药物粘堵后输卵管复通的探讨

药物粘堵后输卵管复通的探讨山东省立医院妇产科（２５００２１）王育华盛燕输卵管药物粘堵绝育因无痛苦受到很多妇女青睐，但化学药物注入输卵管后，输卵管间质部闭塞，一旦需要再通，子宫角切口与远侧通畅段输卵管的关系较难处理。这是药物粘堵绝育术广泛开展受到限制的...     

输卵管粘堵术苯酚过敏2例

输卵管粘堵绝育术是广大妇女易于接受的方法,引起过敏反应较少见.我院曾收治2例以复方苯酚糊剂行输卵管粘堵术,术后发生过敏的患者,报道如下.例1.37岁,住院号137023.1988年11月23日入院.该患者1988年10月11日在外院行复方苯酚糊剂输卵管粘堵术,术中经过顺利,X 线摄片粘堵成功,     

宫腔镜直视下输卵管粘堵绝育术

<正> 七十年代以来,我国研究了经宫颈途径的输卵管药物粘堵绝育方法;若此法被证实安全有效,将有可能在发展中国家被广泛接受。1974年起作者按吴裕浩等报道的操作方法和复方苯酚糊剂开始作非直视下输卵管粘堵绝育术;以后对某些操作困难或失败的对象,在宫腔镜直视下输卵管粘堵绝育作为一种辅助补救措施。一,非直视下输卵管粘堵绝育(一)材料与方法从1974年到1979年间1162例要求绝育的经产妇女接受此术。操作方法按吴裕浩报道所述。应用一根前端套有短橡皮导管的稍弯曲金属套管,经宫颈插入子宫腔探达宫角处,然后将套管内塑料导管(外径约1.4mm)插入输卵管口内,若经导管内注入20ml 生理盐水无回溢且阻力小,显示导管插入正确.进     

自体输卵管移植术的临床应用及方法介绍

我院采用的自体输卵管移植术,经过近10年的临床观察,证明是一种简便、有效、可靠的手术方式,值得同道们共同探讨与完善。1资料与方法1.1研究对象1985～2004年我院行自体输卵管移植术共14例,其中因输卵管间质部阻塞不孕要求手术治疗13例,异位妊娠手术中发现残角子宫而行输卵管移植术1例。14例中原发不孕3例,继发不孕6例,绝育术后要求再通4例,1例异位妊娠破裂手术中发现与子宫相通的输卵管妊娠破裂,无法修复而切除一侧输卵管,另一侧输卵管位于右侧残角子宫上,切除残角子宫同时将输卵管移植于右侧宫角。施术14例,移植26条输卵管。年龄23～42岁…     

药物黏堵绝育术后近端输卵管闭塞的手术复通效果分析

目的探讨药物黏堵绝育术后近端输卵管闭塞的手术复通效果。方法对1986年8月至2004年4月间,在中山大学附属第二医院住院的曾接受药物黏堵绝育术,后因各种原因而再行输卵管复通术——输卵管子宫角移植术患者208例的临床资料进行回顾性分析。结果（1）术中检查输卵管闭塞部位均发生在间质部及峡部。（2）65例盆腔有不同程度粘连,其中57例为轻度疏松粘连,7例为中度粘连,仅1例为重度粘连。（3）输卵管复通术后随访6个月以上者共199例,随访率95．7％。术后第2个月进行输卵管通液检查者共193例,其中185例通畅,通畅率为95．8％（185／193）。（4）获得宫内妊娠143例,宫内妊娠率为71．9％（143／199）,其中已足月分娩125例,占87．4％（125／143）,足月尚未分娩2例;目前正在早期妊娠3例,中期妊娠2例。（5）自然流产11例,自然流产率为7．7％（11／143）。输卵管壶腹部妊娠2例,占1．0％（2／199）。随访的199例中均未发现有子宫内膜异位的征象。结论药物黏堵绝育术后,近端输卵管闭塞患者行输卵管子宫角移植术的治疗效果肯定,是值得推荐的一种方法。     

输卵管间质部妊娠临床诊治分析

输卵管间质部妊娠在异位妊娠中发生率虽不高,但因输卵管间质部破裂损伤大,内出血严重常危及生命。我们对经手术及病理检查确诊的输卵管间质部妊娠３７例进行了临床诊治分析．现报告如下。１资料与方法１．１临床资料　　１９９６年１月至１９９９年９月我院收治异位妊娠４１５例．经手术及病理检查确诊输卵管间质部妊娠３７例,占 ８ ．９２％。未破裂型 ６例,破裂型 ３１例。平均 ３１岁。已婚已育３０例,已婚未有７例。停经１０～１２＋周１５例．８～９周１２例,６～７周１０例。行输卵管结扎术１３例,放节育环１４例,无避孕措施…     

绝育后输卵管妊娠93例浅析

绝育后输卵管妊娠９３例浅析陈筱波，郭盛菊资料与方法一、一般资料：本文收集我院１９８２年１月～１９９１年１２月１０年间输卵管妊娠３９５例，均经剖腹探查肉眼见到绒毛或经本院病理科病检证实。９３例绝育后输卵管妊娠中有２例因手术时未同时行对侧输卵管结扎，而分...     

人工流产术后输卵管通畅度的B超监测及治疗

本文对５０例人工流产术后妇女在Ｂ超监视下进行子宫输卵管通液,以了解人工流产术对输卵管通畅度的影响。结果表明：人工流产术不同程度地影响输卵管通畅度,人流次数越多输卵管阻塞发生率越高。现报道如下。１资料与方法１１一般资料１９９５年１月至１９９６年４月对...     

输卵管妊娠保留输卵管手术后综合疗法的宫内妊娠探讨

对输卵管妊娠52例有生育要求者，其中28例行切开输卵管壶腹部取胚胎术，10例行输卵管峡部破裂口修补术，7例行输卵管伞部成形术，5例行输卵管峡部端端吻合术，2例行输卵管子宫角部植入术。术后给MTX与中药等综合治疗2～5个月，对其中45例行输卵管通畅检查，双侧输卵管通畅4O例，通畅率为88.9％；有41例宫内妊娠，妊娠率为78.9％，另有1例再次异位妊娠。提示：对有生育要求的输卵管妊娠尽量根据输卵管的不同情况采用相应的手术方法，并应用有效的术后综合措施，对保留患者的生育功能和提高妊娠率有重要意义。     

加压法子宫输卵管造影在输卵管间质部阻塞中的应用

目的:分析加压法子宫输卵管造影在输卵管间质部阻塞中的应用价值。方法:选择因不孕症行子宫输卵管造影患者共62例分成两组,加压组采用气囊压迫法及胃肠X线机压迫器机械压迫输卵管阻塞部位,对照组行常规子宫输卵管造影检查,统计两组输卵管再通率。结果:加压组31例患者共41支输卵管间质部阻塞,再通输卵管共24支,再通率58.5%;对照组31例患者共42支输卵管间质部阻塞,造影结束后再通共7支,再通率16.7%,两组再通率比较,差异有统计学意义(P0.05)。加压组4例患者发生轻度不良反应;对照组3例患者轻度造影剂反应。术后随访6个月,加压组31例患者妊娠9例(29.0%),对照组31例患者妊娠3例(9.7%),两组术后妊娠率比较,差异有统计学意义(P0.05)。结论:加压法子宫输卵管造影在输卵管间质部阻塞中有较高应用价值。     

腹腔镜和宫腔镜在不孕症诊治中的应用

本文对320例不孕症患者行腹腔镜检查,其中47例同时行宫腔镜检查及治疗。腹腔镜检查结果表明,盆腔炎症和子宫内膜异位症是本组病例中最常见的病因,占77.5％,由此引起的盆腔粘连和输卵管阻塞占71.33％,而这些病例56.9％(110/255)没有临床表现,因此腹腔镜检查是诊断盆腔炎和子宫内膜异位症的可靠方法。47例宫腔镜检查发现异常占21.3％,其中27例49条阻塞输卵管在宫腔镜下加压通液及行插管术,其中8例11条输卵管通畅,占29.6％,4例妊娠。因此对HSG或腹腔镜检查发现的输卵管阻塞,特别是近端阻塞,可在腹腔镜监视下,行宫腔镜加压通液或输卵管插管再通术以减少误诊。     

Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography.

OBJECTIVE: To compare three-dimensional saline sonohysterosalpingography (SHSG) to X-ray hysterosalpingography (HSG) for the evaluation of the uterine cavity and fallopian tubes. PATIENT POPULATION: Fifteen infertile women on whom X-ray HSG had been performed within 1 year prior to this study. METHOD: Fifteen infertile women underwent three-dimensional power Doppler examination of the uterus and fallopian tubes with three-dimensional SHSG during the follicular phase. Distension was achieved using sterile saline injected through a 5 French HSG catheter. Peritoneal accumulation of free fluid surrounding the ovary and tube was required for a diagnosis of a patent tube. Fluid accumulation in the cul-de-sac without visualization of the tubes was considered consistent with at least one tube being patent. RESULTS: three-dimensional saline SHSG was completed in 14 patients. One patient had cervical stenosis and the procedure could not be performed. No significant intrauterine pathology was identified by either X-ray HSG or sonography. Three-dimensional saline SHSG made false positive diagnoses of tubal occlusion in four out of seven fallopian tubes (57%). The sensitivity and specificity for detecting tubal occlusion was 75 and 83%, respectively, with a positive predictive value of 40% and negative predictive value of 95%. Detection of fallopian tube architecture was not possible with three-dimensional saline SHSG in any patient. Simultaneous use of three-dimensional Doppler did not clearly identify the flow of saline through the fallopian tubes. CONCLUSIONS: Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.     

Evaluation of 500 hysterosalpingograms with special reference to tubal sterility

457 hysterosalpingograms out of 500 could be analysed which were made from sterility patients of the women's clinic, Wilhelm-Pieck-University Rostock, in the period from 1973 to 1980. A normal uterine cavity was found in 395 cases (86.7%), having a tubal patency on both sides (54%). In 8.7% of the cases only the right tube and in 11% only the left tube was patent for contrast medium. In 48 cases there was a tubal occlusion on either side. Uterus arcuatus was diagnosed in 7%, uterus bicornis in 4% and uterus duplex as well as uterine fibromyoma in 0.5% of the cases. Intracavitary processes were evident only in 6 patients. Abnormal long tubes could be found in 79 cases, tubes in high positions in 87 cases, and rigid and very short tubes in 95 cases. In 176 cases a sactosalpinx could be diagnosed. Ampullar tubal occlusion at one side was observed in 105 cases, and the same one in 49 cases on both sides. Following the hysterosalpingography 71 from a total of 122 pregnancies occurred within a period of 6 months, without any additional treatment being carried out in 32 patients.     

Patient rotation and resolution of unilateral cornual obstruction during hysterosalpingography

OBJECTIVE: Unilateral obstruction of the proximal fallopian tube is identified in 10-24% of patients undergoing hysterosalpingography for evaluation of infertility. Upon further testing, this obstruction spontaneously resolves 16-80% of the time. We hypothesized that patient rotation during hysterosalpingography might resolve proximal tubal obstruction in some cases by altering either the location of intrauterine air bubbles or the spatial relationship of the tube to the uterine fundus. METHODS: In patients in whom unilateral proximal tubal obstruction was detected during hysterosalpingography performed for standard clinical indications, the patient was rotated on her hip approximately 45 degrees such that the obstructed tube was first superior (ventral) to the patent tube, and dye was reinjected. If obstruction did not resolve, the patient was rotated in the opposite direction so that the obstructed tube was inferior (dorsal) to the patent tube and dye reinjected. RESULTS: Unilateral tubal obstruction was found in 15% of cases (24 of 156). Rotating the patient with obstructed tube superior to the patent tube never resulted in tubal patency, whereas rotating the patient with the obstructed tube inferior resulted in resolution of tubal patency in 63% of cases (15 of 24) CONCLUSION: .Unilateral cornual obstruction during hysterosalpingography is often resolved by rotating the patient such that the obstructed tube is more inferior. Although this observation may be the result of dislodging smaller air bubbles, from a fluid dynamics perspective a more likely explanation is unkinking of the more inferior tube.     

选择性输卵管造影和再通术1006例随访分析

目的 探讨选择性输卵管造影(SSG)和输卵管再通术(FTR)治疗不孕症的临床疗效和实用价值。方法 对1006例经子宫输卵管造影(HSG)检查诊断为输卵管不同部位、不同程度梗阻的不孕症患者,用自制同轴导管行SSG和FTR,统计1年内的妊娠率和输卵管通畅度治疗的有效率,并结合术前、术后HSG及术中输卵管动态观察结果进行综合分析。结果 输卵管腔完全梗阻315例,共601条输卵管(部分患者曾因各种原因行一侧输卵管切除,完全梗阻组),528条获管腔再通,再通率87．9%．其中35.4％(187条)仅行SSG即获再通,64．6％(341条)在SSG同时行FTR获再通。术后1年内妊娠率为39．9％,异位妊娠发生率2,7％,管腔再闭塞率1．8%;未获再通者中4例为结核性输卵管炎,3例结节性输卵管炎,9例阻塞于峡部,末端呈杵状改变,6例阻塞于壶腹部和伞部,10例输卵管纤维化。管腔不全梗阻691例(不全梗阻组),其中输卵管通而欠畅105例,通而不畅357例,通而极不畅229例,行SSG术后共发现65例术前HSG结果对伞部粘连的诊断有误。1年内妊娠率随访显示,输卵管通而欠畅者为53.6％,通而不畅者为45.7%,通而极不畅者为26,8％,异位妊娠发生率1．4％。术后1年行HSG复查,治疗有效率(管腔通畅度好转)86．9％。两组中经SSG诊断伞端粘连明显或周围包裹形成者共有16例,同时进行了腹腔镜治疗,其手术符合率97．1％。结论 SSG和FTR对输卵管性不孕具有诊断和治疗双重作用,且简便、安全,疗效可靠,值得临床推广。     

Pelvic endoscopy in diagnosing fallopian tube disorders that cause infertility]

Over the period of 25 years, 1080 pelvic endoscopy in infertile women were performed, with special attention payed to the pathology of Fallopian tubes. Pelvic endoscopy was performed after previous HSG. During the pelvic endoscopy, the state of the uterus, ovaries and uterine tubes were evaluated, with much attention paid to the condition of the abdominal ostium of the uterine tube, symptoms of active and chronic inflammation, endometriosis, the authors also tried to diagnose the extension and character of pelvic-salpingian adhesions. Confrontation of the results enabled diagnosis in 111 (41.7%) women, out of 266, with patient Fallopian tubes the organic factors which impaired conception or made conception impossible. In the group of 814 women with tubal impotency in 15 (1.8%) cases extratubal factor was found, subserosal myoma in uterine horn, cyst, adhesions, while Fallopian tube itself was patent and unchanged. Organic factors of Fallopian tube disorder were determined. In 360 (44.2%) patients, out of 814, with tubal impotency pathological status was found (active salpingitis, tuberculosis, endometriosis) which required establishing of a necessary treatment and cancelling the surgical treatment.     

Hysteroscopic selective salpingography.

OBJECTIVE: To evaluate the effectiveness of hysteroscopic selective salpingography (HSS) as a method for diagnosing the tubal proximal occlusion shown by hysterosalpingography (HSG). DESIGN: Prospective study. SETTING: Outpatient Department of Obstetrics and Gynecology, Social Insurance Saitama Chuo Hospital, Urawa, Japan. PATIENT(S): A total of 572 infertile women underwent HSG. Forty-seven of 50 women with unilateral or bilateral proximal tubal occlusion demonstrated by HSG underwent HSS. INTERVENTION(S): Hysteroscopic selective salpingography was performed for the diagnosis of tubal occlusion in cases in which the proximal tubal occlusion was shown by HSG. MAIN OUTCOME MEASURE(S): Number of patients who underwent HSS and pregnancy rate after HSS. RESULT(S): Twenty-seven (79.4%) of 34 patients with unilateral occlusion diagnosed by HSG were shown to have normal patency by HSS. Of 12 women with bilaterally normal patent tubes confirmed by HSS, 8 (66.7%) achieved normal pregnancies within 1 year. Seven (53.8%) of 13 patients with bilateral occlusion found by HSG were shown to have normally patent tubes by HSS. CONCLUSION: The simple method of HSS was clinically effective for evaluating the presence of proximal tubal occlusion.     

Hysteroscopic sterilization with the Nd:YAG laser

In 10 rabbits, ablation of the uterine horn endometrium and the fallopian tube was performed with the Nd:YAG laser at a power of 60 W using the touch technique. Eight weeks postsurgery, biopsies of the tissue site were obtained showing that the endometrium and tubal mucosa were completely destroyed. Thirty women were sterilized using a similar technique hysteroscopically. Tubal occlusion was demonstrated by hysterosalpingography in all cases at 3 months postoperatively.     

The Tortuous Tube: Pregnancy Rate Following Laparoscopy and Hydrotubation

256 infertile women whose ovulatory and related male fertility factors were normal were investigated by diagnostic laparoscopy and dye hydrotubation. The tubes were objectively classed into 4 groups--normal, patent with macroscopic tubal adhesions, patent with one tortuosity, and patent with multiple tortuosities. The latter group had a highly significant response to the above procedures and 66% were pregnant within 1 year and 81% within 2 years. No significant effect was found in the other 3 groups. This multiple tortuosity group represents the type of tube that significantly responds to treatment inherent in all tubal patency tests. Its pathogenesis and management are discussed.     

Saline sonohysterosalpingographic findings in infertile Nigerian women.

This paper describes the findings in the first 100 women who underwent saline sonohysterosalpingography (SHG) at two privately owned health facilities in Enugu, South East Nigeria. This was a prospective study of the first 100 consecutive women presenting with infertility to the authors at Mbanefo Hospital and Hansa Clinics, both in Enugu, South-East geopolitical zone of Nigeria from 1 May 2005 to 20 January 2006. Saline sonohysterosalpingography was carried out in the standard way in these women. The findings were analysed using simple percentages and means +/- SD. The procedure was completed in 98 women, while in two others it was not possible to cannulate the uterine cavity. A total of 61 of the women had normal uterine musculature, 37 had interstitial fibroids and two had sonographic features of adenomyosis. Regarding the endometrial cavity, 93 women had a normal endometrium, four had a submucosal fibroid, one had intrauterine adhesions, while the endometrial cavity could not be assessed in two women who could not be cannulated. No case of submucosal polyp or uterine septa or other congenital uterine anomalies was seen. As assessed sonologically, 77 of the study subjects had bilateral patent tubes, while five had unilateral tubal patency. In one woman, there was uncertainty about tubal patency or blockage; in two women, the tubes could not be assessed because of non-cannulation of the uterine cavity and in 15 women, both tubes were blocked. A total of 74 women had normal ovaries; 15 had polycystic ovaries; five had atrophic ovaries consistent with ovarian failure and six women had ovarian cysts. In 18 women, the findings at sonosalpingography (SSG) were confirmed at laparoscopy in 11 women or laparotomy (two women) or by the fact that the patients became pregnant (five women). In 15 (83.3%) of these 18 women, the findings at SSG and laparotomy/laparoscopy or of the woman becoming pregnant were compatible. SSG is a useful screening test for assessing endometrial, tubal and ovarian factors in infertile Nigerian women, thereby obviating the need for laparoscopy and hysteroscopy in the majority of cases.