I. How to evaluate interventional treatment for tubal obstruction Q: What is interventional treatment for tubal obstruction, what are its features and how to evaluate it? A: Interventional treatment for tubal obstruction was first reported in 1985 and has been gradually carried out since then, and the number of interventional methods has increased. The basic principle is to use a micro catheter containing a guidewire, the diameter of which is about 0.36-0.46 mira, which can be sent into the uterine horn under the supervision of X-ray fluoroscopy, ultrasound and hysteroscopy, and then the guidewire is inserted into the blocked fallopian tube, and when resistance is encountered, pressure is gently applied and pushed back and forth to make the guidewire pass through the blocked part to achieve the purpose of unblocking the lumen. The recanalization rate has been reported to be 76% to 95%. Before a patient needs microsurgical tubal anastomosis or in vitro fertilization or embryo transfer due to tubal obstruction, tubal intervention is the preferred choice because of its low cost, low pain and indications. The first step in tubal intervention is to choose the method of delivering the catheter. It can be delivered under x-ray fluoroscopy and ultrasound through indirect image surveillance without cervical dilatation, which is less painful for the patient; it can also be delivered under official cavity microscopy, which is operated under direct vision, so the intubation under hysteroscopy is more accurate and reliable, but it is necessary to dilate the uterine cavity and do uterine operations. The degree of lesion varies greatly between patients with tubal obstruction. Some lesions only have obstruction of the tubal lumen with normal appearance; some have thickening and hardening of the entire tubal lumen in addition to obstruction of the tubal lumen, and close adhesion to the surrounding tissues, while laparoscopy allows observation of the pelvic cavity. Therefore, combined hysteroscopy and laparoscopy for tubal intervention is a new method for tubal obstruction treatment in recent years. Usually, under the observation of laparoscopy, the condition of the fallopian tubes and their pelvic cavity can be clearly seen, and a judgment can be made immediately whether there are indications and values for interventional treatment. Moreover, when the tubal bending is serious or adhesions are present, it can be operated under laparoscopy to decompose the adhesions or to adjust the direction of the tubes by clamping the tubes so that the interventional guidewire is in the same direction as the tubal lumen, which will help to improve the success rate and reduce complications: interventional treatment under hysteroscopy and laparoscopy is usually performed under general anesthesia and the patient does not feel pain, but this can only be done in medical institutions that have the conditions. The best indication for tubal intervention is obstruction from the interstitial to the junction of the isthmus, which is more effective. Tuberculous tubal obstruction, severe occlusion with scar formation in the uterine horn, distal tubal obstruction, hydrocele and severe pelvic adhesions are less effective. Therefore, it is important to carefully select the indications. Apart from the possible complications of the catheter delivery method itself, the main complications directly related to the intervention are inflammation, tubal perforation and tubal pregnancy. Preventive work and good counseling to the patient should be done before choosing interventional treatment to facilitate informed patient choice. The tubal obstruction, which is an important cause of female infertility, is the cause of 78.8% of infertility patients. Inflammation of the fallopian tubes leads to adhesions and distortions, and inflammatory debris, concentrated thick mucus, and tiny fibrous filaments in the fallopian tubes can cause tubal obstruction. In addition, the traditional water, fluid, gas and microsurgery are not effective and have some limitations. x-ray tubal recanalization by inserting a catheter through the uterine cervix can achieve the purpose of recanalization by using the mechanical dilatation of the guidewire to pass through the adhesively narrowed or even occluded fallopian tubes, plus the flushing and dilating force of contrast and drugs to flush away the blockage in the fallopian tubes, loosen the adhesions and expand the lumen. This method is easy, safe and effective. After long-term anti-inflammatory treatment, repeated fluids or imaging, the effect is not good, but after interventional catheter and guidewire treatment, the effect is satisfactory. The success rate of recanalization does not depend on the degree of obstruction, but on the type of tubal obstruction, with excellent results for simple obstruction. The high success rate of recanalization may be due to the fact that most of the patients only had a history of abortion and no significant pelvic inflammatory disease such as tuberculosis and endometriosis, and the obstruction was mainly simple, and the site of obstruction was mostly located in the interstitial region and isthmus. Interventional guidewire tubal revascularization treatment is suitable for any obstruction caused by any reason. The treatment effect varies depending on the site of obstruction, with the best result for middle and distal obstruction, followed by angular obstruction, and poorer result for umbilical obstruction. After tubal recanalization, it is very important to maintain the patency of the fallopian tubes, and the uterine cavity is lavaged after intubation to prevent reocclusion of the tubes. We believe that iodine oil and medication can be injected into the fallopian tubes after recanalization, and early lavage and imaging, combined with anti-inflammatory treatment, can prevent re-adhesion. The effect of different postoperative management methods on the rate of reobstruction after tubal recanalization remains to be further observed.