选择性输卵管造影与再通术对输卵管近端梗阻的疗效分析

目的 探讨选择性输卵管造影与再通术在诊治输卵管近端梗阻方面的安全性和有效性。方法 １０３例输卵管近端梗阻患者,用自制的导管施行选择性输卵管造影,若输卵管近端仍梗阻,则行输卵管再通术。结果人１３５条输卵管中有５１条仅施行选择性输卵管造影即获得再通,剩下８４条输卵管施行输卵管再通术后６４条获再通,有效率达８５．２％,随访３０例,输卵管再通术后有８例宫内妊娠和１例宫外孕,选择性输卵管造影术后有５例宫内妊     

Selective salpingography and fallopian tube recanalization

Obstruction of the uterine (proximal) end of the fallopian tube is noted on up to 20% of hysterosalpingograms and has a variety of underlying causes. Definitive diagnosis and treatment in the past have required laparoscopy or laparotomy with tubal resection. Selective salpingography and fallopian tube recanalization with fluoroscopically guided catheters has emerged as an improved method both for diagnosis and treatment in these patients. Technical success rates for overcoming the obstruction and visualizing distal tubal anatomy range from 76% to 95%. Pregnancy rates after the procedure vary depending on the patient populations studied; however, early results indicate a greater than 50% intrauterine pregnancy rate by 1 year. The rate of ectopic pregnancy is approximately 10% and that of early tubal reocclusion is less than 30%. Selective salpingography and fallopian tube recanalization is recommended as the first intervention in patients with obstruction of the proximal fallopian tube.     

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.     

Selective fallopian tube catheterisation in female infertility: clinical results and absorbed radiation dose

Clinical results of fluoroscopic fallopian tube catheterisation and absorbed radiation doses during the procedure were evaluated in 30 infertility patients with unilateral or bilateral tubal obstruction documented on hysterosalpingography. The staged technique consisted of contrast injection through an intraurine catheter with a vacuum cup device, ostial salpingography with the wedged catheter, and selective salpingography with a coaxial microcatheter. Of 45 fallopian tubes examined, 35 (78%) were demonstrated by the procedure, and at least one tube was newly demonstrated in 26 patients (87%). Six of these patients conceived spontaneously in the follow-up perod of 1–11 months. Four pregnancies were intraurine and 2 were ectopic. This technique provided accurate and detailed information in the diagnosis and treatment of tubal obstruction in infertility patients. The absorbed radiation dose to the ovary in the average standardised procedure was estimated to be 0.9 cGy. Further improvement in the X-ray equipment and technique is required to reduce the radiation dose. Correspondence to: T. Ishigaki     

简化器械开展输卵管再通治疗的探讨（附 38例报告）

目的：采用简化器械及手术方法开展输卵管再通术治疗输卵管阻塞,探讨其方法的临床意义和效果。采用Cook公司6F直型导管或其它6F导管改制作介入导管,Terumo公司超滑导丝做再通器械,治疗患者36人共38例次,经造诊断输卵管不能共64条,结果：输入卵管实现再通54条,再通有效率达84．37％,其中有2例采用腹腔镜结合管再通术实现再通,1例输卵管再通后8个月造影发现重新阻塞。结论：采用简化芨手术方法进行输卵管介入再操作简便,费用低,是一种治疗输卵管阻塞病变安全有效的方法。器械及手术方法的简化不但降低费用,且能达到理疗效。     

Selective salpingography and tubaric catheterization in the diagnosis and treatment of fallopian tube obstruction

Fallopian tube catheterization with selective salpingography is a new technique for the diagnosis of tubal factors of sterility and also for the treatment of proximal tubal obstruction (PTO). In this study, 156 women, 20–42 years of age, with a mean duration of infertility of 5.7 years, who presented at conventional hysterosalpingography (HSG) a unilateral or bilateral PTO, were studied. Catheterization and selective salpingography was successful in 93% of the cases. Failures (6.1%) were ascribed to obliterative organic diseases, where it was impossible to overcome the stenosis with the catheter or the guidewire. Fourteen spontaneous pregnancies were obtained (7 full term deliveries, 4 miscarriages, 3 tubal pregnancies) and 11 patients became pregnant after gamete intra-fallopian transfer (GIFT). At follow-up, after 12 monts, four out of ten patients had patent tubes, while six presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, it is acknowledged that ectopic pregnancy is a possible outcome, due to the mechanical re-establishment of patency in a non-functioning tube.     

99TcmO4-输卵管显像对不孕症患者腹腔镜手术的价值

目的应用99TcmO₄-输卵管显像研究不孕症患者X线子宫输卵管造影（HSG）显示机械性通畅输卵管的功能受损程度,进而研究99TcmO₄-输卵管显像对腹腔镜手术的价值。 方法对HSG显示至少一侧输卵管通畅或通而不畅的不孕症女性患者166例（通畅输卵管91条,通而不畅输卵管222条,单侧不通输卵管19条）行99TcmO₄-输卵管显像。并对HSG显示通畅的91条输卵管进行99TcmO₄-输卵管显像及腹腔镜对比分析。采用SPSS 17.0软件对HSG检查通畅输卵管99TcmO₄-显像的输卵管功能损伤程度与腹腔镜检查的输卵管通畅性进行比较并行χ2检验。 结果对HSG显示输卵管机械性通畅（包括通畅及通而不畅）的不孕症患者,99TcmO₄-输卵管显像结果显示输卵管功能受损的阳性率为78.3%。对不孕症患者HSG检查显示通畅的输卵管,行99TcmO₄-显像及腹腔镜结果比较,其差异有统计学意义（χ2=27.56,P < 0.05）。其中,若腹腔镜显示通畅,则放射性核素99TcmO₄-输卵管显像显示输卵管功能以正常及轻度受损为主;若腹腔镜显示通而不畅,则放射性核素99TcmO₄-输卵管显像显示输卵管功能以中、重度受损及无功能为主。 结论放射性核素99TcmO₄-输卵管显像对输卵管功能受损程度及通畅性的判断具有重要价值,对临床腹腔镜手术选择具有重要指导价值,尤其对HSG显示输卵管通畅的不孕症患者能否进行腹腔镜手术价值更大。     

Selective transcervical fallopian tube catheterization: technique update

A technique of transcervical fallopian tube catheterization involving use of a new vacuum hysterograph and coaxial catheter set is described. In 25 women, selective catheterization of the uterine cornua was accomplished with a 94% success rate. Ostial salpingography permitted visualization of 26% of the 46 tubes found to be obstructed or poorly visualized with conventional hysterosalpingography. Recanalization was successful in 96% of 28 proximal tubal obstructions and in 33% of six midisthmic obstructions unrelated to surgery. Recanalization attempts resulted in tubal perforations without apparent clinical effects in four tubes, one with proximal and three with midisthmic postsurgical obstructions. The new hysterograph with coaxial catheter set is more suitable for recanalization of the obstructed fallopian tubes than is the previously used balloon catheter set.     

Tubal catheterization with selective salpingography in the diagnosis and therapy of fallopian tube obstruction]

Fallopian tube catheterization with selective ostial [correction of osteal] salpingography is a new technique for the diagnosis of tubal factors of infertility and also for the treatment of proximal tubal occlusion (PTO). In this study, 246 women were considered, 20-42 years old, with primary or secondary infertility, who presented a unilateral or bilateral PTO at hysterosalpingography (HSG). Catheterization and selective salpingography have been successful in 93.9% of the cases. Failures (5.6%) have been ascribed to obstructive organic diseases, where it was impossible to overcome the stenosis with the catheter or the guide-wire. Twenty-six spontaneous pregnancies were obtained (15 full-term deliveries) and 17 patients became pregnant after GIFT (13 full-term deliveries). At follow-up, after 12 months 4 of 10 patients had normal tubes, while 6 patients presented a new unilateral or bilateral PTO. No major complications occurred; nevertheless, ectopic pregnancy is a possible event, because of the mechanically re-established patency in a nonfunctioning tube.     

Occlusion of the fallopian tube by selective transcatheter radiofrequency electrocoagulation: an experimental study in rabbits

PURPOSE: To test the feasibility of performing transcervical fallopian tube occlusion in a rabbit model with use of unipolar radiofrequency (RF) electrocoagulation. MATERIALS AND METHODS: Under fluoroscopic guidance, transvaginal catheterization of the right or left fallopian tube was first performed with use of a coaxial technique in 20 rabbits. With a metal guide wire protruding from the catheter serving as the active electrode, RF electrocoagulation was performed. The power output was set to 200 W and the current was applied for 20 seconds. The fallopian tube on the contralateral side and the uterus were used as controls. Rabbits were randomly designated to be killed either 2 days (group I, n = 10) or 30 days (group II, n = 10) after the procedure, and tubal patency and histologic changes were evaluated. RESULTS: In group I, significant necrosis of the endosalpinx caused by RF electrocoagulation was found in all 10 rabbits. In group II, the occluded fallopian tube showed fibrosis of the wall in all 10 rabbits, but there was no tissue damage to adjacent organs. Histologic findings in the contralateral fallopian tubes were normal in all 20 rabbits. CONCLUSION: Transcatheter RF electrocoagulation proved to be a safe nonsurgical alternative for occlusion of the fallopian tubes in rabbits.     

Ectopic pregnancy: features at transvaginal sonography.

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.     

自制同轴导管引导下选择性输卵管造影及再通术的临床应用

目的：探讨自制同轴导管引导下选择性输卵管造影及再通术的临床应用价值。方法：116例输卵管梗阻患者,用自制同轴导管行选择性输卵管造影,若输卵管近端仍完全 梗阻。则行输卵管再通术。结果：随访116例,有55例宫内妊娠和6例宫外孕,宫内妊娠率为47．4％,116例中有28例再次做HSG,25例有好转,有效率为89．3％。结论：用自制同轴导管施行选择性输卵管造影及再通术对诊治输卵管梗阻是安全而有效的。     

Pregnancy outcomes after fallopian tube recanalization: oil-based versus water-soluble contrast agents

PURPOSE: To determine the pregnancy outcomes in patients undergoing fallopian tube recanalization (FTR) with use of oil-based versus water-soluble contrast agents. MATERIALS AND METHODS: Ninety-three patients with unilateral or bilateral proximal tubal occlusion confirmed by hysterosalpingography or laparoscopy underwent FTR with use of water-soluble contrast material alone (n = 50) or also had an oil-based agent injected into each tube after recanalization (n = 43). Pregnancy rates and outcomes of the two groups were studied retrospectively. RESULTS: With respect to differences between groups, only the body mass index proved to be a significant predictor (oil, 28.4; water, 24.7; P =.008). Mean age, duration of infertility, type of infertility, and initial diagnosis were comparable. There was a weak trend toward a higher pregnancy rate in the oil-based contrast material group, but it was not significant (P =.64). The average time to pregnancy was 4.4 months with use of oil-based contrast material, compared to 7.7 months with use of only water-soluble contrast material (P =.03). CONCLUSION: The use of an oil-based agent had little effect on the rate of conception, but time to conception was reduced by more than 3 months.     

经阴道超声对输卵管脓肿的诊断价值

目的:探讨输卵管脓肿的经阴道超声声像图特征及其诊断价值.方法:回顾性分析53例输卵管脓肿患者的经阴道超声图像,其中48例经手术病理证实为输卵管脓肿.结果:48例患者超声诊断正确,其中一侧输卵管积脓19例,双侧积脓29例.77个输卵管积脓包块呈纡曲管状、腊肠状或曲颈瓶状无回声区,其中71个输卵管管壁有不完全分隔回声,68...     

应用改良装置治疗输卵管阻塞(附800例分析)

目的 评价用一种改良装置对单侧或双侧输卵管阻塞的再通效果。方法 于1995年11月至2002年10月我院放射科对800例年龄为24～42岁不孕妇女经造影证实为单侧性或双侧性阻塞的1489条输卵管应用美国Cook公司产改良装置实施了介入再通术治疗。该技术操作是在X线监视下经宫腔将导管选送至输卵管开口端而进行选择性输卵管造影与输卵管再通术。结果 确诊有阻塞的1489条输卵管，经再通术治疗后，有1137条输卵管得以复通，复通率为76．4％，导管一次性插管成功率为98．8％。结论 用于输卵管再通术的改良装置兼具多方面优点，诸如操作灵活，疗效显，经济实用，因而值得推广。     

A review of selective salpingography and fallopian tube catheterization.

Use of selective salpingography and fallopian tube recanalization has revolutionized the diagnosis and treatment of infertility. Selective salpingography, a diagnostic procedure in which the fallopian tube is directly opacified through a catheter placed in the tubal ostium, has been used since the late 1980s to differentiate spasm from true obstruction and to clarify discrepant findings from other tests. In fallopian tube recanalization, a catheter and guide wire system is used to clear proximal tubal obstructions. The recanalization procedure is simple for interventional radiologists to perform and is successfully completed in most patients (71%-92%). Pregnancy rates after the procedure have been variable, with an average rate of 30%. The combination of selective salpingography with fallopian tube recanalization has improved the overall management of infertility caused by tubal obstruction. The same catheterization technique used in fallopian tube recanalization is currently being explored for use in tubal sterilization.     

Post-ligation dilatation of the fallopian tube.

RATIONALE AND OBJECTIVES. Dilatation of fallopian tube remnants after ligation has been described but never systematically studied in post-ligation hysterosalpingograms (HSGs). This study describes the frequency and appearance of proximal tubal remnant dilatation as seen on HSGs in women with a history of bilateral tubal ligation (BTL). METHODS. A retrospective review of medical records and a subjective and objective evaluation of dilatation seen on HSGs included 68 consecutive women seen for pre-reanastomosis HSG. RESULTS. Among the 68 women, 44 (67%) had objectively measured dilatation on one or both tubes. Dilatation was present in both short and long tubal remnants. There were no measurable differences between women with and without presence of dilatation. Neither length nor dilatation of tubal remnant was associated with pregnancy outcome. CONCLUSIONS. Dilatation of the tubal remnant after bilateral tubal ligation is a common finding on HSG and can be accurately identified from the HSG by radiologists. Dilatation is not strictly related to length, and in our small sample with follow-up, was not associated with pregnancy outcome.     

US-guided fallopian tube catheterization

Ultrasound-guided fallopian tube catheterization was performed in seven women a total of 14 times. The women had normal-appearing fallopian tubes at hysterosalpingography and received sperm via the catheter as a way to overcome their inability to conceive. Techniques similar to those used for fluoroscopically guided fallopian tube catheterization were used. Forty-three percent of fallopian tubes were successfully catheterized.     

输卵管妊娠后慢性输卵管炎的造影分析

目的 研究慢性输卵管炎的造影表现,提高子宫输卵管造影术(HSG)对输卵管性不孕的诊断能力,并对输卵管妊娠患者再次备孕提供指导.方法 回顾性分析2018年1月至2019年8月在我院就诊的既往有输卵管妊娠史患者的资料,共计58例,115条输卵管,其中输卵管妊娠患病64条.在月经干净以后3～7 d内进行HSG检查,观察输卵管...     

Gartner's duct associated with diverticulosis of the fallopian tubes

Hysterosalpingography demonstrated unilateral opacification of Gartner's duct and bilateral diverticulosis (salpingitis isthmica nodosa) of the fallopian tubes. An association of two mesonephric abnormalities in the same patient is postulated. The case also serves as a reminder of the association of diverticulosis with tubal ectopic pregnancy and infertility.