介入再通配合活血化瘀中药治疗输卵管阻塞性不孕症的前瞻性研究

目的 研究介入再通配合活血化瘀中药对输卵管阻塞性不孕症的治疗效果.方法 前瞻性研究经子宫输卵管造影(HSG)检查证实为输卵管近段完全阻塞511例,随机分为试验组和对照组,两组均经输卵管介入再通术疏通阻塞输卵管,试验组术中术后加活血化瘀中药治疗,对照组为经典介入再通术,不予中药治疗.失访病例72例,实际纳入研究病例439例.经12个月和24个月随访,评价输卵管通畅度、宫内妊娠率和输卵管妊娠率.结果 介入后12个月和24个月,试验组的输卵管完全通畅率明显高于对照组,再闭塞率及通而不畅率显著低于对照组;输卵管妊娠率显著低于对照组.结论 介入再通配合活血化瘀中药治疗输卵管阻塞性不孕具有良好的临床疗效.     

选择性输卵管造影与再通术结合中西药治疗阻塞性不孕的探讨

目的探讨输卵管插管造影与再通术结合中西药治疗输卵管阻塞性不孕的效果.方法对不孕妇女排除男女不孕因素及女方功能性不孕后,经宫颈常规行子宫、输卵管造影(HSG),对显示双侧输卵管阻塞的9例妇女,采用选择性插管至输卵管开口处,推注30%泛影葡胺造影剂,对证实阻塞者行导丝再通,其中43例再通术后,中西药治疗1～4个月;40例对照组插管再通术后单服抗生素治疗4～6天,术后均随访1～4个月,6例未随访,观察两组受孕率.结果插管成功率100%,无严重并发症,复通率80%,再通术后未行中药治疗组妊娠率27.5%(11/40),再通术后中西药治疗组妊娠率60%(26/43).结论选择性输卵管造影与插管再通术,术后配合活血化瘀,消炎解毒的中西药治疗是目前治疗输卵管近、中段阻塞性不孕的最好方法.     

选择性输卵管造影与再通术结合中西药治疗阻塞性不孕的探讨

目的　探讨输卵管插管造影与再通术结合中西药治疗输卵管阻塞性不孕的效果 .方法　对不孕妇女排除男女不孕因素及女方功能性不孕后 ,经宫颈常规行子宫、输卵管造影 (HSG) ,对显示双侧输卵管阻塞的 9例妇女 ,采用选择性插管至输卵管开口处 ,推注 30 %泛影葡胺造影剂 ,对证实阻塞者行导丝再通 ,其中 4 3例再通术后 ,中西药治疗 1～ 4个月 ;4 0例对照组插管再通术后单服抗生素治疗 4～ 6天 ,术后均随访 1～ 4个月 ,6例未随访 ,观察两组受孕率 .结果　插管成功率 10 0 % ,无严重并发症 ,复通率 80 % ,再通术后未行中药治疗组妊娠率 2 7.5 % ( 11/ 4 0 ) ,再通术后中西药治疗组妊娠率 6 0 % ( 2 6 / 4 3) .结论　选择性输卵管造影与插管再通术 ,术后配合活血化瘀 ,消炎解毒的中西药治疗是目前治疗输卵管近、中段阻塞性不孕的最好方法 .     

壳聚糖防止输卵管阻塞介入再通术后的复发性黏连

目的评价壳聚糖(几丁糖)在输卵管介入再通术后防止复发性黏连的疗效。方法309例患者随机分为对照组206例和试验组103例。对照组在输卵管阻塞介入复通术中常规注射松解液(α-糜蛋白酶?地塞米松、灭滴灵?庆大霉素)做术后防止黏连。试验组在术中常规注射松解液的基础上联合应用医用几丁糖防止黏连,术后通水治疗。随访观察两组病例松解输卵管的通畅情况。结果试验组,经子宫输卵管碘水造影阻塞190条,缺如10条;介入复通188条,再通率为98.9%;术后随访3个月通水达到无阻力180条,再黏连率4.26%(8/188)。对照组输卵管造影确认堵塞390条,缺如22条,复通385条,复通率为98.7%,术后随访3个月,通水达到无阻力330条,再黏连率14.28%(55/385)。两组术后3个月再黏连率有差异(P<0.01)。结论输卵管介入再通术后应用几丁糖能有效降低输卵管术后复发性黏连。     

壳聚糖防止输卵管阻塞介入再通术后的复发性黏连

目的 评价壳聚糖(几丁糖)在输卵管介入再通术后防止复发性黏连的疗效.方法 309例患者随机分为对照组206例和试验组103例.对照组在输卵管阻塞介入复通术中常规注射松解液(α-糜蛋白酶、地塞米松、灭滴灵、庆大霉素)做术后防止黏连.试验组在术中常规注射松解液的基础上联合应用医用几丁糖防止黏连,术后通水治疗.随访观察两组病例松解输卵管的通畅情况.结果 试验组,经子宫输卵管碘水造影阻塞190条,缺如10条;介入复通188条,再通率为98.9%;术后随访3个月通水达到无阻力180条,再黏连率4.26%(8/188).对照组输卵管造影确认堵塞390条,缺如22条,复通385条,复通率为98.7%,术后随访3个月,通水达到无阻力330条,再黏连率14.28%(55/385).两组术后3个月再黏连率有差异(P＜0.01).结论 输卵管介入再通术后应用几丁糖能有效降低输卵管术后复发性黏连.     

介入术输卵管再通临床应用体会

目的回顾122例已婚不孕妇女行介入术输卵管再通后的临床疗效分析,评价其在治疗输卵管阻塞所致不孕症的应用价值。方法122例不孕症患者均在X线床上取截石位,在电视透视下将导管送入阻塞部位,经造影后行再通治疗,以造影剂进入盆腔证明阻塞段再通。结果122例220条不通输卵管中,行再通术后175条通畅度明显改善,盆腔内造影剂弥散总有效率为79.5%,经再通术后八个月随访观察,有39例发生妊娠,妊娠率占30.5%.因术后不孕复查发生再粘连者31例,占17.7%,其中结核5例10条,伞部重度积水8条.结论选择性输卵管造影再通术是目前诊断和治疗输卵管阻塞所致不孕症最简便、安全、无创伤,经济有效的方法。     

选择性输卵管造影与再通术诊治阻塞性不孕(100例报告)

目的:评价输卵管插管造影及再通术对输卵管阻塞性不孕的诊治价值.材料与方法:先经宫颈对常规子宫、输卵管造影(HSG)显示输卵管阻塞的100例不孕妇女的180条输卵管进行插管,采用选择性插管至输卵管开口处推注30%泛影葡胺造影,对证实阻塞者进行导丝再通,术后随访2～4个月 结果:插管成功率100%.无严重并发症,复通率80%,妊娠系21%(21/100)结论:选择性输卵管造影及再通术是目前诊治阻塞性不孕的最好方法     

宫腹腔镜下输卵管插管及斑马导丝疏通术治疗输卵管阻塞

目的 探讨宫、腹腔镜联合行输卵管插管及斑马导丝疏通术治疗输卵管阻塞性不孕症的临床意义.方法 收集腹腔镜染色通液证实输卵管阻塞的不孕患者83例,共103条输卵管阻塞,行宫腔镜联合腹腔镜下行输卵管插管及斑马导丝疏通术,观察输卵管通畅情况及有无并发症,追踪术后妊娠情况.结果 103条阻塞输卵管,88条疏通成功,以选择性输卵管插管加压通液术成功疏通57条(55.3%),失败46条(44.7%),46条中再以斑马导丝疏通成功31条(67.4%,31/46),总通畅率为85.4% (88:103).15条输卵管斑马导丝疏通失败.术后全部病例随访1～20个月,中位随访时间8个月,21例(25.3%)妊娠:宫内妊娠19例(22.9%),2例自然流产(2.4%),2例输卵管妊娠(2.4%).1条输卵管假道形成,发生率1.0%(1:103).结论 本文结果提示宫腹腔镜联合行输卵管插管及斑马导丝疏通术治疗输卵管阻塞性不孕症安全有效,值得深入研究.     

输卵管介入再通术灌注药物研究

输卵管阻塞性不孕症发病率高,占女性不孕症30%～50%,且有逐年上升的趋势.采用介入方法对输卵管阻塞进行再通和直接对输卵管腔内灌注药物治疗已取得较好的疗效,输卵管介入再通率可达71～92%,受孕率大概为30%[1].大量临床研究表明,术后再粘连是影响介入再通术疗效的关键因素.因此,在解决输卵管梗阻的同时,如何促进炎症吸收和减少术后再粘连,如何选择和规范输卵管腔内灌注药物成为研究的热点之一.     

输卵管阻塞性不孕症介人治疗26例分析

输卵管阻塞是不孕症最常见的病因,约占不孕病因的1/3.本文对26例输卵管阻塞性不孕症采用介入放射学的选择性输卵管造影和再通术,对26例52条输卵管,缺如2条,Ⅰ类梗阻6条,Ⅱ类24条,Ⅲ类9条,Ⅳ类4条,V类7条.SSG43条复通22条,FTR21条复通17条,失败4条.SSG+FTR复通成功率为90.7%.至今已有9例妊娠.采用此介入治疗,提高了诊断和再通的成功率,临床上有其独特的治疗价值.     

Enterobius vermicularis infection of the fallopian tube in an infertile female

Enterobius vermicularis (EV) is the most common nematode to infect humans. It inhabits the intestinal lumen, but rare, ectopic infections have been documented. The female genital tract is the most common ectopic site. We present a unique case of an EV infection of the fallopian tube resulting in inflammation, tubal obstruction, and infertility. A 30-year-old woman presented with infertility. Investigations included a laparoscopy with hydrotubation using methylene blue dye. This showed a left fallopian tube obstruction and extensive pelvic adhesions. A left salpingectomy was performed. Microscopic examination of the fallopian tube revealed numerous calcified and non-calcified ova associated with granulomatous reaction. The microscopic features were compatible with EV infection. Ectopic EV infections of the female genital tract result when the gravid female worm migrates from the perianal area to the vagina and ascends through the uterus and fallopian tubes to the peritoneal cavity. Microscopic examination of these ectopic sites can reveal adult worms or ova with granulomata formation, eosinophilic infiltrate, chronic inflammatory reaction, and fibrosis. The ova have a characteristic asymmetric oval configuration with flattening on one side. We postulate that our patient’s salpingitis due to EV with accompanying fibrosis is a cause of her infertility.     

Recommendations for the reporting of fallopian tube neoplasms

Primary malignancies of the fallopian tube are extremely uncommon, in part due to (admittedly arbitrary) definitional criteria. By convention, epithelial tumors that involve the ovary or peritoneal surfaces are considered to have arisen either in the ovary or endometrium or, in absence of significant ovarian or endometrial involvement, in the peritoneum, irrespective of whether or not the fallopian tube mucosa is also involved. Evidence from the World Health Organization and more recently, from case-control studies of BRCA mutation carriers suggests the fallopian tube may have a more direct role in the development of at least some of these carcinomas. An alternative hypothesis for the origin of ovarian and peritoneal carcinoma has even been proposed, based on the concept of transport and implantation of malignant cells from the tube to the ovary and peritoneum. Malignancies in the fallopian tube can therefore be classified as (1) arising primarily in the fallopian tube, either from preexisting endometriosis (or more rarely, a mature teratoma) or directly from tubal mucosa with metastasis to adjacent tissues; (2) arising in the ovary, endometrium, or peritoneum with metastasis to the tubal serosa or mucosa; or (3) arising primarily in the fallopian tube as well as in the ovary, endometrium, or peritoneum (simultaneous primary tumors). Since there are currently no evidence based criteria for distinguishing primary tubal carcinoma from primary ovarian or primary endometrial carcinoma in patients with high stage disease, the Association of Directors of Anatomic and Surgical Pathology recommended strategies for assignment of site of origin are based on current standard practices.     

Differential impact on pregnancy rate of selective salpingography, tubal catheterization and wire-guide recanalization in the treatment of proximal Fallopian tube obstruction

A total of 66 patients with proximal Fallopian tube (113 tubes)obstruction, as diagnosed by both laparoscopy and hysterosalpingogram,were each subjected to a transcervical recanalization proceduresequentially using selective salpingography followed, if necessary,by tubal catheterization with a soft Teflon 2-French catheterand finally, if needed, wire-guide cannulation. Each procedurewas terminated once patency had been achieved without recourseto the next technique. Bilateral obstruction was present in47 patients and unilateral in 19 patients. Patency was achievedin 39 (34.5%) Fallopian tubes by selective salpingography alone,in 52 (46.0%) by tubal catheterization and in 10 (8.9%) by wireguide, with 12 (10.6%) tubes remaining obstructed. Pregnancyoccurred in 24 (36.4%) patients without recourse to other treatment(mean follow-up, 17 months). Where patency was achieved (59patients), 19 out of 43 (44.1%) of those treated for bilateralobstruction and five out of 16 (31.3%) of those treated forunilateral obstruction achieved a pregnancy. Pregnancy occurredin six out of 22 patients (27.3%) where selective salpingographywas used to produce tubal patency, in 17 out of 30 patients(56.7%) where tubal catheterization was used and in one outof seven (14.3%) where a wire guide was used, which was an ectopicpregnancy. The difference between the ongoing pregnancy ratesfollowing tubal catheterization (50.0%) and wire-guide cannulation(0.0%) was significant (P = 0.033). While wire-guide cannulationis the most effective method used to achieve tubal patency,these results indicate that when it is truly necessary, as opposedto electively used by clinicians, the prognosis with regardto pregnancy is poor and alternative therapy such as microsurgeryor in-vitro fertilization should be considered early.     

输卵管的形态观测及临床意义

目的通过对育龄期妇女输卵管内部形态的观察和测量,提供输卵管各部位的活体和离体数据,为输卵管生育和节育研究提供科学依据。方法输卵管造影100例、宫腔镜检查30例和离体标本20例进行输卵管各部位长度,径线及内口的形态的观察和测量,采用两样本t检验进行分析。结果⑴造影观测双侧输卵管内口直径为(1.07±0.48)mm;间质部中段(0.50±0.22)mm;间质部远端(0.32±0.12)mm;峡部内径(0.46±0.28)mm;壶腹部内径(2.43±1.45)mm;间质部长度(5.27±4.28)mm;峡部长度(24.35±12.27)mm;壶腹部长度(39.94±22.05)mm;总长(70.78±32.07)mm。⑵宫腔镜观测内口为圆形占76.7%和椭圆形占23.3%;⑶离体标本观测内口周径(5.87±1.46)mm;峡部周径(2.83±1.87)mm;间质部长度(6.73±2.49)mm;峡部长度(20.56±7.61)mm;全长(85.42±22.93)mm。结论⑴输卵管是内外口扩大而内径不均匀走行曲折迂回的管道,间质部呈漏斗状,最狭窄的部位在间质部远端。⑵了解输卵管的内部形态对生育和节育的研究都具有重要意义。     

腹腔镜下输卵管切开取胚联合输卵管通液术对远期妊娠的影响

目的 探讨异位妊娠患者腹腔镜下行输卵管切开取胚术联合输卵管通液术对远期妊娠结局的影响。方法 选择2015年1月~2016年7月在我院妇科治疗的输卵管妊娠患者138例,依据手术方式不同分为实验组70例和对照组68例,实验组行腹腔镜下患侧输卵管切开取胚术及子宫输卵管通液术,对照组单纯行患侧输卵管切开取胚术,比较两组手术时间、术中出血量、术后排气时间、住院天数,及术后2年内妊娠情况。结果 两组患者术中出血量,手术时间、术后排气时间、住院天数比较,差异无统计学意义（P＞0.05）。实验组术后2年内再次异位妊娠率为4.23%,3例再次异位妊娠再次行腹腔镜手术,46例宫内妊娠,8例继发性不孕,6例失访。对照组的再次异位妊娠率为16.18%,11例再次异位妊娠再次行腹腔镜手术,30例宫内妊娠,13例继发性不孕,7例失访。实验组的再次异位妊娠率低于对照组,再次宫内妊娠率高于对照组,差异有统计学意义（P＜0.05）。结论 腹腔镜下切开取胚术联合输卵管通液术可同时在术中判断对健侧输卵管通畅度,还可指导通而不畅甚至堵塞输卵管术中同时治疗,可能有助于降低再次异位妊娠的概率。     

Successful conception following Fallopian tube recanalization in infertile patients with a unilateral proximally occluded tube and a contralateral patent tube

BACKGROUND: There are many published case reports of successful conception following transcervical Fallopian tube recanalization (T-FTR) in patients with bilateral proximally occluded Fallopian tubes. However, no serial trials have been published with respect to successful conception following unilateral tubal recanalization in infertile patients with a unilateral proximally occluded tube and a contralateral patent tube. This study was designated to analyse the success rate of T-FTR and the pregnancy rate due to natural fertilization in the lumen of the recanalized tube in these patients. METHODS: We have encountered only 11 patients with this abnormality in our department in the past 10 years. T-FTR with fluoroscopic guidance was performed in these patients, confirmed by at least two hysterosalpingographies to exclude tubal spasm. The uterine catheter devised by us was used during the procedure. RESULTS: All 11 Fallopian tubes were successfully opened by T-FTR. In the six patients who conceived, a preovulatory follicle was demonstrated on the side of the cannulated tube during the conception. The success rate of recanalization, the pregnancy rate due to fertilization in the lumen of the recanalized tube and the successful delivery rate were 100, 55 and 36% respectively. CONCLUSIONS: Our findings suggest that a functional and/or organic disorder in the patent tube resulted in infertility in patients with unilateral proximal tubal obstruction. Our results further show that recanalization of occluded tubes is an effective treatment. Thus, recognition of successful conception following T-FTR in these patients will be beneficial to our clinical approach to this infertile condition.     

Identification of lymphocyte subsets in the human fallopian tube.

PROBLEM: Immunohistochemical investigations for the detection of lymphocyte subsets in the human oviduct have been performed. Knowledge about local immunity especially cell-mediated immunity, in the fallopian tube has been, up to now, limited. As an essential structure for the human reproduction process, the tubal mucous membrane is exposed to a variety of antigens. METHOD: A total number of 20 tubal biopsies obtained from fertile women during gynecological operations like tubal ligations or hysterectomy were examined by the immunoperoxidase technique. Seven specimens were obtained during the proliferative phase, ten during the secretory phase and three during a caesarean section with tubal ligations. RESULTS: It could be established that the presence of lymphocytes in the oviductal mucous membrane is physiological. These cells can be identified by their typical immunohistochemical patterns. There were no significant differences of the type and number of lymphocytes in the mucosa within the phases of menstrual cycle. The dominant cell types in the tubal mucosa were the CD3+ and CD8+ lymphocytes. CONCLUSIONS: It can be suggested that the lymphocytes in the tubal mucosa may involved in the process of immune tolerance, which could realize the transport of sperms and blastocysts through the oviduct under normal conditions without activation of local immune mechanisms. The lymphoid tissue of the oviduct is a specialized form of mucosal-associated lymphoid tissue (MALT).