Aboulghar M A, Mansour R T, Serour G I
The Egyptian IVF-ET Center, Maadi, Cairo.
Hum Reprod Update. 1998 Nov-Dec;4(6):882-90. doi: 10.1093/humupd/4.6.882.
The management of hydrosalpinx is a difficult clinical problem. Surgical treatment includes fimbrioplasty for patients with fimbrial obstruction and salpingostomy to fashion a stoma in the distal Fallopian tube in patients with a damaged fimbrial end. Surgery is only suitable for a small thin-walled hydrosalpinx with healthy mucosa. These operations can be performed via laparoscopy or open microsurgery. The proper selection of patients for surgical treatment and of the type of surgical technique are essential to achieve good results. The results of open microsurgery and laparoscopic surgery are summarized. In general, the prognosis of surgery is poor; however, in well selected cases, good results can be achieved by an experienced surgeon. In-vitro fertilization (IVF) is the main line of treatment for infertility caused by hydrosalpinx. In 1991, our group was the first to report on fluid accumulation in the uterine cavity before embryo transfer as a possible hindrance for implantation. Later, several publications reported an association between patients with hydrosalpinx and a reduced pregnancy rate when treated by IVF. The cause of a low pregnancy rate could be due to mechanical, chemical or toxic effects of the tubal fluid on the endometrium preventing implantation. All these mechanisms are reviewed in detail. The literature is controversial concerning the effect of transvaginal aspiration of hydrosalpinx on the outcome of IVF. Several reports suggest that surgical correction of the hydrosalpinx may improve the outcome of IVF. Further studies are required to verify this assumption and to find out the most suitable surgical procedure and if there is a subgroup of patients who could benefit most from salpingectomy.
输卵管积水的治疗是一个棘手的临床问题。手术治疗包括对输卵管伞端梗阻患者进行输卵管伞成形术，以及对输卵管伞端受损患者在输卵管远端造口进行输卵管造口术。手术仅适用于黏膜健康的小薄壁输卵管积水。这些手术可通过腹腔镜或开放式显微手术进行。正确选择手术治疗的患者和手术技术类型对于取得良好效果至关重要。总结了开放式显微手术和腹腔镜手术的结果。一般来说，手术预后较差；然而，在精心挑选的病例中，经验丰富的外科医生可以取得良好效果。体外受精（IVF）是输卵管积水所致不孕症的主要治疗方法。1991年，我们团队首次报告胚胎移植前子宫腔内积液可能是着床的障碍。后来，几篇出版物报道了输卵管积水患者在接受IVF治疗时妊娠率降低之间的关联。妊娠率低的原因可能是输卵管液对子宫内膜的机械、化学或毒性作用阻止了着床。所有这些机制都进行了详细综述。关于经阴道抽吸输卵管积水对IVF结局的影响，文献存在争议。一些报告表明，手术矫正输卵管积水可能改善IVF结局。需要进一步研究来验证这一假设，并找出最合适的手术方法，以及是否存在能从输卵管切除术获益最大的患者亚组。
