介入性再通术治疗输卵管阻塞性否孕的应用价值与限度

目的 探讨介入性输卵管再通术治疗输卵管阻塞性不孕的应用价值与限度.方法 回顾性分析160例输卵管阻塞性不孕患者行子宫输卵管造影与介入性再通术的X线表现与临床诊疗效果.结果 160例患者中,双侧输卵管阻塞72例（45.0％）,单侧输卵管阻塞88例（55.0％）.320条输卵管中,232条显示不同程度的阻塞,其中间质部阻塞105条（45.3％）,峡部阻塞70条（30.2％）,壶腹部阻塞22条（9.5％）,伞端阻塞（部分合并积水）35条（15.1％）.再通术成功197条,总再通成功率为85.0％,其中间质部再通成功98条,成功率为93.3％,峡部再通成功65条,成功率为92.9％,壶腹部再通成功19条,成功率为86.4％,伞端再通成功15条,成功率为42.9％.术后随访1年,妊娠64例,妊娠率为40.0％；术后发生宫外孕9例,宫外孕发生率为5.6％；术后输卵管再次阻塞40条,再次阻塞率为20.3％.结论 介入性输卵管再通术是治疗输卵管前三段（间质部、峡部、壶腹部）阻塞性不孕症的一种有效方法,但对输卵管伞端阻塞并积水效果差,存在一定难度.

Value and limitation of interventional recanalization for infertility induced by fallopian tube obstruction

Objective To explore the value and limitation of interventional recanalization for infertility induced by fallopian tube obstruction.Methods The X-ray appearances and clinical efficacies of hysterosalpingography and interventional recanalization for infertility induced by fallopian tube obstruction in 160 patients were retrospectively analyzed.Results Of the 160 patients,72 patients had bilateral tubal obstruction and 88 had unilateral obstruction,accounting for 45.0% and 55.0%,respectively.232 of the 320 fallopian tubes showed different degrees of obstruction; 105 tubes （45.3%） occurred interstitial obstruction,70 （30.2%） occurred isthmus obstruction,22 （9.5%） developed ampullary obstruction,and 35 （15.1%） developed umbrella end obstruction （some with hydrosalpinx）.Recanalization was successful in 197 tubes,with a total recanalization rate of 85.0%; 98 of which were successful for interstitial recanalization,with a rate of 93.3%,65 were successful for isthmus recanalization,with a rate of 92.9%,19 were successful for ampullary recanalization,with a rate of 86.4%,and 15 were successful for fimbria recanalization,with a rate of 42.9%.During the period of one-year follow-up,64 were pregnant,with a pregnancy rate of 40.0%; 9 developoed ectopic pregnancy after recanalization,with a rate of 5.6%.40 fallopian tube re-obsturcted,with a rate of 20.3%.Conclusions Interventional recanalization is an effective method for obstructive infertility induced by the three segment （interstitial,isthmus,and pot belly） obstruction of the fallopian tube; but it is not suitable for umbrella end obstruction complicated by hydrosalpinx.