输卵管再通术在输卵管近端阻塞中的应用

摘要

The proximal tubal obstruction (PTO) remains an important cause of tubal infertility, including the plug of mucus and amorphous material, spasm of uterine oviduct, salpingitis isthmica nodosa, pelvic inflammatory disease and anatomic fibrosis occlusion by endometriosis. PTO can be successfully cannulated by the fallopian tube recanalization (FTR) with mechanical principle. The methods of FTR include selective salpingography and tubal catheterization (SSTC), hysteroscopic tubal catheterization, laparoscopy guided hysteroscopic tubal catheterization and falloposcopic tubal catheterization. Operator can select different surgical method according to his (her) qualification. The standard FTR should be the ternary conjunction of hysteroscopy, laparoscopy and falloposcopy. However, this ternary conjunction cannot be widely used in clinical practice due to the limitation of falloposcopy. The rate of natural pregnancy after FTR is equal to that of in vitro fertilization (IVF). FTR and IVF can be used as mutual complementary methods in the therapy of PTO.%输卵管近端阻塞（PTO）是输卵管性不孕的重要组成部分。形成PTO的原因包括黏液栓和其他不定形物质，子宫输卵管口痉挛，结节性输卵管峡炎，盆腔炎性疾病或子宫内膜异位症产生纤维化导致的解剖学阻塞。输卵管再通术（FTR）利用机械性原理将堵塞的近端输卵管打通。FTR的方法有选择性输卵管造影和输卵管再通术，宫腔镜下输卵管插管通液、导丝介入术，宫腹腔镜联合下输卵管插管通液、导丝介入术，输卵管镜下输卵管插管通液、导丝介入术。术者可根据对各种技术的熟练程度选择不同的手术方式。宫腔镜、腹腔镜、输卵管镜三镜联合的手术方式可作为FTR的标准术式，但输卵管镜的局限性限制了“三镜联合”在临床中的应用。FTR术后的自然妊娠率与体外受精（IVF）的妊娠率相似，两者在治疗PTO时互为补充，相得益彰。