经宫颈选择性输卵管造影与再通术诊疗不孕症

目的分析应用导管经宫颈选择性输卵管造影的诊断价值;探讨输卵管阻塞再通术的机理和技术要领。材料与方法经常规碘油输卵管造影诊断为输卵管阻塞者96例,除2例外均成功地进行了选择性输卵管造影,56例确诊输卵管阻塞者施行了再通术。结果本方法造影证实31例双侧输卵管完全通畅,消除了假“阳性”,43例近端输卵管阻塞再通成功,6例中远端阻塞仅1例再通成功,再通成功率为78．6％,随访受孕率为28．6％。结论本方法诊疗输卵管阻塞及时、准确、简便、安全,再通成功率高,是输卵管不孕症者首选的一种有效、快捷诊疗方法。     

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.     

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。     

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。     

选择性输卵管造影与再通术器械的改进及临床应用

目的：探讨选择性输卵管造影与再通术治疗输卵管阻塞的临床价值，验证改进后再通器械的可行性。方法：对６０例１１６条输卵管阻塞引起不孕症患者在透视下，用改进后器械行选择性输卵管造影及再通术。结果：其中近端输卵管再通率９３．８％；总有效率８１．８％；受孕率３１．７％；未发生严重并发症。结论：选择性输卵管造影对病变的诊断效果高于传统的子宫碘油造影，用改进后同轴导管行选择性输卵管造影与再通术方法简便易行，安全可靠，成本低廉     

70例选择性输卵管造影及再通结果分析

目的：探讨选择性输卵管造影及再通的有效性、安全性及术后疗效评价。方法：70例不孕患者，共138条输卵管行子宫输卵管造影，示输卵管近端阻塞，再行选择性输卵管造影及再通术。结果：62例（88．6％）、123条（89．1％）输卵管再通。随访半年的37例再通患者中，16例受孕（43．2％），均为宫内正常妊娠。结论：选择性输卵管造影及再通操作简便，其成功率、再通率及术后妊娠率均较高，不仅能诊治输卵管梗阻，且能为临床进一步治疗提供参考。     

选择性子宫输卵管造影与再通术对阻塞性不孕的诊疗价值

目的探讨选择性子宫输卵管造影与再通术对输卵管阻塞所致不孕的诊疗价值。资料与方法回顾性分析200例女性不孕症患者,年龄20～42岁,平均不孕年限为3.8年,均行选择性子宫输卵管造影与再通术后跟踪观察1年,观察诊疗效果。结果 200例396条输卵管中294条显示不同程度的阻塞,再通成功212条,再通成功率为81.2%,126例患者双侧或单侧再通成功,1年内成功正常受孕46例,占再通成功病例的36.5%。结论选择性子宫输卵管造影对输卵管阻塞所致不孕症具有较高的诊断价值,再通术对输卵管阻塞所致不孕症有一定的治疗价值。     

改良式超选择性再通术治疗输卵管阻塞性不孕症的临床价值

目的：我国育龄妇女不孕症发生率约为6．8％-10．0％，其中20%-40％不孕症原因为输卵管阻塞，而传统的治疗方法是官腔加压输卵管通液，再通成功率较低。介入性超选择插管再通术由于其损伤小、操作简便。同时介入性输卵管再通术兼有选择性输卵管造影的价值．可清楚显示输卵管阻塞部位、形状及有无粘连、积水等情况．有助于鉴别输卵管阻塞的原因，为后续治疗提供有价值的资料。改良传统介入导入装置，用自制导管装置经超选择性输卵管造影（SSG）和输卵管再通术（FTR）治疗不孕症患者，研究手术操作、再通率、妊娠率等相关因素。     

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。     

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.     

自制选择性输卵管再通导管的临床应用研究

目的 探讨自制选择性输卵管再通导管的临床应用效果。方法 ５０４例经证实有一例或双侧输卵管不通的不孕症患者,采用自制选择性卵管再通导管进行再通。该导管由导向导管、锥头导管、微导管和导丝４部分组成,导管头端据子宫形态分别弯曲成不同角度的３种形态。对操作技术也进行了改进。结果 ５０４例中经子宫输卵管造影共发现７９２支输卵管支通,共疏通７３１,总疏通率９２．３％。插管总成功率为９７．４％。发生输卵管穿破２     

Tubal obstruction after ligation reversal surgery: results of catheter recanalization

PURPOSE: To evaluate the role of transcervical fallopian tube catheterization in restoring tubal patency after ligation reversal surgery. MATERIALS AND METHODS: Twenty-four women with tubal obstruction after ligation reversal surgery underwent selective salpingography and tubal recanalization. RESULTS: Patency was established in 26 (68%) of 38 anastomotic tubes without complication. In the 13 patients who were followed up and who could conceive only via a recanalized anastomotic tube, there were six (46%) pregnancies: two (15%) successful uterine pregnancies, two (15%) early spontaneous abortions, and two (15%) tubal pregnancies. The mean time from procedure to conception was 2 months. CONCLUSION: Patency of fallopian tubes not visualized at hysterosalpingography after ligation reversal surgery can be established 68% of the time with selective salpingography. In some patients, selective salpingography can be therapeutic. If subsequent conception occurs in these patients, it occurs shortly after the catheterization procedure.     

Selective osteal salpingography and transvaginal catheter dilatation in the diagnosis and treatment of fallopian tube obstruction

Selective salpingography and transvaginal catheter dilatation were performed in 157 women with infertility to diagnose, localize, and classify obstructive diseases of the fallopian tubes and to correct obstruction of the proximal (uterine-end) tube. In 61 (39%) of the patients, the selective salpingograms showed patent tubes despite the fact that two previous hysterosalpingograms showed obstruction of the proximal (uterine-end) tube. Transvaginal catheter dilatation successfully recanalized the proximal portion of the tubes in 79 (82%) of 96 patients with obstructed tubes. In 18 of 25 with successful transvaginal catheter dilatation and 6-month follow-up salpingography, the tubes remained patent. Coexisting disease of the distal (ovarian-end) tubes was diagnosed in 29 (18%) of the patients. Pregnancy was achieved in 11 of the 157 patients (six in whom obstructions were corrected by transvaginal catheter dilatation and five in whom selective salpingograms showed patent tubes). There were no complications due to the procedure. The excellent diagnostic and therapeutic yield, lack of complications, and low cost justify the use of these percutaneous techniques to investigate female infertility and to treat obstruction of the uterine end of the fallopian tube.     

数字减影技术在不孕症诊断和治疗中的应用

目的：探索数字减影技术在不孕症诊断和治疗中的应用价值。方法：在X线数字减影设备下用复方泛影葡胺对164例不孕症患者行子宫输卵管造影，并用导丝对其中35例输卵管阻塞的患者进行输卵管再通治疗。结果：90.9％(149／164)患者造影发现异常，包括子宫发育异常24例，输卵管阻塞114例，输卵管结核3例，盆腔粘连29例。输卵管再通成功率82．9％，再通后受孕率为34．3％。结论:数字减影成像技术大大提高了子宫输卵管造影对病变的检出率和诊断的准确率；水溶性对比剂比碘油更加准确、安全；输卵管再通术可作为输卵管阻塞患者初步治疗的首选方法。     

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.     

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     

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.     

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.     

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。