Live unilateral twin ectopic pregnancy in a fallopian tube remnant after previous ipsilateral salpingectomy

Ectopic pregnancy remains an important cause of morbidity and mortality in women of childbearing age. We report a case of a unilateral twin ectopic pregnancy in a fallopian tube remnant after previous ipsilateral salpingectomy. The pregnancy was conceived spontaneously and included two live gestations. Although the presentation of this ectopic pregnancy was unique, the patient's risk factors were not. As an example of the type of patient who would benefit from ultrasound screening for ectopic pregnancy, our patient renews the debate around this controversial issue. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :169–171, 2014     

输卵管重复异位妊娠的相关危险因素分析

目的探讨输卵管重复异位妊娠(REP)的相关危险因素。方法选取2016年5月至2019年5月我院收治的输卵管REP 50例患者作为试验组,同时选取未发生REP即巢式病例80例作为对照组,对两组临床特点进行分析,并收集信息和资料,采用单因素和多因素logistic回归分析法分析输卵管REP的相关危险因素。结果经多因素logistic回归分析孕产次>3次、输卵管炎症及放置IUD环为输卵管重复异位妊娠的危险因素(P<0.05)。结论输卵管REP严重影响健康和生命,明确REP发生的危险因素,积极有效防治首次异位妊娠的发生,保证输卵管正常功能,使REP显著降低。     

发生在输卵管以外的异位妊娠96例诊治体会

目的 探讨发生在输卵管以外的异位妊娠的诊断与治疗。方法 回顾性分析我院1991～1998年收治的96例输卵管以外的异住妊娠的诊治经过。结果 96例均经手术和病理证实为异位妊娠，其中卵巢妊娠63例，宫角妊娠17例，宫颈妊娠11例，子宫肌壁间妊娠2例，子宫骶骨韧带妊娠、阔韧带妊娠、肝脏妊娠各1例。结论 发生在输卵管以外的异位妊娠术前诊断较困难，临床应提高对此类特殊异位妊娠的认识，提高诊治水平。     

Interstitial heterotopic pregnancy in a woman conceiving by in vitro fertilization after bilateral salpingectomy

Heterotopic pregnancy, defined as the coexistence of an intrauterine pregnancy and an ectopic pregnancy, occurs in approximately 1 in 100 pregnancies conceived by in vitro fertilization (IVF), particularly when multiple embryos are transferred into the uterus. The ectopic gestation of the combined pregnancy usually occurs within the ampulla of the fallopian tube. If it implants within the interstitial portion of the fallopian tube, however, the resulting interstitial pregnancy eventually can rupture through the uterus, leading to sudden, severe hemorrhage and maternal death. This article describes the rupture of an interstitial heterotopic pregnancy in a 37-year-old woman conceiving by IVF after bilateral salpingectomy. The interstitial pregnancy was removed by laparotomy to protect the intrauterine pregnancy from damage. Physicians should consider interstitial ectopic pregnancy as a cause of abdominal pain, even when a viable pregnancy occurs by IVF after salpingectomy.     

输卵管完全性葡萄胎误诊临床病理分析并文献复习

目的探讨输卵管完全性葡萄胎临床及病理特征、诊治方法、误诊原因、误诊防范措施。方法对2例曾误诊的输卵管完全性葡萄胎的临床资料进行回顾性分析并复习相关文献。结果本文1例因停经2月余,阴道出血6 d入院。查血β人绒毛膜促性腺激素(β-HCG)17 229.3 U/L。术前误诊为异位妊娠,行输卵管切除术。1例因阴道不规律出血1月余,下腹闷痛2周,加剧5 d入院。无明确停经史。查血β-HCG 84 140.0 U/L。术前考虑盆腔炎性包块,卵巢囊肿蒂扭转,异位妊娠。行开腹右输卵管切除、左输卵管结扎及诊断性刮宫术。2例均经术后病理检查确诊为输卵管完全性葡萄胎,皆随访2年,无异常发现。结论输卵管葡萄胎较少见,临床易误诊。临床医生应提高对本病的认识,在遇到类似异位妊娠表现患者时应想到异位葡萄胎的可能性,要综合全面对患者病情进行分析,并仔细鉴别诊断,以减少误诊误治。     

Spontaneous twin tubal ectopic gestation

We present a case of a viable spontaneous unilateral twin ectopic pregnancy in the right fallopian tube that was diagnosed with transvaginal sonography and subsequently treated with laparotomy and salpingectomy.     

不同术式治疗输卵管妊娠后的生育结局研究

目的 探讨使用不同术式和手术方法治疗输卵管妊娠后患者的生育结局及其影响因素.方法 回顾性分析256例输卵管妊娠妇女经手术治疗后的生育状况,比较剖腹手术与腹腔镜手术、输卵管保守手术与切除手术之间的区别.结果 宫内妊娠率在开腹手术组为27.0%,在腹腔镜手术组为51.1%,重复性异位妊娠在开腹手术组为39.7%,在腹腔镜手术组为18.0%.两组不孕率分别是33.3%和30.9%,两者比较差异有显著性（P＜0.01）.宫内妊娠率在输卵管保守手术组为50.0%,在输卵管切除组为22.4%,重复性异位妊娠率在输卵管保守手术组为21.7%,在输卵管切除组为34.5%.不孕在两组分别是28.3%和43.1%,两者比较差异有显著性（P＜0.01）.在去除了引起异位妊娠的相关因素后,宫内妊娠率明显增加,而不孕率和重复性异位妊娠率明显降低.结论 在影响输卵管妊娠手术治疗后生育结局的因素中,腹腔镜手术明显优于开腹手术,保留输卵管的手术明显优于输卵管切除术.如患者没有引起输卵管妊娠的相关因素,则其生殖预后良好.     

超声造影在输卵管源性不孕症中的诊治价值研究

目的 探讨在诊断输卵管源性不孕症中经阴道超声造影评价输卵管通畅性的应用价值.方法 选择不孕症妇女222例,在经阴道超声下观察造影剂在宫腔及输卵管内的显影情况,并与输卵管通液术、X线子宫输卵管碘油造影、腹(宫)腔镜检查结果进行对照分析.结果 222例中73例双侧输卵管通畅,60例双侧梗阻,4例双侧通而不畅,72例一侧通畅,13例一侧通而不畅.超卢造影较输卵管通液术诊断准确率明显提高(P<0.05),与腹(宫)腔镜检查诊断准确率无明显差异(P>0.05),较X线子宫输卵管碘油造影的诊断符合率高.结论 超声造影安全性高,且有诊断和治疗的作用,是检查输卵管通畅性的较佳方法.     

Hydrosalpinx due to asymptomatic bilateral tubal pregnancies associated with metaplastic papillary tumor of the fallopian tube.

The patient described in this report had bilateral hydrosalpinx due to pregnancies in both fallopian tubes, treated by laparoscopic resection. Histologically, both fallopian tubes revealed intratubal occlusion by degenerated, partially calcified chorionic tissue. An incidental finding was an intraluminal papillary epithelial tumor in one of the fallopian tubes. The clinical significance and complications of asymptomatic tubal ectopic pregnancy and the pathogenesis and biologic behavior of papillary epithelial tumors of the fallopian tube are briefly discussed.     

Obturator hernia of the fallopian tube

Obturator hernia of the fallopian tube is extremely rare. Multidetector computed tomography of a 43-year-old nulliparous woman with sudden onset lower right abdominal pain showed a low-density mass in the right obturator canal suspected of being an obturator hernia of the uterine adnexa. She was diagnosed as having an incarcerated obturator hernia of the fallopian tube at operation and treated with prosthetic mesh. Obturator hernia of the fallopian tube is very rare, and all cases reported in the literature were localized on the right side, perhaps due to the lesser mobility of the left than the right fallopian tube.     

Primary mesonephric adenocarcinoma of the fallopian tube: A case report

BACKGROUNDMesonephric adenocarcinoma (MNAC) is an extremely rare malignancy in the female genital tract. Only a few cases have been reported in the literature, and most of them occurred in the cervix, with extremely rare cases in the uterine body and ovary. MNAC has never been reported to arise in the fallopian tube. CASE SUMMARYA 45-year-old woman was referred to our institution with a history of abdominal pain. Ultrasound revealed a cystic and solid mass in left adnexal region. The patient underwent complete staging surgery when intraoperative pathological examination demonstrated that the mass was malignant. The final histological and immunohistochemical results confirmed the diagnosis of MNAC originating from the fallopian tube. Then she received four cycles of combination chemotherapy with carboplatin plus paclitaxel. The tumor recurred with hepatic metastases 4 mo after initial surgery, and second resection of the tumors in the liver plus partial hepatectomy was performed. She was supplemented with five courses of a new combination chemotherapy with gemcitabine plus carboplatin, and there was no evidence of recurrence within the 22-mo follow-up period after the second surgery. CONCLUSIONMNAC originating from the fallopian tube is an extremely rare and high malignancy with a poor prognosis. It can be very aggressive, even at early stage. Little is known about the clinical characteristics, pathological diagnosis, prognosis, and optimal management strategy of MNAC originating from the fallopian tube. Herein we report the first case of primary MNAC deriving from the fallopian tube.     

The role of the fallopian tube in ovarian cancer

High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian cancer. Research over the past decade has strongly suggested that "ovarian" HGSC arises in the epithelium of the distal fallopian tube, with serous tubal intraepithelial carcinomas (STICs) being detected in 5-10% of BRCA1/2 mutation carriers undergoing risk-reducing surgery and up to 60% of unselected women with pelvic HGSC. The natural history, clinical significance, and prevalence of STICs in the general population (ie, women without cancer and not at an increased genetic risk) are incompletely understood, but anecdotal evidence suggests that these lesions have the ability to shed cells with metastatic potential into the peritoneal cavity very early on. Removal of the fallopian tube (salpingectomy) in both the average and high-risk populations could therefore prevent HGSC, by eliminating the site of initiation and interrupting spread of potentially cancerous cells to the ovarian/peritoneal surfaces. Salpingectomy may also reduce the incidence of the 2 next most common subtypes, endometrioid and clear cell carcinoma, by blocking the passageway linking the lower genital tract to the peritoneal cavity that enables ascension of endometrium and factors that induce local inflammation. The implementation of salpingectomy therefore promises to significantly impact ovarian cancer incidence and outcomes.     

Torsion of the fallopian tube

Isolated fallopian tube torsion is a rare entity that most frequently occurs during the menstruating years, but has also been reported in premenopausal and postmenopausal women. Diagnosis of this condition is often delayed because of the rarity of its occurrence and prolonged investigations to rule out more common causes of acute abdominal pain. A case of a 13-year-old girl with isolated left fallopian tube torsion is presented. A high index of suspicion must be maintained for adnexal torsion in women with abdominal pain so that an attempt can be made to salvage the adnexal structures.     

腹腔镜下输卵管吻合术中非置入支架法的临床研究

目的 探讨腹腔镜输卵管吻合术中非置入支架法的临床应用价值。方法 收集84例行腹腔镜输卵管吻合术患者的临床资料,根据其输卵管吻合术后管芯是否置入硬膜外支架分为置入支架组38例（76条输卵管）和未置入支架组46例（92条输卵管）。比较2组患者手术时间、术中出血量、术中吻合通畅率、术后输卵管通畅率和术后1年妊娠率。结果 2组均全部完成输卵管吻合术。置入支架组的术中输卵管吻合通畅率和术后输卵管通畅率分别为99%和96%,术后1年妊娠率为82%,未置入支架组相应分别为99%、98%和87%,2组的术中输卵管吻合通畅率、术后输卵管通畅率和术后1年妊娠率比较差异均无统计学意义（P均> 0.05）。未置入支架组的手术时间短于置入支架组、术中出血量少于置入支架组（P均< 0.05）。结论 腹腔镜输卵管吻合术中非置入支架法与置入支架法的效果相同,但操作相对简单,手术时间短,安全性更高。     

彩超引导介入治疗早期输卵管妊娠的临床研究

目的探讨彩超引导介入治疗早期输卵管妊娠的临床价值.方法彩超引导经阴道对输卵管妊娠囊或滋养层穿刺并注入氨甲蝶呤(MTX).结果诊断符合率41例,符合率97.6%(41/42),误诊1例,占2.4%(1/42).确诊的41例早期输卵管妊娠中孕囊型26例,心管搏动型14例,流产型1例,穿刺注药成功率为100%(41/41),治愈率为95.2%(40/42).结论超声引导介入治疗早期输卵管妊娠具有操作简便、安全、有效、无创伤性,局部用药浓度高、副作用小、费用少并取代了外科手术干预等优点,值得推广应用.     

腹腔镜下黄体剥出预防输卵管妊娠保守手术后持续性异位妊娠的观察

目的 分析腹腔镜下输卵管保守手术同时妊娠黄体剥出预防持续性输卵管妊娠的意义.方法 回顾性分析我院2005年2月至2008年8月对诊断为输卵管妊娠82例患者(其中6例为第2次输卵管妊娠),在腹腔镜下行榆卵管保守手术(71例行输卵管切开取胚术,11例行输卵管壶腹部胚囊挤压术),术中均剥除妊娠黄体,观察手术前后患者血清人绒毛膜促性腺激素(β-HCG)和孕酮值变化并随访手术后持续性输卵管妊娠发生情况.结果 所有病例均在腹腔镜下顺利完成手术,黄体剥出手术时间5～10 min,手术后血清β-HCG[(1213.51±118.84)U/L]和孕酮值[(3.25±2.44)nmol/L]均较手术前[分别为(4267.86±983.56)U/L、(13.71±6.24)nmol/L]显著下降(P均<0.01),血清β-HCG与孕酮水平显著相关(r=0.697,P<0.05).术后仅有1例发生持续性输卵管妊娠;术后3个月45例行子宫输卵管碘油造影显示患侧输卵管通畅32例,通畅率71.1%(32/45),7例患侧输卵管阻塞,阻塞率为15.6%(7/45).术后1年发生患侧输卵管再次异位妊娠2例.结论 输卵管妊娠腹腔镜下保守手术时黄体剥出对有生育要求的患者是一种安全有效的手术方式,有预防持续性输卵管妊娠的意义.     

介入性再通术结合中药治疗输卵管阻塞

目的观察介入性再通术(以下称再通术)结合中药治疗输卵管阻塞的疗效。方法治疗组200例,对照组120例,术后治疗组同时行中药治疗,全部病例6个月后复查输卵管通畅情况,1年后随访受孕情况。结果再通率:治疗组83%,对照组:81.5%(P>0.05);再粘连率:治疗组7.6%,对照组22%(P<0.01);受孕率:治疗组67%,对照组42%(P<0.05)。结论再通术结合中药治疗输卵管阻塞性不孕症疗效确切。术后再粘连率低,近段阻塞效果更好。     

低机械指数实时谐波声学造影对输卵管通畅性的初探

目的探讨低机械指数实时谐波声学造影对输卵管通畅性临床应用的可行性。方法选择不孕症妇女46例,采用全氟显作为造影剂,行经腹部B超引导下子宫输卵管声学造影术,观察造影剂在子宫、输卵管内的流动情况。结果46例不孕症妇女中,11例双侧输卵管通畅,7例双侧输卵管不通畅,9例单侧输卵管不通畅,15例单侧输卵管通而不畅,4例双侧输卵管通而不畅。结论低机械指数实时谐波声学造影对输卵管显像清晰,且安全、经济、无副作用,可作为临床不孕症患者输卵管通畅性检查的一种有效方法。     

Ultrasonic features of fallopian tube carcinoma

With the routine use of sonography in the evaluation of patients with pelvic masses, it is essential to be familiar with the sonographic features of fallopian tube carcinoma so that diagnosis can be made early and thus contribute to prompt management of these patients. The authors present the clinical manifestations, sonographic features, and pathologic correlations in three cases of fallopian tube carcinoma.     

Microsurgery of the fallopian tube.

Microsurgery is a techniqe whereby visual acuity is increased through the use of a microscope or other optical magnifying device. Because of the delicate nature of this procedure, an experienced surgeon does not necessarily make a good microsurgeon. A good microsurgeon should be able to consistently reanastomose 1 to 2 mm vessels. The technique is learned through constant practice on laboratory animals. A special attitude and demeanor toward microsurgical techniques is also important for success. Microsurgery of the fallopian tube should be done only under special conditions, and using special microsurgical instruments and equipments. Before tubal plastic surgery is considered, 2 issues must first be resolved: 1) if there is any other cause for the infertility, and 2) if tubal plastic surgery is indicated for the patient at this time. Before tubal surgery is performed, the following conditions must be met: 1) semen analysis must be met, or couple must agree to artificial insemination using a donor; 2) female should have either spontaneous or induced ovulatory cycle; and 3) couple must understand possibility of failure, overall success rate, and sequelae of ectopic pregnancy. Couple must also agree to preoperative investigation of the tube. General tubal techniques include hysterosalpingography, laparoscopy, and hydrotubation. Also discussed are implantation, fimbriolysis, fimbrioplasty, and salpingostomy.