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目的:探讨改良输卵管阻塞介入技术在不孕症中的价值。材料与方法:经HSG诊断为输卵管梗阻性不孕症患者25例,先行选择性输卵管造影术,对目标子宫角进行选择性插管,将3F微导管穿过造影导管头端嵌入间质部,注入造影剂明确阻塞部位后,将导管尽量送至远段,在患者能忍受的情况下逐步加压,至输卵管再通,造影剂弥散进入盆腔,术后随访受孕情况。结果:本组25例经选择性输卵管造影显示46条输卵管阻塞,其中间质部、峡部梗阻41条(89.3%),壶腹部及伞端梗阻5条(10.7%)。除伞端阻塞1条改为腹腔镜手术治疗外,其余均行改良输卵管介入再通术成功,疏通43条,总复通率为95.56%,其中间质部全部复通35条,复通率为100%;峡部6条复通后远段积水黏连3条(占50%)。壶腹部复通3条,复通率为60%。随访复通成功患者1~2年,18例受孕,受孕率为72%,其中1例于2月后死胎;未有异位妊娠,无输卵管穿孔等严重并发症发生。结论:改良输卵管阻塞介入技术能对局限性阻塞和黏连部位进行机械疏通和扩张,解决输卵管内黏连和梗阻,并发症少,是治疗输卵管梗阻性不孕症较好的方法。
Objective: To explore the value of modified tubal occlusion intervention in infertility. MATERIALS AND METHODS: Twenty-five patients diagnosed as tubal obstructive infertility by HSG were enrolled in this study. First, selective salpingography was performed to selectively insert the targeted uterine horn. The 3F microcatheter was inserted into the interstitial part of the head through the contrast medium, Injection of contrast agent clear obstruction site, the catheter as far as possible to the distal segment, the patient can tolerate the gradual increase in pressure to the fallopian tube recanalization, contrast agent diffuse into the pelvis, postoperative follow-up of pregnancy. Results: Twenty-five tubal occlusions were observed in 25 patients undergoing selective salpingography, of which 41 (89.3%) were interstitial and isthmic obstructions, and 5 (10.7%) were ampulla and umbrella obstructions. In addition to the obstruction end of a change to laparoscopic surgery, the rest were performed modified tubal recanalization success, dredge 43, the total recovery rate was 95.56%, of which 35 were all of the interstitial recanalization, complex pass rate 100%; Isthmus 6 afloat remnants hydrocele 3 (50%). Ampullarex 3, pass rate of 60%. Follow-up patients in Fu Tong successful 1-2 years, 18 cases of pregnancy, pregnancy rate was 72%, of which 1 case of stillbirth after February; no ectopic pregnancy, no tubal perforation and other serious complications. Conclusion: The modified tubal occlusion interventional technique can limit the blockage and adhesion sites of mechanical dredging and expansion, to solve tubal adhesions and obstruction, with fewer complications, is the treatment of tubal obstruction infertility better method.