Interventional treatment of tubal infertility means interventional treatment of tubal infertility under the direct view of X-ray screen.
Tubal obstruction accounts for about 1/3 of the causes of female infertility, and the diagnosis and treatment of tubal infertility is a difficult problem in the diagnosis and treatment of infertility. In foreign countries, coaxial catheter system has been used since 1980s to perform selective tubal imaging and recanalization, and satisfactory results have been achieved. Interventional method of tubal is adapted to tubal obstruction infertility. Selective tubal angiography, aeration and reperfusion are feasible in all segments of tubal obstruction. The catheter dilation is mainly used to insert the catheter guidewire, and the catheter and guidewire are used to advance, dilate and separate the tubes and the impact of the contrast agent to unblock the tubes to the umbilical end. Indications for interventional treatment : ① 3-5 days after menstruation and no infection in the genitalia or pelvis. ②Trial tubal recanalization can be performed for bilateral or unilateral obstruction from the interstitial part of the fallopian tubes to the proximal part of the jugular. (③Conventional hysterosalpingography may be tried cautiously if it cannot be completed because the cervical opening is too loose. ④Bilateral or unilateral tubal patency, thinness or distortion ⑤For ectopic pregnancy, inserting a catheter into the pregnant side of the fallopian tube and injecting pinyamycin or embolic agent can inactivate the embryo, terminate the pregnancy and treat the ectopic pregnancy. Contraindications to interventional therapy: ①Acute inflammation of the genitalia or pelvis. ②Serious systemic diseases. ③The distal end of the jugular and umbilical obstruction should not be recanalized by guidewire. ④Severe occlusion at the uterine horn, reocclusion after tubal anastomosis and recanalization, and tuberculous tubal obstruction should not be performed. Interventional procedure
Intervention should be performed on the 3rd-5th day after the menstrual cycle, and should be preceded by urinary evacuation and vaginal irrigation. The patient should be placed in a lithotomy position, routinely disinfected and toweled, and a hysterosalpingogram should be performed first. Selective hysterosalpingography is preferred.
To apply the instrument, a vacuum-absorbing cup catheter is fixed transvaginally to the cervix, and the catheter is placed sequentially into the uterus, under fluoroscopic guidance with a J-shaped guidewire, at the inner orifice of the rotunda of the uterine horn, the guidewire is withdrawn, and a small amount of isotonic sodium chloride injection is injected via the catheter. If it does not show up, catheter dilation is given by inserting an ultra-soft guidewire and using the dilating and separating effect of the guidewire and flushing with isotonic sodium chloride injection to dilate the umbilical end of the fallopian tube. For distal tubal obstruction, local injection of lidocaine followed by pressure injection of isotonic sodium chloride injection was used to open up the fallopian tubes. After clinical application, the effective rate is 85.2%-89.9%, and the conception rate is 43% six months after the operation.