近端输卵管闭塞的病理形态及其超微结构探讨

目的探讨近端输卵管闭塞的病理形态和超微结构。方法采用回顾性方法对1985年1月-2004年12月间182例近端输卵管闭塞性不孕症患者进行分析，主要是闭塞的近端输卵管的病理形态改变，部分输卵管标本行透射电镜观察。结果导致输卵管近端闭塞的首位病因是输卵管非特异性慢性炎症，占67．02％，其次是输卯管管腔纤维闭塞和结节性输卯管炎，各占11．54％，再次为输卵管子宫内膜异位症，占6．60％，输卵管结核、输卵管异物结节以及未见明显病变者各占1．10％。透射电镜发现4例患者阻塞段输卵管切面为大量胶原纤维和少量的纤维细胞，排列较为紊乱，未见上皮和管腔；有1例仍可见输卵管上皮，但纤毛互相粘连填塞管腔，致使管腔变窄甚至闭锁，部分细胞纤毛出现退化或脱落，纤毛的横切面9＋2微管系统结构欠清晰，胞质内线粒体肿胀及内质网扩张，胞质内可见空泡。而邻近阻塞部位输卵管（通畅段）：电镜下上皮细胞主要由单层柱状分泌细胞和纤毛细胞构成，纤毛细胞顶端的纤毛排列比较规整，未见明显退化和脱落的现象。结论闭塞的近端输卵管呈多种病理类型改变，其主要病因是输卯管非特异性慢性炎症，其次为输卵管管腔纤维闭塞和结节性输卵管炎。感染及人工流产的增加可能是导致输卵管性不孕发病率增加的因素。

Observation on the pathological morphous an ultrastructure of proximal oviduct occlusive infertility

Objective To explore the pathological morphology and ultramicrostructure of proximal oviduct occlusive infertility.Methods One hundred and eighty-two proximal oviduct occlusive infertile women who were admitted to the second affiliated hospital of Yat-Sen University between 1985 and 2003 were included.Part of oviduct samples were examined by transmission electron microscope.Results The pathological morphology of proximal oviduct occlusion included non-specific chronic oviduct inflammation(67.02%),lumens obliterative fibrosis(11.54%)and nodular salpingitis(11.54%),endometriosis of fallopian tube(6.60%),tuberculosis,foreign substance and normal oviduct each occupied 1.10%.Conclusion There are all kinds of pathological changes in proximal oviduct occlusion.The major cause is non-specific chronic oviduct inflammation,and the secondary causes are lumens obliterative fibrosis and nodular salpingitis.Infection and artificial abortion may be the causes which resulted in increasing of tubal infertility.