Diagnosis and treatment of fallopian tubes

Author of this article: Lu Zhenzhen/Li Aijun, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University.Article source: International Reproductive Health/Family Planning Magazine, January 2018, Vol. 37, No. 1.

[Abstract] Volcanion of fallopian tubes is a kind of morphological change from chronic inflammatory exudation of fallopian tubes. The pathological basis is chronic inflammation of the fallopian tube.Examination, and laparoscopic joint detection is the gold standard of its diagnosis, while exploring the pelvic cavity and the treatment effect.Clinically, the treatment method is determined based on the degree of water accumulation, whether there are fertility requirements, and the clinical symptoms of patients, including conservative treatment and surgical treatment. Especially in surgical treatment, it is increasingly pursuing minimally invasive, safe, and effective.In recent years, the fluid accumulation of fallopian tubes has also become one of the main causes of fallopian tube secondary infertility. The treatment has also played an extremely important role in the pre-treatment of natural conception and in vitro fertilization-embryo transplantation.

[Keywords] Volcanion of fallopian tube; fallopian tube disease; diagnosis; treatment

Volcanion of fallopian tubes is a tubal disease that is filled with remote obstruction and expansion filled by slurry or transparent liquid.Due to the pathological factors such as fallopian tube inflammation and pelvic inflammation, the tubal umbrella end and the gorge adhesion lock, the secretion of mucosal cells can be discharged in time in time, or the long -term ovulation abscesses caused by chronic inflammation of the fallopian tube are absorbed into pulp.

The incidence of water accumulation of fallopian tubes has increased year by year. The main causes are reproductive tract infections, childbirth, artificial abortion, unclean behavior, gynecological surgery, or inflammation of its surrounding organs.The main clinical manifestations include infertility, dysmenorrhea, menstrual disorders, increased vaginal secretions, and acute and chronic abdominal pain.The diagnosis of fallopian tube accumulation is mainly based on its clinical manifestations and related auxiliary examinations such as ultrasonic and fallopian tube angiography. The treatment method is closely related to whether it has fertility requirements.

In 1990, the American Reproductive Society was divided into pelvic lesions of the fallopian tube.① Mild: The diameter of water accumulation is <1.5 cm or no water, and the end of the umbrella is not obviously adhesive to the fallopian tube or the ovarian.It is necessary to identify the umbrella end and the ovarian or ovarian or fallopian tubes. There are adhesion around the ovarian or fallopian tube. The rectal uterine is involved with a little adhesion, and the normal structure of the HSG can be lost before surgery.The end lock is not visible.

1.1 color ultrasound

Ultrasonic is the most commonly used non -invasive inspection method. For asexual life, a sexual life preferred abdominal ultrasound or rectal three -dimensional ultrasound. In addition, there are no special requirements for 3D ultrasound examination. Generally, 3 to 7 d examinations after menstruation is clean, and the rowEmpty bladder, cutting the bladder cutting position, the severity of water accumulation is divided into the following types.

① A small amount of effusion: The fallopian tube is curved in shape, the tube wall is thicker, and the inner wall is incompletely separated, and part of the bead -like changes are changed;Increase; ③ A lot of effusion: round or oval, thin and smooth tube wall.The three -dimensional ultrasound is used from 3 different planes to make the image more three -dimensional, and can display small lesions and internal fine structures.

Some literature reports that the sensitivity of ultrasound in the diagnosis of tubal water is as high as 86%, which is a front -line check method with non -invasive, practical and high diagnostic value.

1.2 HSG

HSG has the characteristics of simple and intuitive, and it is prompted whether the fallopian tube is unobstructed and pelvic lesions according to the scattering of the contrast agent.Select 3 to 7 d after menstruation for examination. The taboos of surgery should be excluded. Patients with vaginitis should be cured before HSG should be performed to avoid inflammation to spread to the pelvic cavity.

HSG can understand whether the cervical pipe is lesion, the uterine cavity is deformed, the length of the fallopian tube, and its shape, and has a positioning effect on the water accumulation of the fallopian tube. The specific performance in the HSG examination is as follows.

① Mild fallopian tube accumulation: The abdomen of the pot is slightly thickened, the mucosa tattoo is blurred, and the contrast agent enters the pelvic cavity smoothly, which is uniform;Unexplained; ③ Severe stagnation: The fallopian tube is significantly thickened, and the intestine is sausage, and the contrast agent cannot enter the pelvic cavity.HSG’s diagnosis accuracy is as high as 82.9%, and its error may be related to the patient’s emotional tension and the fallopian tube spasm during the operation.

1.3 Joint Laparoscopic Joint Exploration

It is the gold standard diagnosis of water accumulation of fallopian tubes. Laparoscopy can look directly at the uterus, fallopian tube shape, the parts of the fallopian tube water, the diameter of the stagnant water, and the surrounding pelvic cavity.And whether the bilateral fallopian tube port is abnormal. During the operation, the fallopian tubal liquid can be more intuitive to understand the smoothness of the fallopian tubes. During the operation, the pelvic adhesion, uterine fibroids, submucosal fibroids, endometrial and cervical polyps, relieve fallopian tube accumulationWater or obstruction and other gynecological problems have both diagnosis and treatment.

The purpose of the treatment of fallopian tubes is to eliminate water accumulation, restore the normal anatomical structure and function of the fallopian tube, and alleviate clinical symptoms. The stagnant water seriously causes the fallopian tube to reduce eggs and the transportation capacity.Multi -reversed flowing to the uterine cavity causes endometritis, affecting the embryo bed, causing infertility or ectopic pregnancy.There are many treatment methods, so it is very important for women with different needs.

2.1 Conservative treatment

For mild fallopian tube accumulation without obvious clinical symptoms and non -fertility requirements, it may not be treated. For patients with acute fallopian tubulitis without fertility, it can be conservatively treated. Generally, effective antibiotic therapy is treated at the same time for pathogenic microorganisms.

Physical therapy midwarm uses thermal effects and field effects to act on the part of the lesion, convert microwave to thermal energy, promote blood circulation, significant anti -inflammatory effects, and reduce the excitement of nerve endings.

Acupoints such as Chinese medicine acupuncture, Guan Yuan, and uterus, can improve the fallopian tube and the surrounding blood circulation through the reflection of nerve body fluids and local direct effects, promote the absorption and resignation of inflammation, and conducive to the smoothness of the fallopian tube.

In addition, traditional Chinese medicine retains enema therapy, ion import therapy and external application of traditional Chinese medicine, as well as anti -inflammatory analgesic, reduced inflammatory exudation, promoting blood circulation and other therapeutic effects, which can effectively treat chronic pelvic inflammatory disease.

2.2 Surgical treatment

2.2.1 Underproofaloplastment underclavixous tubal resection

It is a mature minimally invasive surgery, with exact and significant effect, but its invasion and permanent characteristics should be cautious when choosing.In pre-treatment of in vitro fertilization-embryo transplantation (IVF-ET), the clinical pregnancy rate and continuing pregnancy rate of patients with fallopian tube resection are significantly higher than the unavailable group.It is a better choice.

It can be seen that for patients with severe fluids, fallopian tube division is indeed an effective method, but the arterial arch of the uterine arterial ovarian branches and ovarian arteries can be easily damaged during the operation, which affects the supply of ovarian blood.The impact should avoid this damage during the operation.

In the IVF-ET cycle, the reactivity of ovaries, follicles and total ovarian parent cells have been significantly reduced compared to before and after the fallopian tube resection. It can be seen that fallopian tube resection may affect the affected ovarian reserve function.In addition, if the fallopian tube resection is omitted, the quality of the interior may lead to the occurrence of ectopic pregnancy.

2.2.2 Laphoscopic fallopian tubal system

During the operation, it can intuitively and clearly see fallopian tubes and its surroundings. It can also explore the smoothness of the fallopian tube and the blockage site. It will not cause serious damage to the fallopian tube, nor will it affect the patient’s ovarian function.

Specific surgery: ① The surrounding tissue adhesion, separated adhesion, and restore the anatomy of the fallopian tube and umbrella end;The end bag is buried in the pelvic adhesion band. After the stagnant water is released, the electrocoagulation umbrella is fixed to fix it to restore the normal shape of the umbrella end;Another mouth -free zone is used to make a new umbrella end after the end of the umbrella end; ⑤ The loss of the umbrella end structure is used in other surgery: for those who form a blind end at the mouth of the umbrella, the thinnest part of the blind end can be used.Cut it or cut it with scissors to make it petals. After forming an umbrella shape, the ovary mouth is used to turn the umbrella mouth on the fallopian tube plasma surface, or the exterior can be sutured outside the tube slurry film with an absorbable line.

After the postoperative physiological saline, the pelvic cavity and anti -adhesive items were repeatedly rinsed to reduce the postoperative inflammatory response to prevent stagnant water again.However, the patent water accumulation after surgery is easy to relapse, and the incidence of ectopic pregnancy is increased.Due to the short follow -up time and other reasons after oral surgery in chu et al. Due to the short follow -up time, the natural pregnancy rate is only 27%.

For those who have fertilized requirements, they should be pregnant as soon as possible after active anti -inflammatory treatment, and at the same time closely monitor patients’ pregnancy conditions, and detect abnormal signs such as abnormalities as soon as possible.Studies in Li Baiga and others have shown no significant differences in improving the ending of IVF pregnancy.

2.2.3 Waspopurping

Under the laparoscopic ligament with Filshie Clip or Homelock, or ligated by electrocoagulation fallopian tubes in laparoscopy, some studies have shown that the single -pole electrode electrode vapornexation effect can be achieved in the tubal ligation effect in the uterine laparoscopy.No matter what kind of fallopian tube ligation, it has the characteristics of relatively small trauma, simple and safe.

Zhang Hanwang and others pointed out the indicator of the fallopian tubal ligation: ① The lesions are light but the diameter of the water accumulation is <3 cm, and the recurrence of water recurrence after ligation and oral oral surgery;Strongly require retaining tubes.Studies have shown that the fallopian tube resection and fallopian tube ligation can effectively prevent the effusion retrograde to the uterine cavity and increase the pregnancy rate.

Compared with fallopian tube resection, fallopian tube ligation has the advantages of less damage, simple operation, short surgical consumption, effectively preventing the accumulation of water return uterine cavity and no impact on ovarian function.

2.3 Ultrasonic guidance under fallopian tube puncture therapy

2.3.1 Ultrasonic guidance under the fallopian tube stagnation and pumping suction

Although the effect of surgery is very positive, not all patients are willing to undergo surgical treatment.Type B ultrasonic (B -ultrasound) guidance under the guidance of fallopian tubes is a choice. By removing the effusion and reducing the lumen pressure, it can achieve the effect of rapid treatment, but the clinical application is not wide.

There are two main ways, namely the leather puncture and vaginal puncture.The possibility of rapid recurrence of water after surgery is possible. It is necessary to puncture multiple times. If the fallopian tube wall damage is caused, there is a risk of atomic pregnancy in the future.

2.3.2 Ultrasonic guidance under the fallopian tube stagnation and hardening therapy

It refers to a treatment method that adds sclerosis agents on the basis of puncture and suction under ultrasound guidance. Usually, the pituitary downside of the menstrual cycle is usually carried out before surgery, eliminating the history of alcohol allergies, coagulation disorders, organ failure, acute infection, and giant ureter.

After the negative pressure is used to suck the effusion, the lumen is repeatedly rinsed with the galcolin injection (80 mg), 98%ethanol is added into the cyst cavity, and 5 to 10 min is stayed in the lumen cavity, and then removed.

Ethanol has a strong dehydration effect on cells, which makes the cells in the fallopian tube atrophy, necrotic, and lost function, effectively avoiding the occurrence of recurrence and ectopic pregnancy. It has no effect on ovarian function. It is suitable for women in all ages.The advantages of non-invasive, low cost, and repetition, can improve pregnancy ending in IVF-ET pre-processing.

2.4 Essure miniature insertion

It is a type of fallopian tube intervention. Although laparoscopic surgery is good, the cost is high and there is a risk of anesthesia. Essure micro -insertion is a new treatment method.Essure is a permanent confession device similar to a spiral bullet circle approved by the US Food and Drug Administration in 2002. The polyester fiber contained in it caused a local inflammatory response, which caused the near -end fibrosis of the fallopian tube and achieved the effect of fallopian tube ligation.

Essure is placed without the inpatient operating room. It can be performed under general outpatient hysteroscopy. The whole journey is 5 to 8 min.3 months after surgery, HSG to view the effect of fallopian tube embolism.Since Rosenfield and other reports have published ESSURE’s reports of the successful pregnancy of IVF-ET after the treatment of fallopian tubes, many international reproductive medical workers have begun to try this convenient and effective method.

Mijatovic and others used Essure to implement near -end foothills of fallopian tubes for 10 patients. The postoperative confirmed embolism success rate was 90%(9/10). In its forward -looking studies, the clinical pregnancy rate was 40%after using Essure.Whether Essure can be a reasonable alternative to fallopian tube water accumulation needs to be studied. For those with difficult operations and high surgical risks, they can be used as one of the therapies.Due to the lack of random control tests, the safety and effectiveness of its treatment need to be confirmed more.

2.5 Selection of Clinical Treatment

For a unilateral mild moderate fallopian tube accumulation, except for infertility caused by the fallopian tube, surgery and conservative treatment play a positive effect on natural pregnancy.There are many methods and significant curative effects. The observation period after surgery or non -surgical treatment is relatively long, with a maximum of about 40 years old.

For those with severe water accumulation of a single -sided tubal, they can promote natural pregnancy after fallopian tubal surgery and Essure embolism.If natural pregnancy fails, you can also consider IVF-ET treatment after the fallopoppopular bolt embolism.Yang Nian and others pointed out that the time for observing natural pregnancy after treatment: age is 35 years old, which can shorten the observation time and actively do IVF-ET after half a year; those who are ≤35 years old and have poor economic conditions, can extend the observation time appropriately, but butControl within 2 years.

For bilateral water accumulation, due to limited treatment methods and patients with a slightly older time and older infertility, positive intervention measures are generally taken.Mild water -strica persons can use bioplasmal water staggers under laparoscopy, which may have natural pregnancy after surgery.Liu Yunqi and others pointed out that the natural pregnancy ending after bilateral fallopian tube accumulation fistula was worse than the unilateral fallopian tube accumulation.

For patients with mild water accumulation, comprehensive considerations should be comprehensively considered from age and infertility time. Those with age ≤ 37 years old have relatively short infertility time. After surgery, embolism, or after ultrasonic sclerosis, wait for natural conception.The annual pregnancy rate is the highest, so the waiting time cannot exceed 1 year; the age is> 37 years old, considering the decline of ovarian function, it is recommended to actively do the IVF-ET after a short observation time.

For medium-weight accumulated water, Daniilidis et al. Show that the clinical pregnancy rate of tubal resection, fallopian tube closedness and ultrasonic guidance under IVF-ET pre-processing is significantly better than non-intervention group.However, for patients with severe pelvic adhesion and difficulty in operating, laparoscopic surgery for the treatment of bilateral fallopian tubes is not significant to natural pregnancy. It is advisable to assist reproductive after embolism treatment or tubal cutting.

For those who are accompanied by severe pelvic adhesion and the ovarian adhesion, it is not good for the auxiliary reproductive.There are literature reports that those who are old and 37 -year -old are accompanied by long -term infertility and severe pelvic adhesion. It is best to choose IVF.

In addition, for women with menopause, the tubal stagnation can be rare in concurrent uterine endometrial cancer and ovarian cancer, but the fallopian tube itself will not cancer. The treatment of fallopian tubes can help discover other sources of tumors.At present, further research on the best treatment of double -sided medium -sided demented tubular accumulation is needed.

For the stagnation of tubal water during pregnancy, on the one hand, the fluctuation of water accumulation of fallopian tube to the uterine cavity may interfere with embryos or has toxic effects on the embryo. It has risks to reverse, rupture, bleeding, ascites and other risks, which may complicate the pregnancy process; on the other hand, surgical intervention willIt may affect the stability of the fetus in the pelvic cavity, and the complications of the surgery during pregnancy are high. Therefore, the adequate risk assessment of pregnant women and the fetus should be determined whether intervention treatment is determined.

In recent years, the proportion of tubal secondary infertility has gradually increased, accounting for 35%of female infertility.The treatment method of fallopian tubes has become the key.

Conservative treatment has a significant effect on the efficacy of mild moderate fallopian tube water accumulation, has no good effect on the treatment of severe fallopian tube accumulation, long treatment and easy to delay; fallopian tube resection can achieve the purpose of cure, but it has permanent damage, which brings patients with patients.Psychological and economic burden, it is easy to damage ovarian blood supply during surgery and affect ovarian function; fallopian tube oral surgery exports water into the pelvic cavity, but due to chronic pelvic inflammation, the umbrella end can be tied again.Suffering, retaining the fallopian tube function, it is easy to relapse after surgery, and increase the incidence of volatile pregnancy after fallopian tube damage; although the treatment of tubal pumping and absorbing hardcix treatment under ultrasound guidance can avoid recurrence of water accumulation and fallopian tube pregnancy, its taboos are relatively large; although ESSURE, although ESSUREIt is proven to be convenient and effective, but it still needs to be further confirmed in large quantities.

Although various treatment methods are beneficial and disadvantages, in the IVF-ET pre-processing, various methods intervention groups are better than the non-intervention group. It is necessary to choose carefully according to the specific situation during treatment.

S18 Double Breast Pump-Tranquil Gray