Johnson N, Vandekerckhove P, Watson A, Lilford R, Harada T, Hughes E
Obstetrics & Gynaecology Department, National Women's Hospital, Claude Road, Epsom, Auckland, New Zealand.
Cochrane Database Syst Rev. 2002(3):CD003718. doi: 10.1002/14651858.CD003718.
A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. Historically a variety of agents have been used to 'flush' the fallopian tubes, although tubal flushing does not currently form part of routine practice in the treatment of fertility delay.
To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent pregnancy outcomes in couples with infertility.
The search strategy of the Menstrual Disorders and Subfertility Group and a recent search of electronic databases completed in December 2001 was used for the identification of relevant randomised controlled trials.
All randomised trials where tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media was compared with one another or with no treatment were considered for inclusion in the review.
Eight randomised controlled trials were identified and included in this review. A further one randomised controlled trial is ongoing. All trials were assessed for quality criteria. The studied outcomes were pregnancy, live birth (and ongoing pregnancy), miscarriage, ectopic pregnancy, treatment complications including pain, intravasation of contrast medium, infection and haemorrhage, and image quality.
Tubal flushing with oil-soluble media versus no intervention was associated with a significant increase in the odds of pregnancy (OR 3.57, 95%CI 1.76-7.23). There were no data from RCTs to assess tubal flushing with water-soluble media versus no intervention. Tubal flushing with oil-soluble media was associated with a significant increase in the odds of live birth versus tubal flushing with water-soluble media (OR 1.49, 95%CI 1.05-2.11) but the odds of pregnancy showed no significant difference (OR 1.23, 95%CI 0.95-1.60) and there was evidence of statistical heterogeneity for these two outcomes. The addition of oil-soluble media to flushing with water-soluble media (water-soluble plus oil-soluble media versus water-soluble media alone) showed no significant difference in the odds of pregnancy (OR 1.16, 95%CI 0.78-1.70) or live birth (OR 1.06, 95%CI 0.64-1.77).
REVIEWER'S CONCLUSIONS: There is some evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy versus no intervention. The limited evidence of an increase in the odds of live birth from tubal flushing with oil-soluble contrast media versus water-soluble contrast media must be interpreted cautiously. Further robust randomised trials, comparing oil-soluble versus water-soluble media and comparing each versus no intervention, are required to provide convincing evidence as to whether the technique should be accepted into widespread clinical practice.
半个世纪以来，诊断性输卵管通畅性检测可能具有的治疗效果一直是文献中争论的焦点。关于油溶性或水溶性造影剂是否可能具有更大的提高生育能力的效果，也存在进一步的争论。从历史上看，曾使用过多种药物来“冲洗”输卵管，尽管目前输卵管冲洗并不属于治疗生育延迟的常规做法。
评估用油溶性或水溶性造影剂冲洗女性输卵管对不育夫妇后续妊娠结局的影响。
使用月经紊乱与亚生育组的检索策略以及2001年12月完成的近期电子数据库检索，以识别相关的随机对照试验。
所有将用油溶性造影剂进行输卵管冲洗或用水溶性造影剂进行输卵管冲洗相互比较，或与不治疗进行比较的随机试验均被考虑纳入本综述。
确定了八项随机对照试验并纳入本综述。另有一项随机对照试验正在进行中。所有试验均根据质量标准进行评估。所研究的结局包括妊娠、活产（及持续妊娠）、流产、异位妊娠、治疗并发症（包括疼痛、造影剂血管内渗漏、感染和出血）以及图像质量。
与不干预相比，用油溶性介质进行输卵管冲洗与妊娠几率显著增加相关（比值比3.57，95%可信区间1.76 - 7.23）。没有随机对照试验的数据来评估用水溶性介质进行输卵管冲洗与不干预的情况。与用水溶性介质进行输卵管冲洗相比，用油溶性介质进行输卵管冲洗与活产几率显著增加相关（比值比1.49，95%可信区间1.05 - 2.11），但妊娠几率无显著差异（比值比1.23，95%可信区间0.95 - 1.60），并且这两个结局存在统计学异质性的证据。在用水溶性介质冲洗的基础上加用油溶性介质（水溶性加脂溶性介质与仅用水溶性介质相比）在妊娠几率（比值比1.16，95%可信区间0.78 - 1.70）或活产几率（比值比1.06，95%可信区间0.64 - 1.77）方面无显著差异。
有一些证据表明，与不干预相比，用油溶性造影剂进行输卵管冲洗在增加妊娠几率方面是有效的。关于用油溶性造影剂进行输卵管冲洗与用水溶性造影剂相比活产几率增加的有限证据必须谨慎解读。需要进一步开展有力的随机试验，比较油溶性与水溶性介质，并将每种介质与不干预进行比较，以提供关于该技术是否应被广泛应用于临床实践的令人信服的证据。
