选择性输卵管造影和再通术对输卵管阻塞性不孕的疗效分析

为提高子宫输卵管疾病诊疗手术的成功率，降低其并发症，2002年我们在美国COOK公司生产的非手术性子宫输卵管治疗器的基础上改良并研制了性能更加完善的子宫输卵管诊疗器并获得专利（专利号01244229．1）。此器械操作方便，成功率高，安全可靠，价格低廉，有较好的应用前景。2002年我院分别应用COOK公司的仪器和我们研制的仪器施行选择性输卵管造影与输卵管再通术，取得了满意效果，现报告如下。     

选择性输卵管造影及再通术的临床探讨

输卵管梗阻是不孕症最常见的病因,约占女性不孕的1／3,以往诊断及治疗成功率不高。1988年澳大利亚皇家妇女医院Rosch和Thurmono医师首次采用介入放射学的选择性输卵管造影（selectivesalpingography,SSG）和再通术（fllopiantuberecanalization,FTR）,提高了诊断和再通成功率。我院自1997年5月以来用Cook公司生产的真空同轴导管子宫输卵管造影装置对36例不孕患者进行介入诊断和治疗,现将结果报告如下。1材料与方法1．1一般资料1997年5月至1998年12月间我院共对36例不孕患者施行SS3与ITHZ,年龄对～36岁,平均为28．8岁。36例中…     

输卵管阻塞性不孕症的介入性输卵管再通术治疗护理体会

输卵管阻塞是导致育龄期妇女不孕症的重要因素,文献报道占不孕妇女的1／3左右,以往临床常用通液治疗,但成功率低,痛苦大,因此患者较难接受。我科于2001年至2012年应用岛津数字胃肠机和美国COOK公司生产的输卵管同轴再通器材,为180例患者进行了输卵管介入再通治疗,取得了满意的效果。现将有关护理方面的体会报告如下。     

输卵管再通术联合腹腔镜子术治疗中远端输卵管阻塞

输卵管阻塞是造成女性不孕的诸多因素中最常见的一种。约占20％～40％。在输卵管阻塞中，近端阻塞占20％～45％。通过选择性输卵管造影术(SSG)和输卵管再通术(FTR)可以获得很高的输卵管再通率。中远端阻塞占35％～80％，仅通过SSG和FTR治疗，再通率较低(约45％)。受孕率更低。我院自1999年开始，对部分患者在     

输卵管再通术对近端输卵管阻塞不孕症临床治疗结局的影响

目的:探讨输卵管再通术(FTR)治疗近端输卵管阻塞(PTO)不孕症后受孕方式的选择及影响术后妊娠率的相关因素。方法:回顾分析2019年7月至2021年12月在西安交通大学第二附属医院行FTR后双侧输卵管通畅的93例患者的临床资料。根据自主选择受孕方式不同分为观察组(32例)及对照组(61例),观察组采取促排卵周期的宫腔内人工授精(IUI)助孕,对照组采取自然受孕,比较两组的妊娠率及妊娠结局。按照受孕后妊娠情况分为妊娠组(56例)和非妊娠组(37例),采用多因素logistic回归分析影响患者术后妊娠率的危险因素。结果:两种受孕方式的妊娠率和妊娠结局比较,差异均无统计学意义(P>0.05)。术后1～6月的妊娠率均高于术后7～12月(P<0.05);受孕时间在术后7～12月时,促排卵周期IUI的妊娠率明显高于自然受孕(P<0.05),受孕时间在术后1～6月时,两者的妊娠率无显著差异(P>0.05)。女性年龄、输卵管阻塞程度、AMH是影响FTR术后妊娠率的独立危险因素(P<0.05)。结论:输卵管再通术后前半年的妊娠率高于后半年,半年后自然受孕的妊娠率低于促排卵...     

应用输卵管导向管经宫颈行输卵管造影及再通术

对２０例输卵管近端梗阻的患者经宫颈施行输卵管造影及再通术，并对杯状导管法及导向管法进行比较。结果：２０例患者有１９例输卵管获得再通，再通成功率为９５％；４例获宫内妊娠成功；８例输卵管近端梗阻松解后，远端显示不同的病变；７例术后半年输卵管仍保持通畅。输卵管造影及再通术中，患者接受放射剂量平均为６．３５ｍＧｙ。提示：应用导管对输卵管近端梗阻患者进行输卵管造影及再通术简便，有效。导向管法优于杯状导管法。     

介入疗法行输卵管再通术580例临床分析

我院介入科与妇产科从1998年5月至2002年10月,应用介入技术治疗输卵管阻塞580例,收到良好效果。现报道如下。1　资料与方法1.1　对象　我院1998年5月至2002年10月期间对580例不孕症患者1102条完全性阻塞的输卵管进行了介入再通术。患者年龄22~48岁,平均(321±47)岁。其中原发性不孕25例,继发性不孕555例;双侧输卵管间质部阻塞232例、峡部阻塞240例、壶腹部至伞部阻塞50例,单侧间质部阻塞58例。1.2　方法1.2.1　手术器械　采用美国库克公司生产的FTC550输卵管再通系列导管、导丝及TRH250子宫杯。影像设备为荷兰菲利浦公司生产的CV12…     

双氧水输卵管超声造影在不孕症中的应用分析

输卵管堵塞是导致女性不孕的一个重要原因，随着超声技术的不断发展，普通输卵管超声造影、脉冲多普勒输卵管超声造影、彩色多普勒输卵管超声造影等已广泛应用于临床。现将我院30例双氧水输卵管超声造影进行分析并探讨其临床价值。     

双侧输卵管同时妊娠破裂1例

患者39岁，不孕症，输卵管碘油造影显示：双侧输卵管通而不畅，在外院行输卵管再通术，末次月经2002年4月24日。停经35d，查尿妊娠试验弱阳性，无明显早孕反应。B超报告：宫内外未见异常，停经41d查血清β-hCG：38．2ng/ml，诊为宫内妊娠。未引起重视，孕56d，由于用力负重后出现下腹撕裂样痛，肛门坠胀。送我院查体：神志清、面色苍白、下腹压痛明显、触诊不满意。     

子宫输卵管造影的图像解读

女性不孕症25%～35%由输卵管不孕症引起，子宫输卵管造影是诊断输卵管不孕症的一线方法。文章探讨输卵管通而不畅，输卵管近端阻塞，结节性输卵管峡部炎，输卵管远端积水，盆腔粘连，盆腔结核等常见输卵管病变的造影图像表现，以指导临床诊断和手术预后评估。     

选择性输卵管造影术的诊断及治疗意义

目的　探讨选择性输卵管造影术 (SSG)的诊断及治疗效果。方法　 1996年 6月至 2 0 0 2年 10月对 74例经子宫输卵管造影术 (HSG)诊断的输卵管阻塞患者行SSG诊治。结果　经过SSG后希望妊娠且随访 1年以上者 6 4例中妊娠 2 4例 ,妊娠率 37 5 %。其中自然妊娠 18例 ,人工授精 (AIH) 5例 ,配子输卵管内移植 (GIFT) 1例。双侧阻塞组 2 0例中有 3例妊娠占 15 0 % ;单侧阻塞组 4 4例中有 2 1例妊娠占 4 7 7%。即单侧阻塞组妊娠率高 ,与双侧阻塞组比较差异有显著性意义 (P <0 0 1)。结论　SSG因操作简便 ,疗效确实 ,适于临床应用     

Torsion of the fallopian tube

Isolated torsion of the Fallopian tube is an uncommon condition. It occurs at all ages, though most frequently at the menstruating age, in normal as well as diseased tubes, in pregnancy and even after tubal sterilization. A case is reported and the symptoms, differential diagnoses, etiology and diagnostic procedures are discussed. Early diagnosis and treatment is necessary if a twisted tube or a part of it is to be preserved; especially early laparoscopy may be a momentous diagnostic tool in these cases.     

Fluoroscopy-guided, transcervical, selective salpingography and fallopian tube recanalisation

This study is a retrospective review of the transcervical fluoroscopy-guided fallopian tube recanalisation (FTR) procedures done in a multi-ethnic south-east Asian population, over 9 years. A total of 100 patients with infertility and documented proximal tubal obstruction (PTO) were referred for FTR. On-table hysterosalpingography under sedation demonstrated true PTO in 96 patients. At selective-salpingography, the PTO cleared in 16 patients; 78 required FTR and two had fimbrial blockage. The technical success rate of FTR was 86.8% and the post-FTR pregnancy rate was 36.84% at a mean follow-up interval of 12.2 months. There were no major, immediate procedure-related complications. There was an ectopic pregnancy in a single treated patient. Fluoroscopy-guided FTR is a safe treatment option in patients with infertility from PTO, with high technical success rate, low complication rate and increased chances of pregnancy; therefore it should be preferred before attempting more expensive and resource-intensive procedures.     

Laparoscopic management of fallopian tube carcinoma with paraneoplastic cerebellar degeneration

An asymptomatic tumor of the fallopian tube with elevation of serum CA125 concentration was found in a 75-year-old woman during a search for primary malignancy that was causing paraneoplastic cerebellar degeneration with a positive anti-Yo antibody. Since there were no apparent metastatic lesions detected by image diagnostic procedures, a diagnosis of early fallopian tube carcinoma was made preoperatively. After confirmation of the presence of a left tubal tumor without apparent invasion to the adjacent organs and peritoneal metastasis, laparoscopic salpingo-oophorectomy was subsequently performed. The histopathological diagnosis was of moderately differentiated serous adenocarcinoma of the fallopian tube with marked plasma cell infiltration. After surgery, the CA125 value immediately decreased, and there was no evidence of tumor recurrence noted thereafter. The patient died 51 months after surgery due to progression of neurological symptoms.     

Para-aortic lymphadenectomy for primary fallopian tube cancer

Objective

To investigate the topography of lymph node spread and the need for para-aortic lymphadenectomy in primary fallopian tube cancer (PFTC).

Methods

Twenty-six women were diagnosed with PFTC at Cheil General Hospital and Women's Healthcare Center, Seoul, Korea, between March 1992 and November 2009. Of the 26 patients, we retrospectively analyzed 15 patients who underwent complete staging surgery, including bilateral pelvic and para-aortic lymphadenectomy.

Results

The median follow-up period was 57.9 months (range, 3-185 months) and the 5-year survival rate was 86.3%. Five (33.3%) patients were diagnosed with FIGO stage I, 1 (6.7%) with stage II, and 9 (60%) with stage III cancer. The median number of lymph nodes removed was 53.8 (range, 18-106 nodes). Four (26.7%) patients had nodal involvement: 2 patients with para-aortic lymph node involvement and 2 patients with both pelvic and para-aortic lymph node involvement. None of the patients was positive for pelvic lymph nodes alone.

Conclusion

A comprehensive para-aortic lymphadenectomy was necessary for accurate staging in PFTC.     

Primary fallopian tube carcinoma

Primary fallopian tube carcinoma (PFTC) is a rare gynaecological tumour that accounts for 0.14–1.8% of genital malignancies. The most common age of occurrence is between 40 and 65 years, and the mean age is 55 years. The factors that contribute to its appearance are not well known. Population studies show that the mean incidence of PFTC is 3.6 per million women per annum. Overall survival percentages for patients with PFTC are generally low, in the range of 22–57%. Pre-operative diagnosis is rare and PFTC is usually confirmed by a pathologist, but earlier diagnosis with early clinical manifestation and prompt investigation improves the prognosis. Both PFTC and epithelial ovarian cancer (EOC) are treated with similar surgical and chemotherapy methods. Studies have shown that the prognosis for PFTC is worse than that for EOC or other primary gynaecological tumours. This article reviews and presents the current updates of this rare gynaecological malignancy.     

Solitary fibrous tumor arising in the fallopian tube

BACKGROUND: Solitary fibrous tumor (SFT) is an uncommon neoplasm that usually arises in the pleura. Although this tumor has been described at other sites, in the female genital tract it is extremely uncommon. CASE: We present a case of solitary fibrous tumor arising in the fallopian tube. A 32-year-old woman who presented with acute flank pain had a presumptive diagnosis of leiomyoma of the fallopian tube after abdominopelvic ultrasound. The adnexal mass was excised laparoscopically. Histologic examination showed the characteristic features of a solitary fibrous tumor. CONCLUSION: Although rare, the diagnosis of solitary fibrous tumor can be considered in the differential diagnosis of adnexal masses.     

子宫全切除术后发生输卵管脱垂的临床分析

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。     

Primary neuroendocrine carcinoma of the fallopian tube: a case report

Neuroendocrine carcinomas arise from Kulchitsky cells and are frequently seen in gastrointestinal tract and lungs. But they are unusual in gynecology practice. The Fallopian tube is one of the rarest locations for the development of a female genital malignancy. The most common histologic subtype is adenocarcinoma in malignancies of fallopian tubes, but rarely other histologic subtypes have been reported. Here we present a primary neuroendocrine carcinoma of the fallopian tube. To the best of the our knowledge, it was not reported previously.