Introduction to interventional treatment of tubal obstructive infertility
Tubal obstructive infertility accounts for about 1/3 of all infertility cases. The commonly used methods include tubal lavage and conventional hysterosalpingogram with iodine. Although laparoscopy and dissection can help to determine whether the fallopian tubes are really obstructed or not, they are complicated and traumatic due to their technical complexity. Although laparoscopy and caesarean section can help to determine whether the fallopian tubes are really obstructed or not, due to their complicated and invasive techniques, their wide application is limited. In terms of treatment, lavage and anti-inflammatory treatment have become the main methods of treating tubal obstruction, but the results are not satisfactory. Although laparoscopic and microsurgical tubal reconstruction surgery is effective for distal tubal obstruction, proximal tubal obstruction is difficult to unblock and is highly invasive, so there is a limit to its wide application.
Selective tubal angioplasty and recanalization is mainly performed by inserting catheters and guidewires, and using the advancing, dilating and separating effects of the guidewires to unblock the fallopian tubes to the umbilical end, which can help to determine whether the fallopian tubes are really blocked, the site and cause of the blockage, and can directly recanalize the blocked tubes at the same time. The procedure is intuitive, visual, safe, non-invasive and less painful. The success rate of selective tubal cannulation is about 96%, and the success rate of proximal blockage recanalization is about 90%, which is a better diagnosis and treatment method for tubal obstruction infertility, and has a high reference and guiding significance for the treatment that may be chosen later (such as laparoscopy, test tube baby, etc.). The operation usually takes only 20 minutes, and some patients can also choose painless (under intravenous anesthesia) surgery, and they can go home immediately after the operation without hospitalization.
This technique has been carried out in our department since 1997, and it has solved the fertility problems of many infertility patients inside and outside the province, enjoying a high reputation and becoming a special treatment item of our department. We insist on the tenet of “patient first”, so as to shorten the waiting time of patients.
In which cases should selective tubal angiography and recanalization be performed?
1. Selective tubal angiography can be performed in all sections of the fallopian tube;
2. Tubal recanalization can be performed in cases of interstitial tubal, isthmus and proximal abdominal incompetence;
3, conventional hysterosalpingography can be tried if the cervical opening is too loose;
4. If the fallopian tubes are bilaterally or unilaterally incompetent, too thin or twisted, catheter dilation is recommended, followed by insertion of drugs through the catheter to reach the lesion site for better results.
Contraindications to tubal recanalization
1.Incompetence of the distal end of the abdomen and the umbilical end of the jug;
2.Severe occlusion at the uterine horn, reobstruction after tubal anastomosis and tuberculous tubal obstruction should not be performed;
3. Patients with active tuberculosis;
4.Iodine allergy;
5. Acute inflammation of the genitals or pelvis;
6, fever and menstrual period.
Pre-operative precautions and workflow of uterine tubal recanalization.
1. The operation is usually performed within 3-7 days after menstrual cleansing and avoid intercourse before the operation.
2. On the day of surgery, it is recommended to have a person accompanying you and to sign a consent form for the surgery.
★Interventional treatment operation procedure
Interventional operation should be performed on the 3rd-7th day after menstruation. Before the operation, urine should be evacuated and vaginal douche should be performed. The patient should be placed in a lithotomy position, routinely disinfected and toweled, and the catheter should be inserted into the uterine cavity in sequence. If the fallopian tube is not visualized, guide wire dilation is given. An ultra-soft guide wire is inserted and the tube is dilated to the umbilical end by using the dilating and separating effect of the guide wire.
Post-tubal recanalization precautions
After tubal revascularization, you may experience the following discomforts, please do not be nervous, take rest and deal with them as follows
1.Mild abdominal pain, nausea, vomiting: all are transient.
2.Vaginal bleeding: it can last for 3-5 days and will disappear naturally.
3.Regular oral antibacterial agent for about 5 days.
4.No intercourse for 1 month and contraception for 1 month after the operation.
5.If you get pregnant after this treatment, please let us know so that we can share the joy with you.
★Typical case presentation
Female, 32 years old, had one abortion in the past, but had not been pregnant for 4 years after marriage. She had been treated in many hospitals, and had taken various Chinese medicines and prescriptions, but failed to get pregnant. Then she came to our hospital for a hysterosalpingogram, which confirmed that both fallopian tubes were incompetent, and she was advised to use interventional treatment. On the 5th day after menstruation, the interventional doctor inserted a fine catheter through the cervix into the uterine cavity, and then inserted the catheter into the openings of the left and right fallopian tubes respectively under X-ray television surveillance, and used an ultra-smooth micro-guide wire to unblock both fallopian tubes. Six months later, the woman finally became pregnant, and after 10 months of pregnancy, she gave birth to a normally developed baby boy. Now the child is healthy and active, bringing great joy and happiness to the family!
1. Pre-operative hysterosalpingogram showed that both fallopian tubes were incompetent
2.Ultra-slip guide wire entered the right fallopian tube to unblock it
3. The right fallopian tube was unblocked and the imaging confirmed that it was open
4.The left fallopian tube was unblocked and the imaging confirmed that it was also unblocked