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。

Analysis of 1006 cases with selective salpingography and fallopian tube recanalization

OBJECTIVE: To retrospectively analysis of selective salpingography (SSG) and fallopian tube recanalization (FTR) in 1006 infertile women with tube obstruction, to summarize their clinical effect and practical value, to analyze the related factors which can improve treatment effect and pregnancy rate, and give suggestions of their indication and contraindication. METHODS: SSG and FTR using self-made coaxial catheter were carried out in 1006 infertile cases with tube obstruction of various portions and extents confirmed by hysterosalpingography (HSG). The one-year cumulative pregnancy rate and the effective rate by HSG reexamination were calculated, in combination with dynamic observation of preoperative HSG and intraoperative tube imaging. RESULTS: In the complete tubal occlusion group of 601 tubes in 315 cases, the recanalization rate was 87.9% (528/601), among which, 35.4% was only treated by SSG and 64.6% by FTR. Postoperative pregnancy rate and ectopic pregnancy rate were 39.9% and 2.7% respectively, and tubal reocclusion was 1.8% in one-year's follow up. In those failure to recanalization, tubal tuberculosis was in 4 cases, salpingitis isthmica nodosum was in 3 cases, isthmic occlusion was in 9 cases with club-changed terminal, ampullar or fimbrial occlusion was in 6 cases, and tubal fibrosis in 10 cases. In the incomplete tubal occlusion group of 1314 tubes in 691 cases, catheterized hydrotubation was carried out. Fimbrial adhesion diagnosed by HSG was found false positive or negative in 65 cases. The pregnancy rate was 53.6%, 45.7% and 26.8% in the mildly, moderately and severely occluded cases respectively. The ectopic pregnancy rate was 1.4%. The patent rate confirmed by HSG reexamination was 86.9% one year later. Sixteen cases with obvious fimbrial adhesion or enwrapped adnexa in both groups were treated by laparoscopy, with a coincidence rate of 97.1%. CONCLUSIONS: Selective salpingography and fallopian tube recanalization have both effects of diagnosis and treatment on tubal infertility. The techniques are simple, safe, and credible, and worth to be applied clinically. Knowing the shapes of fallopian tube confirmed by preoperative HSG can increase the rates of recanalization.