Observation on the efficacy of interventional treatment of 100 cases of tubal obstruction
Jiao Qinshu
Department of Interventional Therapy, The Second People’s Hospital of Anyang City, Anyang 455000, Henan, China
Abstract: Objective To explore the clinical value of interventional recanalization in the treatment of tubal obstruction infertility and to improve the effect of treatment of infertility. Methods One hundred patients were enrolled, 12 with primary infertility and 88 with secondary infertility. 100 patients were treated by hysterosalpingography, 33 with unilateral tubal incompetence and 67 with bilateral tubal incompetence. One case of severe uterine adhesions and one case of congenital vaginal uterine malformation resulted in failed intubation. After the operation, 62 cases conceived spontaneously with a pregnancy rate of 62%, one ectopic pregnancy and two miscarriages. Conclusion Interventional recanalization for tubal obstructive infertility is simple, easy to perform, safe and reliable. Jiao Qinshu, Department of Interventional Medicine, Zhengzhou Central Hospital
100 cases of tubal occlusion on treatment of intervention JIAO qin-shu, Department Abstract: Objective Investigating the infertility value of interventional recanalization treatment of tubal obstruction, enhancing the effect of treatment of infertility. Methods selected 100 patients, including 12 cases of primary infertility, 88 cases of secondary infertility. we applied the selective salpingography and fallopian tube recanalization for treatment of 100 cases of infertility caused by fallopian tube obstruction, of the 100 cases, there are 33 cases of Unilateral fallopian tube obstruction, and 67 cases of Both fallopian tube obstruction. Results: Successful recanalization was achieved in 151out of 165 fallopian of the 167 fallopoan of 100 cases, the success rate was 91.5%. One case of severe intrauterine adhesions, one case of congenital vaginal malformations, caused failing intubation. after the procedure, 62 cases become pregnant, pregnancy rate was 62%, one case of ectopic pregnancy, two cases of abortion. Conclusion: Interventional recanalization treatment of tubal obstruction infertility was easy, safe and reliable. [Keywords] Tubal obstruction, selective interventional therapy Key words】Fallopial Tube obstruction Selective Interventional therapy Tubal obstruction is one of the major causes of female infertility, accounting for 30%-40% of all infertility causes [1]. Because interventional treatment of tubal obstruction is easy, practical and effective, it is used as the preferred method for the treatment of tubal obstruction. The results of 100 patients with complete data from June 2006 to June 2009 are reported below. 1 Clinical data 1.1 Materials 1.1.1 Cases In this group of 100 patients, there were 12 cases of primary infertility and 88 cases of secondary infertility. Age 21-41 years old, average age 30 years old. The duration of infertility ranged from 1.5 to 8 years, with an average of 4.1 years. 1.1.2 Equipment and instruments The machine was an angiography machine. The FTC-550 tubal recanalization kit manufactured by COOK, USA was used for the device. 1.1.3 Intraoperative medication The overnight medication was gentamicin injection 80,000 units, chymotrypsin injection 4000 units, dexamethasone injection 5 mg. 2 Method 2.1 Preoperative preparation 3-7 days after menstrual cleansing and negative iodine allergy test. Preoperatively, 10mg of diazepam and 10mg of scopolamine were injected intramuscularly, and the patients were told about the treatment and procedure to obtain their cooperation. 2.2 Intraoperative operation Lie supine on the catheter bed in a bladder truncated position and disinfect the vulva with complex iodine gauze. A speculum was placed to expose the cervix, and the vagina and cervix were disinfected again. The tip of the 5.5F horned catheter was selected at the left and right fallopian tube openings, and selective tubal angiography (SSG) was performed. The tube morphology, alignment, site and degree of obstruction were displayed. If the contrast agent can diffuse smoothly through the fallopian tube from the umbilical end to the pelvis, the tube is unblocked and recanalization by guidewire is not necessary. 8 ml of therapeutic drug (containing 80,000 units of gentamicin, 4,000 units of chymotrypsin and 5 mg of dexamethasone) was instilled through the 3.0F recanalization catheter. If the fallopian tube is not visualized or the contrast agent is retained in the fallopian tube, recanalization treatment with guidewire is necessary. The guide wire was passed through the obstructed segment. The contrast agent can be diffused smoothly through the fallopian tube from the umbilical end to the pelvic cavity, indicating that the fallopian tube on that side has been unblocked. If the fallopian tube is still obstructed, the procedure can be repeated. 2.3 Postoperative management Postoperative anti-infection treatment for 1 week. The lavage treatment is maintained for 2 menstrual cycles, twice a month. No intercourse was allowed during the month. 3 results Of the 100 patients, 67 (67%) had bilateral tubal incompetence and 33 (33%) had unilateral tubal incompetence. A total of 167 fallopian tubes were intubated in 100 cases and 165 were successfully intubated, with a success rate of 98.8%. One case of severe adhesions in the uterine cavity and one case of congenital vaginal uterine malformation were the causes of failed intubation. The success rate of recanalization was 91.5% in 151 of the 165 tubes. After 15 months of postoperative follow-up, 62 cases conceived spontaneously, with a pregnancy rate of 62%, 1 ectopic pregnancy and 2 miscarriages. 18 cases (18%) had reobstruction after 6 months. 91.5% of the cases were followed up after surgery. Twenty patients had postoperative abdominal distension and abdominal pain, and the symptoms disappeared after rest. In all cases, there was no vaginal haemorrhage or tubal perforation. 4 Discussion 4.1 Clinical value of imaging Selective tubalography (SSG) can eliminate the false positive rate of up to 30%-40% that occurs with conventional hysterosalpingography [3]. The application of the pathogram technique of the DSA machine to precisely determine the uterine angle and the site of tubal obstruction is conducive to super-selective intubation and improves the success rate of intubation [4]. The multi-angle rotation of the C-arm facilitates the demonstration of flexed uterus and malformations and tubal tortuosity. 4.2 Etiology Tubal obstruction can be caused by infections such as chlamydia, gonococcus and tuberculosis, as well as by endometriosis and tubal tumors, the main cause being infection. Another part of obstruction is mucus plug in the fallopian tube. 4.3 Complications and prevention 4.3.1 Pain Uterine tubal spasm and contrast dilation of the uterus and fallopian tubes can also cause lower abdominal pain. It usually does not require special treatment and may resolve on its own after rest.
Gentleness can usually be avoided. Thurmond [6] reported an incidence of 0.3%, manifesting as pelvic pain and fever, with infection occurring as a re-activation of the original lesion and recanalization of the proximal obstructed tube, which opens up a potentially infected tubal segment. Preoperative examination and treatment of pelvic inflammatory disease should be routine. None of the cases in our group developed infection, outside of routine preoperative infusion of antibiotics and strict intraoperative disinfection. Postoperative antibiotic infusion. 4.3.3 Reocclusion To prevent reocclusion, the cause of the blockage should be treated postoperatively. The perioperative period should be treated with regular anti-inflammatory therapy. Drugs can be kept in the fallopian tube to prevent reobstruction. Commonly used drugs are: jeltex, sodium hyaluronate, etanercept, salvia and super liquid iodized oil. 4.3.4 Tubal pregnancy The fertilized egg moves to the uterine cavity for implantation with the help of tubal peristalsis and propulsion of the tubal epithelial cilia [2]. The rough advancement of the guidewire causes damage to the epithelial cilia of the fallopian tube, preventing the fertilized egg from moving to the uterine cavity and developing in the tubal abdomen, resulting in tubal pregnancy. Therefore, the operation should be performed gently to avoid damage to the epithelial cilia of the fallopian tube. 4.3.5 Fallopian tube perforation Fallopian tube perforation is usually caused by rough handling. Interventional treatment is simple, accurate in diagnosis, effective, reliable and safe, and is currently a better method for the treatment of tubal obstruction.