Letterie G S, Luetkehans T
Reproductive Endocrinology Service, Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii.
J Gynecol Surg. 1992 Spring;8(1):11-3. doi: 10.1089/gyn.1992.8.11.
Surgical therapy for coexistent proximal and distal obstruction has consisted of combined proximal (reimplantation of reanastomosis) and distal (salpingostomy) repairs. Data suggest that successful relief of proximal obstruction by fluoroscopically guided tubal canalization (FTC) may be achieved in 60% to 95% of cases. We studied the use of FTC as a preoperative adjunct in 14 patients with coexistent proximal tubal obstruction (PTO) and distal tubal obstruction, progressing to surgical repair of distal disease if proximal patency was achieved. Unilateral (9/14) or bilateral (5/14) PTO was demonstrated on at least one hysterosalpingogram (HSG) and during chromotubation performed as part of the diagnostic laparoscopy. FTC was successful in four patients (28%). HSG revealed proximal reocclusion in two patients. Two patients had persistent proximal patency and underwent distal salpingostomies and adhesiolysis for mild hydrosalpinges and pelvic adhesive disease. No pregnancies have been achieved after 12 and 18 months follow-up. The lower patency rate and higher recurrence rates of PTO when compared to data of prior studies suggest that in vitro fertilization, though more costly, ultimately may represent the most expedient and effective method of management of coexistent proximal and distal tubal disease.
对于同时存在近端和远端梗阻的情况，手术治疗包括近端（重新植入或重新吻合）和远端（输卵管造口术）联合修复。数据表明，在60%至95%的病例中，通过荧光镜引导下输卵管疏通术（FTC）可成功缓解近端梗阻。我们研究了FTC作为术前辅助手段在14例同时存在近端输卵管梗阻（PTO）和远端输卵管梗阻患者中的应用，若近端通畅，则对远端疾病进行手术修复。在至少一次子宫输卵管造影（HSG）以及作为诊断性腹腔镜检查一部分进行的输卵管通液术中，证实了单侧（9/14）或双侧（5/14）PTO。FTC在4例患者中成功（28%）。HSG显示2例患者近端再次梗阻。2例患者近端持续通畅，因轻度输卵管积水和盆腔粘连性疾病接受了远端输卵管造口术和粘连松解术。随访12个月和18个月后均未实现妊娠。与先前研究数据相比，PTO的通畅率较低且复发率较高，这表明体外受精虽然成本更高，但最终可能是治疗同时存在近端和远端输卵管疾病最便捷有效的方法。
