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输卵管通畅性检测常用的检查方法 Common Test Method for Salpinx Fracture转载2008-05-05

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1 输卵管通畅性检测常用的检查方法1 Common Test Method for Salpinx Fracture 1.1 输卵管通气术月经干净 3~7天,禁性生活,排空膀胱,双合诊查清子宫位置大小及患侧附件情况。以宫颈钳钳夹宫颈前唇,消毒宫颈管,探针沿宫腔方向探测宫腔深度,插入导管至宫

1 输卵管通畅性检测常用的检查方法1 Common Test Method for Salpinx Fracture

1.1 输卵管通气术月经干净 3~7天,禁性生活,排空膀胱,双合诊查清子宫位置大小及患侧附件情况。以宫颈钳钳夹宫颈前唇,消毒宫颈管,探针沿宫腔方向探测宫腔深度,插入导管至宫颈内口,通过导管向宫腔内注入CO2气体最高压力可200 mmHg(1mmHg=0.133 Kpa)。如提示不通可于下次月经干净后 3~7天再次行输卵管通气术。

1.1 Verbal ventilation is clean for 3 to 7 days, sex is forbidden, bladder is empty, and double diagnosis identifies the uterine position and side attachment. The cervical forceps are used to clamp the anterior lip of the cervix, disinfect the cervix tube, probe the depth of the cavity along the direction of the cavity, insert the catheter into the cervix, and inject the highest pressure of CO2 gas into the cavity through the catheter to 200 mmmHg(1 mmHg = 0.133 Kpa). If the reminder is not clear, you can perform tubal ventilation again 3 to 7 days after the next menstrual cycle.

1.2输卵管通液术 月经干净 3~7天,禁性生活,排空膀胱,输卵管通液术前半小时肌注阿托品0.5mg ,常规消毒外阴、阴道及宫颈 ,插入金属通水器或双腔子宫造影导管,注入生理盐水 20ml,地塞米松5 mg ,α-糜蛋白酶400U,硫酸庆大霉素16万U。1.2 Verbal fluid surgery 3 to 7 days clean, forbidden sex, empty bladder, fallopian fluid preoperative half an hour muscle injection atropine 0.5 MG, routine sterilization vulva, vagina and cervix, insertion of metal permeator or double-cavity uterine angiography catheter, injection of physiological saline 20ml, dexamethasone 5mg, α-chymotrypsin 400U, gentamicin sulfate 160,000 U.

1.3 子宫输卵管造影术(Hysterosaipingography.HSG)  月经干净 3~7天,禁性生活,排空膀胱,输卵管通液术前半小时肌注阿托品0.5mg ,常规消毒外阴、阴道及宫颈 ,插入金属通水器或双腔子宫造影导管,在 X 线荧屏监视下 ,经导管注入40 %碘化油10ml ,即时拍片 ,24h 后再拍腹部平片1 张,或经导管注入76%复方泛影葡胺即时拍片,也可用非离子型造影剂如碘海醇等。

1.3 Hysterosaipipingolphy.HSG has 3 to 7 days of clean menstruation, forbidden sex, emptying of bladder, half an hour before operation of tubal fluid, intramuscular injection of atropine 0.5 MG, routine sterilization of vulva, vagina and cervix, insertion of metal water or double-cavity uterine angiography catheter, Under X-ray screen surveillance, 40 % of iodized oil 10ml was injected through the catheter, immediate filming, 24h was followed by 1 flat film on the abdomen, or 76 % of the compound panthylamine was injected through the catheter. Non-ionic contrast agents such as iododiol and so on.

1.4 B型超声监测下输卵管通液术采用超声彩色多谱勒诊断仪,探头频率35 MHz,双腔子宫导管。B型超声监测下输卵管通液术制剂:生理盐100 ml。3%双氧水10 ml,庆大霉素4万U,地塞米松5mg,α-糜蛋白酶400U。选择月经干净3~5天,膀胱中度充盈,取膀胱截石位,常规消毒外阴、阴道、宫颈,宫腔内放置双腔子宫造影导管。向外腔管内注入空气 4~5 ml,使气囊阻塞宫颈内口,向内腔管先缓慢注入 3%双氧水 2 ml+生理盐水20 ml。在超声实时监测下,观察宫腔内气体充盈情况及微气泡从输卵管伞端溢出情况,再注人生理盐水50~80 ml+庆大霉素 4万 U+地塞米松5 mg,α-糜蛋白酶400 U,仔细观察子宫直肠窝有无液性暗区,术后禁性生活7天。(7)

1.4 Ultrasonic monitoring of the tubal fluid by ultrasound color multispectral diagnostic instrument, probe frequency 35 MHz, double-cavity uterine catheter. Preparation of tubal fluid under B-type ultrasound monitoring: physiological salt 100 ML. 3 % hydrogen peroxide 10 ML, gentamicin 40,000 U, dexamethasone 5 MG, α-chyase 400U. Choose 3 to 5 days clean menstruation, bladder moderately filled, take bladder truncated stone, routine disinfection vulva, vagina, cervix, double cavity uterine angiography catheter placed in the cavity. The air is injected into the outer cavity tube 4 to 5 ML, causing the airbag to block the inner cervix, and the inner cavity tube is slowly injected with 3 % hydrogen peroxide 2 ml + saline 20 ML. Under ultrasound real-time monitoring, the filling of gas in the cavity and the overflow of microbubbles from the fallopian tube end were observed, and then human saline 50 ~ 80 ml + gentamicin 40,000 U + dexamethasone 5 MG, α-trypsin 400 U, Careful observation of the uterine rectum fossa there is no liquid dark area, post-operative forbidden sex for 7 days. (7)

1. 5 宫腔镜下输卵管口插管通液术月经干净 3~7天,禁性生活,待患者膀胱充盈后,取膀胱截石位,常规消毒无菌操作,采用宫颈阻滞麻醉,或静脉麻醉,或药物纳肛麻醉后,探测宫腔,用宫颈扩张器扩张宫颈至7.5号,用 50 g/L葡萄糖液作膨宫递质(宫腔内压力≤25 kPa,膨宫递质流速为 25~50ml/min),按顺序检查宫颈,宫腔前、后、侧壁,宫底宫角及两侧输卵管内口,注意宫腔形态及内膜有无病变。将输卵管插管由操作孔入口处徐徐插入至一侧输卵管间质部,深度平均为 5mm(2~10 mm)先缓慢推注亚甲蓝混合液 (亚甲蓝0.5 ml+2.mg/L甲硝唑 20 ml混合而成),推注过程中测试其阻力大小,然后分次推注 2.0 ml/L 甲硝唑 30~70ml。镜下观察亚甲蓝混合液有无反流,反流量多少,同时进行盆腹部B型超声波检查,观察宫内有无漩涡状液体回声流动光点,输卵管管腔是否膨胀伞端液体溢出的流速和子宫直肠陷凹有无液性暗区出现。1. 5 Under hysteroscopy, tubal mouth intubation is performed for 3 to 7 days, and sexual life is forbidden. After the patient's bladder is filled, the bladder is cut up, routine sterilization and aseptic operation is performed, cervical block anesthesia, or intravenous anesthesia, or drug. After anal anesthesia, detect the uterine cavity, The cervical dilator is used to expand the cervix to 7.5, and 50 g/L glucose fluid is used as an inflatable(intrauterine pressure ≤ 25 kPa, and the inflatable transmitter flow rate is 25 to 50 ml/min). The cervix is examined sequentially., anterior, posterior, lateral wall, At the end of the palace and the inner mouth of the fallopian tubes on both sides, pay attention to the morphology of the cavity and the presence of lesions in the inner membrane. The tubal intubation is inserted slowly from the operating hole entrance to the side of the tubal interstitial part, with a depth of an average of 5mm(2 to 10 mm) and a slow push of the methylene blue mixture(mixed with 0.5 ml and 2. mg/L metronidazole 20 ML).), The resistance size was tested during the push process, and then 2.0 ml/L metronidazole 30 to 70ml was pushed in sequence. Microscopically, observe whether the submethylene blue mixture has reflux and how much reflux, and at the same time perform an abdominal B-type ultrasound examination to observe whether there is a swirling liquid echo flow light point in the palace. Whether the tubal cavity expands the flow rate of liquid overflow at the umbrella end and there is a liquid-free dark area in the uterine rectum depression.

1. 6 经阴道注水腹腔镜(transvaginal hydrolaparoscopy THL)下通液术月经干净 3~7天,禁性生活,术时患者取膀胱截石位,在外阴阴道充分消毒后,用宫颈钳夹持宫颈后唇,充分暴露阴道后穹隆。利多卡因于后穹隆中央局部麻醉后,气腹针穿刺后穹隆中央进入腹腔,约进针1.5 cm。将 100 ml生理盐水 (水温为37℃,可加入浓度为 1%的利多卡因) 注入 Douglas窝。然后套管系统深入穹隆一些,拔除气腹针,将一直径为 2.7 mm带有通液通道的30度视角硬性内镜经套鞘导人 Douglas窝开始探查盆腔。为方便术者观察,内镜的另一端可连接至电视摄像系统。检查从识别子宫后壁开始,随着转动和推进30度的光学视管,可直接检视盆侧壁和直肠子宫陷凹、输卵管--卵巢的结构,观察卵巢的每个面和每段输卵管,自宫腔双腔导管注入稀释美蓝液作输卵管染色通液检查,当子宫后壁、输卵管、卵巢、盆侧壁、直肠子宫陷凹、子宫骶骨韧带等盆腔所有器官都见到时,THL即告完成。如有EMs、盆腔粘连、染色通液检查提示输卵管阻塞为THL异常,可建议进行其它诊断或考虑适当治疗。术毕从套管排出注入盆腔的液体,取出套管。术后有少量阴道分泌物和出血,需禁性生活7d。(23)1. 6 After transvaginal water injection laparoscopy(transvaginal hydrolaparoscopy THL), the menstrual cycle is clean for 3 to 7 days and the sexual life is forbidden. During the operation, the patient takes a bladder truncated stone position. After the vulva vagina is fully sterilized, the cervical clamp is used to hold the posterior lip of the cervix and fully expose the vaginal posterior dome. After lidocaine is partially anaesthetized in the center of the posterior dome, the abdominal needle enters the abdominal cavity after puncture, about 1.5 cm into the needle. 100 ml saline solution(37 °C water temperature, 1 % lidocaine can be added) into Douglas nest. The casing system then goes deeper into the dome, removes the air-abdominal needle, and a 30-degree viewing angle with a diameter of 2.7 mm with a liquid passage guides Douglas nest through the sheath to begin exploring the pelvic cavity. In order to facilitate the observation of the surgeon, the other end of the endoscope can be connected to the television camera system. The examination begins with the identification of the posterior wall of the uterus. As the optical tube rotates and pushes forward at 30 degrees, it can directly examine the structure of the basin side wall and the rectum uterine depression, the fallopian salpine-ovary, and observe each surface of the ovary and each tubal. From the double-cavity catheter of the uterine cavity, the diluted blue liquid was injected for the examination of the tubal staining liquid. When all pelvic organs such as the posterior uterus, the fallopian tube, the ovary, the basin side wall, the rectum uterine depression, and the uterine sacral ligament were seen, THL It is completed. If EMs, pelvic adhesion, staining liquid examination indicates that the tubal obstruction is THL abnormal, other diagnosis or appropriate treatment may be recommended. After the operation, discharge the liquid from the sleeve into the pelvic cavity and remove the sleeve. There is a small amount of vaginal secretions and bleeding after surgery, and sexual life needs to be banned 7D. (23)

1.7联合应用宫腔镜腹腔镜子宫输卵管通液术术前相关检查正常 , 月经干净后 3~7d 在连续硬膜外麻醉下行腹腔镜检术。使用电视腹腔镜检查子宫、卵巢、输卵管及盆腔情况。再依靠宫腔镜观察子宫腔内形态 ,内膜厚度 ,将亚甲蓝稀释 ,宫腔镜下插管 ,行双侧输卵管通液 , 镜下可将导管插入输卵管间质部约 0.5~0.8c m,对宫角和间质部近段梗阻起到机械性疏通作用。

1.7 The combined use of hysteroscopic laparoscopic hysterectomy was performed with normal preoperative associated examination. After menstrual cleansing, 3-7d laparoscopic examination was performed under continuous epidural anesthesia. Use television laparoscopic examination of uterus, ovary, fallopian tube and pelvic cavity. Then rely on hysteroscopy to observe the endometrial morphology, the thickness of the endometrium, the submethylene blue dilution, the hysteroscopic intubation, the bilateral tubal fluid, and the catheter can be inserted into the tubal interstitial department about 0.5 to 0.8 C M. The mechanical dredging effect on the proximal obstruction of the uterine angle and interstitial part.

2 输卵管通畅性检测常用的检查方法的诊断标准2 Diagnostic criteria for commonly used test methods for oviduct patency testing

2. 1 输卵管通气术的诊断标准:输卵管正常情况下,用听诊器在患者下腹两侧进行听诊,可听到气泡音,说明输卵管通畅;反之下腹部听不到气泡音,说明输卵管阻塞。休息片刻重复试验,若能听到气泡音,说明输卵管原有轻度粘连或阻塞已经被分离或痉挛缓解而通畅。2. 1 Diagnostic criteria for tubal ventilation: Under normal tubal conditions, stethoscope is used to perform stethoscope on both sides of the patient's lower abdomen. Vapor sounds can be heard, indicating that the fallopian tubes are open; On the contrary, the lower abdomen can not hear the bubble sound, indicating that the fallopian tube is blocked. Repeat the test during the break. If you can hear the bubble sound, it means that the original slight adhesion or obstruction of the fallopian tube has been relieved by separation or spasm.

2. 2 输卵管通液术的诊断标准:若注入宫腔无阻力 ,患者无不适感 ,诊断输卵管通畅;若注入时有阻力 ,需经加压注射 ,并有少量外漏 ,诊断输卵管通而不畅;若阻力大 ,边推边漏 ,病人腹痛难忍 ,诊断为输卵管不通。

2. 2 Diagnostic criteria of tubal fluid surgery: If there is no resistance to the injection of uterine cavity, the patient has no discomfort, and the diagnosis of fallopian tubes is open; If there is resistance during injection, it must be injected under pressure and there is a small amount of leakage. The diagnosis of fallopian tubes is not smooth; If the resistance is large, the side push side leakage, the patient abdominal pain is unbearable, the diagnosis is tubal impassability.

2. 3 子宫输卵管造影术的诊断标准:HSG正常表现,输卵管呈水平走行或稍向下行至壶腹部时又稍向上行或在子宫体部两侧弯曲绕行 ,从内到外由细到粗 ,自然柔软。造影剂经输卵管伞部流出后经卵巢窝而下 ,进入子宫直肠凹呈横行条纹影 ,侧位片上 ,涂布于子宫直肠凹的后方、膀胱子宫凹的前方 ,两侧卵巢窝呈对称性圈形负影 ,造影剂在正常情况下极易流至卵巢附近 ,呈波浪状或弧线形阴影称“腹膜涂抹” ,其阴影较淡而边界逐渐移行。输卵管周围粘连的 X 线线索: ①块状、结节状阴影:造影剂涂布与正常片状弥散不同 ,表现为高密度 ,明显高于周围丝条状的涂布影像 ,边缘清晰锐利 ,与正常弥散时边界逐渐移行不同 ,位置较固定 ,立卧位变化相对较小。腹腔镜下为较大范围、多处粘连 ,与X线征象相一致。②串珠状、滴状阴影,呈簇状分布或分散排列 ,边缘清晰锐利 ,密度高而均匀似油珠样 ,腹腔镜下为多数细小粘连伴有少量盆腔积液。③输卵管积水及伞端闭锁:由于伞部及周围有粘连存在 ,造影剂不能流至卵巢窝 ,呈团块状堆积于伞部或输卵管内扩张、积液形成典型串珠状输卵管积水征象。④输卵管向上走行 ,伞端上举而固定,除伞端上举、位置固定外 ,常合并有造影剂块状聚集或输卵管内造影剂 24h 后残留、延长复查时间造影剂涂布位置形态固定等改变。

2. 3 Diagnostic criteria for uterine tubal angiography: HSG normal performance, fallopian tubes are horizontal or slightly down to the belly of the pot and slightly up or curved around on both sides of the uterus, from inside to outside fine to thick, natural soft. After the contrast agent flows through the fallopian tube umbrella, it passes through the ovary socket and enters the uterus rectum to show a horizontal Stripe shadow. On the lateral slice, it is coated in the rear of the uterus rectum concave, in front of the bladder uterus concave, and on both sides of the ovary socket. Symmetric circle negative shadow, The contrast agent is easy to flow to the vicinity of the ovary under normal conditions. The wavy or arc-shaped shadow is called "peritoneal smear". The shadow is lighter and the boundary gradually moves. X-ray clues around the fallopian tubes: 1 block, nodular shadow: the contrast agent coating is different from the normal sheet dispersion, showing a high density, obviously higher than the surrounding filamentous coating image, the edges are clear and sharp, and the normal dispersion The boundary gradually moves different, The position is relatively fixed and the vertical position changes relatively little. Under the laparoscopy, there are a large range of multiple adhesions, which are consistent with the X-ray signs. 2 beaded, droplet shadows, clustered or scattered, sharp edges, high density and uniform like oil beads, laparoscopic most of the small adhesion with a small amount of pelvic effusion. 3 fallopian tube water and umbrella end locking: due to the presence of adhesion around the umbrella, contrast agent can not flow to the ovary Nest, mass accumulation in the umbrella or expansion of the fallopian tube, accumulation of liquid form a typical beaded tubal water sign. 4 4 The fallopian tubes go up, and the umbrella ends are raised and fixed. In addition to the umbrella ends, the position is fixed, and there are often changes such as the massive aggregation of contrast agents or the residue of the intratubal contrast agent after 24h, and the position of the extended review time contrast agent coating.

2. 4 B型超声监测下输卵管通液术的诊断标准:输卵管通畅推注无阻力颈口无溢液,患者无自觉症状、推注后宫腔内迅速呈现一条强回声带,纵切面显像宫腔分离≤ 0.7 cm.推注中见液体及微气泡沿两侧输卵管外溢,子宫直肠窝见积液。输卵管阻塞:推注阻力大停推注时药液返流,宫腔分离< 1.1 cm,液体及微气泡在宫腔内闪烁,加压颈口有溢液,注射侧下腹胀痛明显。近端梗阻可见子宫角回声增强或牛角型低回声像,输卵管远端梗阻,可见输卵管扩张.子宫周围无暗区形成。输卵管通而不畅:反复稍加压可缓慢推进,患者感注射侧腹酸胀明显。B超可见小光点缓慢移动,有时可见输卵管扩张,无回声暗区片刻消失。子宫周围及子宫直肠窝有少量液性暗区。

2. 4 B ultrasound monitoring of the diagnostic criteria of tubal fluid surgery: the tubal smooth injection of no resistance neck spillage, patients without conscious symptoms, after the injection of a rapid display of a strong echo zone in the uterine cavity, The longitudinal section image is separated by the cavity ≤ 0.7 cm. In the push, the liquid and the microbubble spillage along the two sides of the fallopian tube, and the rectum of the uterus sees the effusion. Tubal obstruction: Injection resistance large stop push when the liquid regurgitation, uterine separation & lt; 1.1 cm, liquid and microbubbles flicker in the palace cavity, overflow in the pressurized neck, and pain in the lower abdomen of the injection side. Near-end obstruction can be seen to increase the horn echo or horn type low echo sound, fallopian tube distal obstruction, can be seen fallopian tube expansion. There is no dark area around the uterus. The fallopian tube is not smooth: repeated slightly pressurized can be slowly advanced, the patient feels the lateral abdominal acid distension obviously. B super visible small light point slowly moving, sometimes visible tubal expansion, no echo dark area disappeared for a moment. There is a small amount of liquid dark area around the uterus and the uterine rectum.

2. 5宫腔镜下输卵管口插管通液术的诊断标准:输卵管通畅:镜下见输卵管导管内亚甲蓝混合液及药液被推注进输卵管,且宫腔内无反流,助手推注药液时阻力小,盆腔B型超声见液体流向输卵管远端并经伞端快速流出,宫旁及子宫直肠窝内液体骤然增多;输卵管通而欠畅:镜下见输卵管导管内亚甲蓝混合液及药液被推注进输卵管过程中,少许反流至宫腔,助手推注药液时感到阻力,盆腔B 型超声波见输卵管内有液体缓慢积聚,但渐向伞端流动,直到流失,宫旁及子宫直肠窝内液体缓慢显示,或在同侧卵巢窝处有积液;输卵管阻塞:镜下见输卵管导管内亚甲蓝混合液及药液不易被推注进输卵管,或宫腔内返流明显,助手推注药液时感到阻力大,若加压推注,可见官腔内反流液体逆流至加压注水塑料管中,盆腔B型超声波见漩涡状液体回声流动光点,宫腔明显扩张,输卵管及伞部增粗、积液或不显示,宫旁及子宫直肠窝无积液出现。

2. 5 Diagnostic criteria for hysteroscopic tubal opening intubation: fallopian tube patency: under the mirror, the submethylene blue mixture in the tubal catheter and the liquid were pushed into the fallopian tube, and there was no reflux in the uterine cavity, and the resistance of the assistant was small., The pelvic B-type ultrasound saw that the liquid flowed to the distal end of the fallopian tube and quickly flowed out through the umbrella end, and the liquid in the uterine and uterine rectum suddenly increased; The fallopian tubes pass through and fail: under the mirror, the submethylene blue mixture in the fallopian tube tube and the drug fluid are pushed into the fallopian tube. A little reflux flows back to the uterine cavity. The assistant feels resistance when pushing the drug fluid. The pelvic B-type ultrasound sees the fallopian tube. The liquid slowly accumulates, However, it gradually flows toward the umbrella end until it is lost, and the liquid in the uterine and uterine rectum slowly shows, or there is fluid at the same side ovarian nest; Tubal obstruction: Under the mirror, the submethylene blue mixture in the fallopian tube and the drug solution are not easily pushed into the fallopian tube, or the cavity reflux is obvious. The assistant feels great resistance when pushing the drug solution. If the pressure is pushed, it can be seen that the inside of the cavity reflux liquid to pressurized water injection plastic tube, The pelvic type B ultrasonic wave sees a swirling liquid echo flow point, the uterine cavity is obviously expanded, the fallopian tubes and umbrellas are thickened, accumulated fluid or not displayed, and there is no accumulation fluid near the palace and the uterine rectal fossa.

2. 6 经阴道注水腹腔镜下通液术、联合应用宫腔镜腹腔镜子宫输卵管通液术镜检时输卵管通畅度的诊断标准 ①输卵管通畅:在推注液体约 10ml 后继续推注时 ,双侧输卵管内见蓝色液体畅流无阻 ,并很快从伞端流出; ②通而欠畅:推注液体稍有阻力 ,略加压后 ,即见液体从伞端流出 ,输卵管轻度扭曲; ③远端阻塞:推注时见蓝色液体流经输卵管直达远端 ,积液于输卵管远端 ,不断注入液体 ,见伞端形成逐渐扩大的蓝色囊性积液 ,盆腔内无蓝色液体; ④近端阻塞:推注时阻力大 ,有反流 ,镜下见子宫张力高而色泽变浅 ,尤其在双侧宫角隆起呈元宝状 ,输卵管内无蓝色液体。

2. 6 Diagnostic criteria for the fluidity of the fallopian tube during laparoscopic catheterization and combined hysteroscopic laparoscopic hysterectomy. 1 The fallopian tube is open: blue liquid flows unimpeded in the bilateral fallopian tubes when the liquid is pushed after approximately 10 ML is pushed. And soon flow out from the umbrella end; 2 pass and not smooth: push the liquid slightly resistance, slightly pressurized, that is, the liquid out of the umbrella end, fallopian tube slightly twisted; 3 Remote obstruction: When pushing, see the blue liquid flowing through the fallopian tube to the far end, the accumulation of liquid in the far end of the fallopian tube, continuous injection of liquid, see the umbrella end to form a gradually expanding blue cystic effusion, no blue liquid in the pelvic cavity; 4 The proximal obstruction: When pushing, the resistance is large, there is reflux, and under the mirror, the uterine tension is high and the color becomes lighter. In particular, the bilateral angle of the palace is in the shape of a treasure, and there is no blue liquid in the fallopian tube.

3 输卵管通畅性检测常用的检查方法的价值3 The value of commonly used test method for oviduct patency

3.1输卵管通气术是了解输卵管通畅性的初筛手段,具有操作简单 ,经济 ,病人痛苦轻等优点。当输卵管轻度粘连时,输卵管通气术运用较高的压力 (200 mmHg)时,输卵管进行扩张,使轻度的粘连剥离,塞输卵管的粘液可以被排出使扭转的输卵管被整理复位,输卵管通畅,但准确度较差,特异度和敏感度都不好。输卵管通气术在临床上已很少应用。3.1 Tubal ventilation is an initial screening method to understand the fluidity of the fallopian tubes. It has the advantages of simple operation, economy, and light pain of the patient. When the fallopian tubes are slightly bonded, when the fallopian tube is ventilated using a higher pressure(200 mmHg), the fallopian tubes are expanded so that the slight adhesion is stripped, and the mucus of the stopper fallopian tube can be discharged so that the twisted fallopian tube is rearranged and reset. The fallopian tube is unobstructed, but the accuracy is poor. It's not specific or sensitive. Tubal aeration has rarely been used in clinical practice.

3. 2输卵管通液术也是输卵管通畅性的初筛手段,具有操作简单 ,经济安全 ,病人痛苦轻等优点。同时具有一定的治疗作用,但准确度较差,特异度和敏感度都不好,输卵管积水可造成通液通畅的假象 ,而输卵管痉挛可致通液不通的假象。因此术前肌注阿托品 ,通液用生理盐水冬天时需要加温以缓解或防止输卵管及子宫平滑肌收缩痉挛 ,影响通液效果。由于输卵管通液术准确性明显低于造影术 ,目前更多地用作治疗、疏通输卵管。

3. The tubal fluid technique is also a means of screening the fallopian tubes. It has the advantages of simple operation, economic safety, and light pain of the patient. At the same time, it has a certain therapeutic effect, but its accuracy is poor, its specificity and sensitivity are not good, and tubal water can cause an illusion of fluid flow, while tubal spasm can cause an illusion of fluid flow. Therefore preoperative muscle injection atropine, liquid with saline needs to be heated in winter to relieve or prevent tubal and uterine smooth muscle contraction spasm, affecting the liquid effect. Because the accuracy of tubal fluid surgery is significantly lower than that of angiography, it is now used more for treatment and dredge fallopian tubes.

3.3子宫输卵管造影术现在是输卵管通畅性检测的常规检查方法,子宫输卵管造影术是一种无创性检查 ,不但可以了解输卵管通畅性 ,还可观察宫腔及输卵管内腔的病变。但不能发现盆腔的病变及输卵管周围粘连情况。国内多数生殖医学中心已将造影列为常规检查项目。Snowden提出不孕症病人先行造影检查 ,如造影有异常或造影正常半年不孕者再行腹腔镜检查。现采用宫颈扩张棒行造影术 ,碘油外流至阴道减少 ,判断结果更准确。放射线辐射可引起DNA损伤,染色体畸变,基因突变等危险,人们对子宫输卵管造影检查时患者受到的辐射非常关切。有文献报道如果单纯子宫输卵管造影,放射线辐射量将更微小,说明这项检查对育龄妇女是在安全范围内。但仍值的考虑。35

3.3 Uterine tubal angiography is now a routine method for the detection of oviduct patency. Uterine oviduct angiography is a non-invasive test that not only understands the patency of the oviduct, but also observes the lesions in the uterine and oviduct cavities. However, the pelvic lesions and adhesion around the fallopian tubes can not be found. Most of the country's reproductive medical centers have included mammography as a routine inspection program. Snowden proposed that infertility patients should be examined first, such as abnormal imaging or normal imaging infertility for half a year. Now using cervical dilatation stick radiography, iodine oil outflow to vagina decrease, the judgment result is more accurate. Radiation radiation can cause DNA damage, chromosomal aberrations, genetic mutations, and other risks. People are very concerned about the radiation received by patients during uterine fallopian tube angiography. It has been reported that if a simple hysterectomy is performed, the amount of radiation will be smaller, indicating that this examination is within a safe range for women of childbearing age. But still worth considering. 35

3. 4 B型超声监测下输卵管通液术有直视观察指标,在 B超下可以清晰地显示药液自子宫→两侧输卵管→腹腔移动情况,从而对两侧输卵管情况作出准确评价,克服了传统输卵管通液术凭借手感或压力不能对双侧输卵管通畅或阻塞情况作准确评价的缺陷,还可减少以往盲目通液而造成输卵管积水破裂的并发症。过氧化氢是一种强氧化剂,对细菌有杀灭作用,因在B超下进行,故可及时发现某些与不孕有关的妇科疾病,以便及时指导治疗。但B超显像不清晰,不能判断输卵管形态和盆腔粘连情况,是其缺点。

3. 4 B-type ultrasound monitoring of tubal fluid surgery has direct observation indicators, under B ultrasound can clearly show the liquid from the uterus → both sides of the fallopian tube → abdominal cavity movement, so as to make an accurate evaluation of the two sides of the fallopian tube situation. It overcomes the defect that traditional tubal fluid technique can not accurately evaluate bilateral tubal patency or blockage by hand feeling or pressure, and can also reduce the complications of tubal water rupture caused by blind fluid flow in the past. Hydrogen peroxide is a strong oxidant and has an killing effect on bacteria. Since it is carried out under B ultrasound, certain gynecological diseases related to infertility can be found in a timely manner in order to guide treatment in a timely manner. However, B Super imaging is not clear, can not judge the tubal shape and pelvic adhesion situation, is its shortcomings.

3. 5 宫腔镜下输卵管口插管通液术对近端输卵管梗阻的诊断和疏通及通而不畅的治疗效果较好。输卵管近端梗阻患者无组织学改变,梗阻可能是功能性的或由子宫角粘连或息肉所致,宫腔镜可进行诊断和进一步治疗。在宫腔镜直视下,将导管插入宫角部输卵管开口处,减少了普通通液的盲目性,起到机械性疏通作用,再加上直接加压于输卵管内部对粘连起到分解作用,并辅以药物治疗,可达到较理想的治疗目的。同时对不孕患者进行宫腔镜检查,可以发现宫腔息肉、宫腔粘连、粘膜下肌瘤、子宫畸形、胎骨残留、胎盘组织机化等病变,有时尚找到导致输卵管阻塞的原因,例如宫角或输卵管间质部近段内息肉、粘连疤痕等,在检查的同时可以适当给予处理,达到治疗目的。20)但是他对输卵管远端病变,及盆腔粘连不能做出很好的诊断,如输卵管积水可造成通液通畅的假象。

3. The diagnosis and dredging of proximal tubal obstruction by hysteroscopic tubal opening intubation was better than that of the treatment. There is no histological change in the near end of the fallopian tube obstruction. The obstruction may be functional or caused by cervix adhesion or polyp. The hysteroscopy can be diagnosed and further treated. Under hysteroscopy, the catheter is inserted into the opening of the fallopian tube at the corner of the uterus, which reduces the blindness of the ordinary liquid and plays a mechanical dredging role. In addition, direct pressure on the inside of the fallopian tube decomposes adhesion, and is supplemented by drug treatment. Can achieve more ideal treatment purposes. At the same time, hysteroscopic examination of infertile patients can find lesions such as uterine polyp, uterine adhesion, submucosal myoma, uterine deformity, fetal bone residue, and placenta tissue mechanization. There is fashion to find the cause of tubal obstruction. For example, intrauterine or tubal interstitial polyps, adhesion scars, etc., can be properly treated at the same time as the examination, to achieve the purpose of treatment. 20) However, he can not make a good diagnosis of the distal tubal lesions and pelvic adhesion. For example, tubal water can cause an illusion of fluid flow.

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