, as determined by hysterosalpingograms (HSG). All patients (age 21–46 years) had an infertility problem for at least 18 months. Results: In 196 patients, 325 tubes were patent on SS. TCR recanalized 243 tubes in 176 patients. Disease of the distal tube was demonstrated in 66 patients. There were 39 live babies in a group of 176 patients with successful TCR. Best live birth rate was in 7 of 12 (58%) patients with underlying endometriosis, followed by postsurgical strictures in inflammatory disease, 6 of 31 (19%), and salpingitis isthmica nodosa in 25 of 168 (15%). There were no pregnancies in patients with cobblestone pattern of the distal tubes. Conclusions: SS and TCR were capable of correcting obstruction of the proximal tubes in 243 of 465 tubes in 176 of 234 patients (75%). With patency of the proximal tube restored, the distal tube could be assessed for changes indicative of damage to the ciliated epithelium which was likely to reduce the ability to become pregnant. This allowed for the triage of patients into groups benefiting from the relatively inexpensive and low complication TCR or patients in need of in vitro fertilization or similar assisted reproductive technologies.     

子宫腔碘水加压法输卵管再通术的临床研究

目的寻求一种简便快速、安全有效、经济实用,将造影诊断与输卵管再通治疗结合起来的新方法。方法应用双腔球囊胶管插入子宫腔,充盈球囊堵塞子宫颈内口,用助推器注入碘海醇充盈子宫腔及输卵管,电视动态观察实时点片,完成造影诊断。当发现输卵管阻塞时,用手助推加压,逐渐增高宫腔内压力,使阻塞输卵管被造影剂压力钝性开通。结果本组2698例,插管成功2685例。其中,原发不孕806例,继发不孕1868例,其他24例,输卵管阻塞3082支(右1561支、左1521支),占实有输卵管的59%,加压开通率为77.8%(2397/3082);通而不畅343支(右175支、左168支),加压开通率:93.9%(322/343),出现静脉逆流27例。除局部疼痛及少量阴道流血外,无严重并发症病及病死率。结论该法简便快速,安全有效,经济实用,将造影诊断与输卵管再通相结合,深受患者欢迎,值得推广应用。     

Fallopian tubes: improved technique for catheterization

Successful fallopian tube catheterization for diagnosis or treatment of infertility combines hysterosalpingographic and angiographic techniques. An improvement in the catheterization strategy was developed so that angled, tortuous, or more distally obstructed fallopian tubes could be catheterized. In 22 patients, 38 fallopian tubes were catheterized by using this strategy. In nine tubes (24%), forceful ostial injection alone of contrast material was able to open and/or depict the fallopian tube. In 13 tubes (34%), a discrete obstruction was recanalized by using the standard fallopian tube catheterization set. In 12 tubes (32%), successful recanalization required the use of a softer, tapered guide wire and catheter. In four tubes (10%), recanalization was unsuccessful.