Philippe E, Satgé D
Institut de Pathologie, CHU, Strasbourg.
J Gynecol Obstet Biol Reprod (Paris). 1988;17(4):467-76.
The 100 fallopian tubes had been obtained from women whose mean age was 30 and whose mean period of amenorrhea was 38 days. Each fallopian tube gave rise to at least sixteen samples and was sectioned if necessary several times. There had been tubal rupture in 25 cases, and in at least 7 cases the rupture involved the ovum and its implantation site. The location of the implantation site could be determined in only 30 cases: 10 in the mesosalpin; x 10 in the antimesosalpinx; 8 lateral and 2 circumferential. The anatomic site of the implantation was isthmic in 7 cases; ampullary in 85 cases, of which 6 were near to the isthmus; infundibular in 7 cases and fimbrial in 1 case. Tubal lesions were found in 22% of the cases, but associated were also found frequently: tubal adenomyosis (17 cases); adherent tubal fimbriae (14 cases); peritoneal adhesions (11 cases) and decidual changes in 12 cases. The 74 remaining fallopian tubes were considered to have been previously normal and to have been affected only by changes linked to the pregnant state (edema, congestion, lymphocytic infiltration) or to complications or this state (a smoothing out of the tubal mucosa; a peritoneal granuloma surrounding blood products; a localized infarct of the fimbriae or wall; and haemorrhage involved in thromboses, ovum detachment or necrosis). The ovum and implantation appeared to be normal in 26 cases and to have had development prematurely stopped because of extensive haemorrhage in 41 cases. In 22 cases there was hypoplasia, and difficulty in determining the cause in 11 cases. From a morphological point of view preserving at least one third of gravid fallopian tubes is justifiable, because the chronic lesions are often discrete and the changes of pregnancy generally appear to be reversible. The persisting pathogenic factors are not necessarily tubal, as can be seen by the role of delays in transport of the ova.
这100条输卵管取自平均年龄为30岁、平均闭经时间为38天的女性。每条输卵管至少产生16个样本,必要时可进行多次切片。25例出现输卵管破裂,至少7例破裂涉及卵子及其着床部位。仅在30例中能确定着床部位:10例位于输卵管系膜;10例位于输卵管系膜对侧;8例在外侧,2例在周围。着床的解剖部位:7例在峡部;85例在壶腹部,其中6例靠近峡部;7例在漏斗部,1例在伞部。22%的病例发现有输卵管病变,但也经常发现相关病变:输卵管腺肌病(17例);粘连的输卵管伞端(14例);腹膜粘连(11例)和蜕膜变化(12例)。其余74条输卵管被认为先前正常,仅受与妊娠状态相关的变化(水肿、充血、淋巴细胞浸润)或该状态的并发症影响(输卵管黏膜变平;围绕血液产物的腹膜肉芽肿;伞端或管壁的局部梗死;以及血栓形成、卵子脱离或坏死相关的出血)。26例卵子和着床似乎正常,41例因广泛出血导致发育过早停止。22例存在发育不全,11例难以确定原因。从形态学角度看,保留至少三分之一的妊娠输卵管是合理的,因为慢性病变往往不明显,妊娠变化通常似乎是可逆的。持续的致病因素不一定是输卵管性的,卵子运输延迟所起的作用就可见一斑。