Gomel V, Yarali H
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Curr Opin Obstet Gynecol. 1992 Jun;4(3):390-9.
Tubal and peritoneal factors continue to be a leading cause of infertility. In vitro fertilization, operative laparoscopy, and microsurgery are alternatives, but they are frequently complimentary therapeutic approaches. Proper investigation is the key to select the primary treatment modality. A well-performed hysterosalpingography is most valuable in the initial assessment of the tubes and uterus. Hysterosalpingosonography, radionuclide hysterosalpingography, and falloposcopy are experimental investigative tools that may be useful in selected circumstances. Effective adjuvants to reduce postoperative adhesions continue to elude the surgeon and new substances are being experimented with. In proximal tubal obstruction, selective salpingography and tubal catheterization may differentiate cornual spasm from pathologic tubal occlusion and may be therapeutic when viscous material or endotubal synechia are the cause of obstruction. Microsurgery remains the effective approach for significant lesions such as salpingitis isthmica nodosa, endometriosis, obliterative fibrosis, and chronic follicular salpingitis. Distal tubal occlusion is amenable to treatment via either laparoscopy or microsurgery. The functional status of the oviduct appears to be the most important prognostic factor in subsequent pregnancy outcome.
输卵管和腹膜因素仍然是不孕症的主要原因。体外受精、手术腹腔镜检查和显微手术是可供选择的方法，但它们常常是相辅相成的治疗手段。正确的检查是选择主要治疗方式的关键。一项操作得当的子宫输卵管造影术在对输卵管和子宫的初步评估中最具价值。子宫输卵管超声造影、放射性核素子宫输卵管造影和输卵管镜检查是实验性的检查工具，在特定情况下可能有用。减少术后粘连的有效辅助手段仍然是外科医生难以攻克的难题，新的物质正在进行试验。在近端输卵管阻塞中，选择性输卵管造影和输卵管插管可以区分子宫角痉挛和病理性输卵管闭塞，当粘性物质或输卵管内粘连是阻塞原因时，它们可能具有治疗作用。显微手术仍然是治疗诸如结节性输卵管峡部炎、子宫内膜异位症、闭塞性纤维化和慢性滤泡性输卵管炎等严重病变的有效方法。远端输卵管阻塞适合通过腹腔镜检查或显微手术进行治疗。输卵管的功能状态似乎是后续妊娠结局最重要的预后因素。
