Hurd William W, Wyckoff Erich T, Reynolds David B, Amesse Lawrence S, Gruber Jack S, Horowitz Gary M
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio 45409-2793, USA.
Obstet Gynecol. 2003 Jun;101(6):1275-8. doi: 10.1016/s0029-7844(03)00361-2.
Unilateral obstruction of the proximal fallopian tube is identified in 10-24% of patients undergoing hysterosalpingography for evaluation of infertility. Upon further testing, this obstruction spontaneously resolves 16-80% of the time. We hypothesized that patient rotation during hysterosalpingography might resolve proximal tubal obstruction in some cases by altering either the location of intrauterine air bubbles or the spatial relationship of the tube to the uterine fundus.
In patients in whom unilateral proximal tubal obstruction was detected during hysterosalpingography performed for standard clinical indications, the patient was rotated on her hip approximately 45 degrees such that the obstructed tube was first superior (ventral) to the patent tube, and dye was reinjected. If obstruction did not resolve, the patient was rotated in the opposite direction so that the obstructed tube was inferior (dorsal) to the patent tube and dye reinjected.
Unilateral tubal obstruction was found in 15% of cases (24 of 156). Rotating the patient with obstructed tube superior to the patent tube never resulted in tubal patency, whereas rotating the patient with the obstructed tube inferior resulted in resolution of tubal patency in 63% of cases (15 of 24)
. Unilateral cornual obstruction during hysterosalpingography is often resolved by rotating the patient such that the obstructed tube is more inferior. Although this observation may be the result of dislodging smaller air bubbles, from a fluid dynamics perspective a more likely explanation is unkinking of the more inferior tube.
在因不孕症接受子宫输卵管造影检查的患者中，10%-24%被发现存在近端输卵管单侧阻塞。进一步检查发现，这种阻塞在16%-80%的情况下会自行缓解。我们推测，子宫输卵管造影检查期间患者体位旋转可能会通过改变宫腔内气泡位置或输卵管与子宫底的空间关系，在某些情况下解除近端输卵管阻塞。
对于因标准临床指征进行子宫输卵管造影检查时检测到单侧近端输卵管阻塞的患者，让患者臀部旋转约45度，使阻塞侧输卵管最初位于通畅侧输卵管上方（腹侧），然后再次注入造影剂。如果阻塞未解除，将患者向相反方向旋转，使阻塞侧输卵管位于通畅侧输卵管下方（背侧），并再次注入造影剂。
15%的病例（156例中的24例）发现单侧输卵管阻塞。将阻塞侧输卵管置于通畅侧输卵管上方旋转患者，从未使输卵管通畅；而将阻塞侧输卵管置于下方旋转患者，63%的病例（24例中的15例）输卵管恢复通畅。
子宫输卵管造影检查期间的单侧宫角阻塞通常通过旋转患者使阻塞侧输卵管更靠下得以解除。尽管这一观察结果可能是较小气泡移位的结果，但从流体动力学角度来看，更可能的解释是位置更靠下的输卵管解扭。
