应用输卵管导向管行介入性输卵管疏通术

输卵管性不孕是造成不孕症的主要原因之一，输卵管近端梗阻的约占输卵管性不孕的15％～25％。其中50％为非器质性病变，对非器质性病变采用非手术治疗是很必要的。笔者于2001年1月～2003年3月应用介入性输卵管再通术对54例输卵管近端梗阻的不孕症患者进行治疗，取得较好的效果，现报告如下。     

选择性输卵管造影及再通术的临床探讨

输卵管梗阻是不孕症最常见的病因,约占女性不孕的1／3,以往诊断及治疗成功率不高。1988年澳大利亚皇家妇女医院Rosch和Thurmono医师首次采用介入放射学的选择性输卵管造影（selectivesalpingography,SSG）和再通术（fllopiantuberecanalization,FTR）,提高了诊断和再通成功率。我院自1997年5月以来用Cook公司生产的真空同轴导管子宫输卵管造影装置对36例不孕患者进行介入诊断和治疗,现将结果报告如下。1材料与方法1．1一般资料1997年5月至1998年12月间我院共对36例不孕患者施行SS3与ITHZ,年龄对～36岁,平均为28．8岁。36例中…     

选择性输卵管造影和再通术对输卵管阻塞性不孕的疗效分析

为提高子宫输卵管疾病诊疗手术的成功率，降低其并发症，2002年我们在美国COOK公司生产的非手术性子宫输卵管治疗器的基础上改良并研制了性能更加完善的子宫输卵管诊疗器并获得专利（专利号01244229．1）。此器械操作方便，成功率高，安全可靠，价格低廉，有较好的应用前景。2002年我院分别应用COOK公司的仪器和我们研制的仪器施行选择性输卵管造影与输卵管再通术，取得了满意效果，现报告如下。     

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。     

介入疗法行输卵管再通术580例临床分析

我院介入科与妇产科从1998年5月至2002年10月,应用介入技术治疗输卵管阻塞580例,收到良好效果。现报道如下。1　资料与方法1.1　对象　我院1998年5月至2002年10月期间对580例不孕症患者1102条完全性阻塞的输卵管进行了介入再通术。患者年龄22~48岁,平均(321±47)岁。其中原发性不孕25例,继发性不孕555例;双侧输卵管间质部阻塞232例、峡部阻塞240例、壶腹部至伞部阻塞50例,单侧间质部阻塞58例。1.2　方法1.2.1　手术器械　采用美国库克公司生产的FTC550输卵管再通系列导管、导丝及TRH250子宫杯。影像设备为荷兰菲利浦公司生产的CV12…     

输卵管阻塞性不孕症的介入性输卵管再通术治疗护理体会

输卵管阻塞是导致育龄期妇女不孕症的重要因素,文献报道占不孕妇女的1／3左右,以往临床常用通液治疗,但成功率低,痛苦大,因此患者较难接受。我科于2001年至2012年应用岛津数字胃肠机和美国COOK公司生产的输卵管同轴再通器材,为180例患者进行了输卵管介入再通治疗,取得了满意的效果。现将有关护理方面的体会报告如下。     

输卵管再通术联合腹腔镜子术治疗中远端输卵管阻塞

输卵管阻塞是造成女性不孕的诸多因素中最常见的一种。约占20％～40％。在输卵管阻塞中，近端阻塞占20％～45％。通过选择性输卵管造影术(SSG)和输卵管再通术(FTR)可以获得很高的输卵管再通率。中远端阻塞占35％～80％，仅通过SSG和FTR治疗，再通率较低(约45％)。受孕率更低。我院自1999年开始，对部分患者在     

输卵管再通术对近端输卵管阻塞不孕症临床治疗结局的影响

目的:探讨输卵管再通术(FTR)治疗近端输卵管阻塞(PTO)不孕症后受孕方式的选择及影响术后妊娠率的相关因素。方法:回顾分析2019年7月至2021年12月在西安交通大学第二附属医院行FTR后双侧输卵管通畅的93例患者的临床资料。根据自主选择受孕方式不同分为观察组(32例)及对照组(61例),观察组采取促排卵周期的宫腔内人工授精(IUI)助孕,对照组采取自然受孕,比较两组的妊娠率及妊娠结局。按照受孕后妊娠情况分为妊娠组(56例)和非妊娠组(37例),采用多因素logistic回归分析影响患者术后妊娠率的危险因素。结果:两种受孕方式的妊娠率和妊娠结局比较,差异均无统计学意义(P>0.05)。术后1～6月的妊娠率均高于术后7～12月(P<0.05);受孕时间在术后7～12月时,促排卵周期IUI的妊娠率明显高于自然受孕(P<0.05),受孕时间在术后1～6月时,两者的妊娠率无显著差异(P>0.05)。女性年龄、输卵管阻塞程度、AMH是影响FTR术后妊娠率的独立危险因素(P<0.05)。结论:输卵管再通术后前半年的妊娠率高于后半年,半年后自然受孕的妊娠率低于促排卵...     

Transcervical selective salpingography: a diagnostic and therapeutic approach to cases of proximal tubal injection failure

OBJECTIVE: Evaluation of selective salpingography for diagnosis and treatment of tubal injection failure during hysterosalpingography (HSG). DESIGN: Prospective study. SETTING: Obstetrics and Gynecology Department, University of Genoa (Italy)--tertiary care. PATIENTS: One hundred eighty infertile women with unilateral or bilateral proximal tubal injection failure during HSG were submitted to the procedure. INTERVENTION: Under fluoroscopy, a 4.5-F nylon catheter (3-F tip) was inserted into the ostium with or without the aid of a J-shaped, coaxial, angiographic guide wire, and 2 to 3 mL of contrast medium were injected. The procedure lasts 20 to 30 sec/tube. MAIN OUTCOME MEASURES: Of 155 tubal ostia, 145 (94.2%) were catheterized. RESULTS: Of the 146 catheterized tubes, 110 (75%) were rendered patent. Of the others, 21 (14.3%) presented hydrosalpinx or distal obstructions, and isthmic obstruction was present in 5 (3.4%). Patency of at least one tube was achieved in 82 (81.2%) of the 101 catheterized women; 8 conceived spontaneously and 11 after gamete intrafallopian transfer to the recanalized tube. CONCLUSIONS: During HSG, selective salpinography can be performed when proximal injection failure is observed to determine its cause or to restore patency.     

Selective salpingography and tubal interventional radiography]

The study involved 70 patients considered to be sterile and in whom hysterosalpingography showed no tubal passage. Selective catheterisation enabled opacification under pressure in more than 80 p. cent of cases, with perfect visualisation of the entire tubes and significant peritoneal passage. In the presence of obstructive stenosis, disobstruction-reacanalisation using a soft probe was attempted with success in more than one case out of two. Future perspectives of selective salpingography appear to be very large. This technique seems to have a large number of indications apart from transport problems: recanalisation, sterilisation, and tubal antibiotic sensitivity studies.     

Selective salpingography in cases of proximal tubal occlusion

The technical performance and results of selective salpingography (SGS) in 28 infertile women with proximal tubal occlusion (PTO) are presented. In 50 cases of PTO, diagnosed first by hysterosalpingography (HSG) and/or laparoscopy, 14 oviducts (28%) were patent during initial HSG using the baloon catheter tightly filling the internal cervical orificium and from remaining 36 tubes 27 (75%) were successfully recanalized by SGS. Three patients after successful SGS became pregnant. One of the pregnancies was ectopic. The SGS should be widely accepted in diagnosing and treatment of PTO as a cheap, simple, noninvasive and very effective method.     

The learning curve of selective salpingography and tubal catheterization

OBJECTIVE: To determine the effect of increasing experience in fluoroscopically guided selective salpingography and tubal catheterization on radiation doses and screening times, thus establishing a learning curve for the procedure. DESIGN: Retrospective case note analysis. SETTING: IVF center of an academic teaching hospital. PATIENTS: Three hundred sixty-six patients with infertility seen over 3.5 years. INTERVENTION(S): Fluoroscopically guided selective salpingography and tubal catheterization. MAIN OUTCOME MEASURE(S): Reductions in radiation doses and screening times for different categories of selective salpingography and tubal catheterization, expressed as percentage reductions during the study period and reductions per 10 procedures. RESULT(S): During the study period, The median dose of radiation decreased by 62.6%-71.9%, and the median screening time declined by 61.5%-78.5%. Reductions per 10 procedures were 2.5%-4.2% and 2.7%-5%, respectively. CONCLUSION(S): Significant reductions in radiation doses and screening times start early in a clinical team's practice of selective salpingography and tubal catheterization and continue even as trainees are added to the pool of operators.     

Transcervical tubal cannulation: a comparison of two techniques.

Transcervical tubal cannulation using tactile guidance has a similar rate of successful cannulation compared with that with US guidance (78% versus 73%) but takes less time to perform (2.3 +/- 1.8 minutes versus 8.7 +/- 6.2 minutes, mean +/- SD) and is associated with less pain and bleeding. This appears to be because of the design of the Labotect tubal cannulation set that uses a special speculum and tenaculum to straighten the uterus before insertion of the guide cannula and a less traumatic ball-tipped guide catheter.     

Transcervical tubal embryo-stage transfer (TC-TEST)

Ultrasound-guided transcervical tubal cannulation (TC-TEST) was used to replace embryos to the fallopian tubes in 17 women whose fallopian tubes were inaccessible by the abdominal route but where at least one tube was shown to be freely patent on a preliminary hsterosalpingogram investigation. In two further cases, the fallopian tubes proved impossible to cannulate, and along with two instances where difficulty was experienced, a common underlying feature was an arcuate or septate configuration of the uterus. Three pregnancies ensued (17%) in cases where the procedure was free of difficulty and the transfers were demonstrably intratubal: two went to term and the third resulted in an ectopic pregnancy. The procedure has so far not shown a benefit over conventional IVF-ET and probably should be avoided in women with any type of tubal disorder.     

Hysterosalpingography and selective salpingography in the differential diagnosis of chemical intrauterine versus tubal pregnancy.

OBJECTIVE: To determine the validity of hystersalpingography (HSG) and/or bilateral selective salpingography in the differential diagnosis of early (biochemical) intrauterine versus intratubal abortions. DESIGN: The study design involved the performance of HSG and selective salpingography in sequential patients with low declining beta-human chorionic gonadotropin (beta-hCG) values. SETTING: Medical School-affiliated Infertility Center. PARTICIPANTS: Four sequential pregnant infertility patients who demonstrated declining beta-hCG levels before pregnancy could be confirmed by ultrasound (chemical pregnancies). RESULTS: Three of four patients demonstrated a characteristic tubal opacification pattern in conjunction with a normally appearing endometrial cavity, considered diagnostic of an early tubal pregnancy. In contrast, a missed intrauterine pregnancy (IUP) demonstrated a characteristically abnormal endometrial cavity. CONCLUSIONS: Some early (chemical) pregnancy losses are intratubal rather than intrauterine. The correct differential diagnosis of early missed IUPs versus intratubal pregnancies is important because of its prognostic significance.     

Proximal tubal unblocking by selective salpingography, apropos of 8 cases

Proximal tubal desobstuction by selective salpingography: through a study of eight cases, the authors give their first results about tubal desobstruction by selective salpingography.     

Outpatient evaluation and treatment of tubal obstruction with selective salpingography and balloon tuboplasty

OBJECTIVE: To compare selective salpingography and balloon tuboplasty for the treatment of tubal obstruction. DESIGN: A retrospective evaluation of results of women treated for tubal obstruction by outpatient methods at a single center. SETTING: Tertiary-care, university-affiliated hospital. PATIENT(s): A total of 3,424 infertile women, of whom 418 had bilateral tubal obstruction by hysterosalpingography, treated at Nihon Medical Center from 1982 to 1997. INTERVENTION(s): Women with tubal obstructions who had visual evidence of an intact uterine tubal ostium at hysteroscopy were treated by selective salpingography. If selective salpingography could not establish patency, then transcervical balloon tuboplasty was performed with one of three catheter systems. Patients were followed expectantly for 1 year after treatment. MAIN OUTCOME MEASURE(s): Postoperative tubal patency and overall pregnancy rates (PRs) at 1-year of follow-up. RESULT(s): The overall patency rate was 67.5%, with 30% of these patients conceiving (20.2% of all subjects). Selective salpingography was associated with a 35. 7% patency rate, and 27.3% of these patients conceived. Of the subjects who failed selective salpingography and underwent balloon tuboplasty, 66.2% achieved patency, of whom 33% spontaneously conceived. Balloon tuboplasty was effective in restoring patency in many cases after selective salpingography had failed. Statistically significant differences were found between selective salpingography and balloon tuboplasty and for the different balloon tuboplasty catheters in terms of patency rates, while a trend was seen for PRs. CONCLUSION(s): Many women diagnosed as having tubal obstruction can be treated by outpatient methods that do not require general anesthesia. Achieving patency by these methods is associated with high PRs and avoids the need for assisted reproductive technologies in some cases. Balloon tuboplasty is a more effective treatment than selective salpingography. The choice of balloon tuboplasty catheter system may affect success rates.     

Diagnostic and therapeutic value of selective salpingography and tubal catheterization in an unselected infertile population

OBJECTIVE: To present diagnostic findings and fertility outcome after selective salpingography and tubal catheterization in an unselected infertile population. DESIGN: Cohort study. SETTING: Tertiary reproductive medicine unit. PATIENT(S): One hundred ten consecutive infertile women. No exclusion criteria were applied. Follow-up ranged from 16 to 54 months. INTERVENTION(S): Selective salpingography and tubal catheterization under fluoroscopic guidance as the primary test for the assessment of the fallopian tubes. MAIN OUTCOME MEASURE(S): Incidence of tubal disease at selective salpingography, therapeutic effectiveness of tubal catheterization, and fertility outcome after the procedure. RESULT(S): Tubal disease was present in 31.4% of the tubes examined. Of tubes proximally blocked at selective salpingography, 52.1% were found to be normal after tubal catheterization. Proximal tubal blockage (bilateral or unilateral) was detected in 34.8% of women. This was reduced to 5.5% after tubal catheterization. Spontaneous conceptions occurred in 21.9% of the women. In total, 36.2% conceived without IVF or ICSI. CONCLUSION(S): Selective salpingography and tubal catheterization can be useful as a primary tubal assessment tool in the investigation of infertility. In cases of proximal tubal blockage, an effective see-and-treat approach can be adopted. More research into the possible therapeutic benefits of the procedure is justified.