导管顶端封堵健侧宫角液体加压法联合导丝再通术在单侧输卵管阻塞中的应用
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摘要
目的探讨双腔球囊导管顶端封堵健侧宫角液体加压再通法联合导丝再通术在单侧输卵管梗阻中的应用。方法对不孕症患者行子宫输卵管造影(HSG),筛选出单侧输卵管梗阻者50例,尝试用导管顶端封堵健侧宫角液体加压法再通输卵管,观察再通与子宫形态间的关系,此法不能再通的患者进一步应用导丝再通术并观察再通率。结果 50例患者中,33例宫角至宫颈内口的距离小于导管进入子宫内的长度,且宫角的宽度小于导管的直径,导管顶端封堵宫角严密,19例输卵管再通,14例因梗阻严重未能再通。17例宫角至宫颈内口的距离大于导管进入子宫内的长度,且宮角的宽度大于导管的直径,导管顶端不能封堵宫角再通失败。未疏通的31例患者联合导丝再通术后22例输卵管复通。结论导管顶端封堵健侧宮角液体加压法能使部分输卵管再通,其与子宫形态关系密切,联合导丝再通术能明显提高单侧输卵管梗阻的再通率。
Objective To investigate the clinical application of liquid pressurization under obstruction of healthy-side uterine horn with the tip of double lumen balloon catheter combined with guidewire recanalization in treating unilateral obstruction of fallopian tube. Methods Hysterosalpingography was performed in infertility patients. A total of 50 patients with unilateral obstruction of fallopian tube were selected. Attempt was made to use catheter tip to obstruct the healthy-side uterine horn, then liquid pressurization was carried out to reopen fallopian tube, and the relationship between the success of recanalization and uterine morphology was analyzed; further guidewire recanalization was employed when liquid pressurization method failed, and the recanalization rate was calculated. Results In 33 among the 50 patients, the distance from the uterine horn to the cervical internal orifice was shorter than the catheter length that was inserted into the uterus, besides, the width of the uterine horn was smaller than the catheter diameter, thus the uterine horn was tightly occluded by the catheter tip. Recanalization of the fallopian tube was obtained in 19 patients, and recanalization of the fallopian tube failed in 14 patients because the obstruction was very severe. In 17 among the 50 patients, the distance from the uterine horn to the cervical internal orifice was longer than the catheter length that was inserted into the uterus, besides, the width of the uterine horn was larger than the catheter diameter, thus the uterine horn could not be tightly occluded by the catheter tip, resulting failure of recanalization of fallopian tube. Further guidewire recanalization had to be carried out for the 33 patients whose recanalization of fallopian tube with liquid pressurization method failed, and recanalization of fallopian tube was achieved in 22 patients. Conclusion Liquid pressurization under obstruction of healthy-side uterine horn with the tip of double lumen balloon catheter can reopen the obstructed fallopian tube in some patients,and the success of recanalization is closely related to the uterine morphology. Additional use of guidewire recanalization technique can significantly improve the recanalization rate for unilateral fallopian tube obstruction.
Objective To investigate the clinical application of liquid pressurization under obstruction of healthy-side uterine horn with the tip of double lumen balloon catheter combined with guidewire recanalization in treating unilateral obstruction of fallopian tube. Methods Hysterosalpingography was performed in infertility patients. A total of 50 patients with unilateral obstruction of fallopian tube were selected. Attempt was made to use catheter tip to obstruct the healthy-side uterine horn, then liquid pressurization was carried out to reopen fallopian tube, and the relationship between the success of recanalization and uterine morphology was analyzed; further guidewire recanalization was employed when liquid pressurization method failed, and the recanalization rate was calculated. Results In 33 among the 50 patients, the distance from the uterine horn to the cervical internal orifice was shorter than the catheter length that was inserted into the uterus, besides, the width of the uterine horn was smaller than the catheter diameter, thus the uterine horn was tightly occluded by the catheter tip. Recanalization of the fallopian tube was obtained in 19 patients, and recanalization of the fallopian tube failed in 14 patients because the obstruction was very severe. In 17 among the 50 patients, the distance from the uterine horn to the cervical internal orifice was longer than the catheter length that was inserted into the uterus, besides, the width of the uterine horn was larger than the catheter diameter, thus the uterine horn could not be tightly occluded by the catheter tip, resulting failure of recanalization of fallopian tube. Further guidewire recanalization had to be carried out for the 33 patients whose recanalization of fallopian tube with liquid pressurization method failed, and recanalization of fallopian tube was achieved in 22 patients. Conclusion Liquid pressurization under obstruction of healthy-side uterine horn with the tip of double lumen balloon catheter can reopen the obstructed fallopian tube in some patients,and the success of recanalization is closely related to the uterine morphology. Additional use of guidewire recanalization technique can significantly improve the recanalization rate for unilateral fallopian tube obstruction.
引文
[1]黄理华.加压法子宫输卵管造影在输卵管间质部阻塞中的应用[J].实用妇产科杂志,2015,31:73-75
[2]陈利军,叶振中,何卫,等.输卵管造影中双腔球囊导管顶管位置对输卵管显示率的影响[J].临床放射学杂志,2015,34:1163-1165.
[3]周晓陆,秦将均,王秀萍,等.压迫按摩法子宫输卵管造影在输卵管阻塞再通术中的应用[J].临床放射学杂志,2013,32:276-278.
[4]王丽,周伟生,鲁琳.高压注射法子宫输卵管造影对输卵管阻塞性不孕症的诊疗价值[J].临床放射学杂志,2010,29:1394-1396.
[5]相龙彬,宫元芳,董秀莲,等.介入再通术联合药物、臭氧灌注治疗输卵管性不孕症[J].介入放射学杂志,2013,22:924-926.
[2]陈利军,叶振中,何卫,等.输卵管造影中双腔球囊导管顶管位置对输卵管显示率的影响[J].临床放射学杂志,2015,34:1163-1165.
[3]周晓陆,秦将均,王秀萍,等.压迫按摩法子宫输卵管造影在输卵管阻塞再通术中的应用[J].临床放射学杂志,2013,32:276-278.
[4]王丽,周伟生,鲁琳.高压注射法子宫输卵管造影对输卵管阻塞性不孕症的诊疗价值[J].临床放射学杂志,2010,29:1394-1396.
[5]相龙彬,宫元芳,董秀莲,等.介入再通术联合药物、臭氧灌注治疗输卵管性不孕症[J].介入放射学杂志,2013,22:924-926.