Westmed Reproductive Services, Purchase, NY.
Brown University, Providence, RI.
JSLS. 2022 Oct-Dec;26(4). doi: 10.4293/JSLS.2022.00047.
To evaluate the cannulation success rate, cumulative pregnancy, and time to intrauterine pregnancy rate following fluoroscopically-guided hysteroscopic tubal cannulation (FHTC) for infertile subjects with proximal tubal obstruction.
This retrospective study evaluated subjects with unilateral or bilateral proximal tubal obstruction on hysterosalpingography, who failed concomitant selective salpingography and subsequently underwent FHTC at the time of a hysteroscopy performed for findings seen on sonohysterography. FHTC employed a Novy Catheter (CooperSurgical, Inc, Trumbull, CT.) with or without the 3 French inner catheter and guidewire, to cannulate the occluded fallopian tube(s), followed by the injection of Hypaque (Amersham Health, Inc, Princeton, NJ.) contrast under C-arm imaging. Technical success rates, complications, post-procedure pregnancies, and average time from surgery to pregnancy were evaluated.
Thirty-two women between January 1, 2017 and December 31, 2019 met the entry criteria and underwent FHTC. Of those women with bilateral obstruction, 6/6 (100%) of subjects achieved at least unilateral patency, while patency was achieved in 23/26 (88.5%) subjects with unilateral obstruction. Twenty-nine of 32 (90.6%) subjects had at least one tube successfully cannulated with 34/38 (89.5%) of proximally obstructed tubes opened. Asymptomatic tubal perforation occurred in 1/38 tubes (2.6%). Ten subjects (34.5%) achieved intrauterine pregnancies without in vitro fertilization in an average of 64.9 days from the procedure. There were no multiple pregnancies and one ectopic pregnancy.
FHTC is a safe, effective, incision free procedure that results in 90% of tubes successfully cannulated, and an observed short time to intrauterine pregnancy.
评估经荧光宫腔镜下输卵管插管（FHTC）治疗因近端输卵管阻塞而导致不孕的患者的插管成功率、累积妊娠率和宫内妊娠率。
本回顾性研究纳入了子宫输卵管造影显示单侧或双侧近端输卵管阻塞且同期选择性输卵管造影失败的患者，随后在经阴道超声造影检查发现异常时行宫腔镜检查，并进行 FHTC。FHTC 采用 Novy 导管（CooperSurgical，Inc.，Trumbull，CT.），或联合 3Fr 内导管和导丝，以插管阻塞的输卵管，随后在 C 臂成像下注入 Hypaque（Amersham Health，Inc.，Princeton，NJ.）造影剂。评估技术成功率、并发症、术后妊娠情况和从手术到妊娠的平均时间。
2017 年 1 月 1 日至 2019 年 12 月 31 日，共有 32 名女性符合纳入标准并接受了 FHTC。对于双侧阻塞的女性，6/6（100%）的患者至少一侧输卵管通畅，而单侧阻塞的 23/26（88.5%）患者输卵管通畅。32 名女性中有 29 名（90.6%）至少有一侧输卵管成功插管，38 个近端阻塞的输卵管中有 34 个（89.5%）通畅。1 个输卵管（2.6%）发生无症状性输卵管穿孔。10 名女性（34.5%）在平均 64.9 天的时间内无需体外受精就实现了宫内妊娠。没有多胎妊娠，仅有 1 例异位妊娠。
FHTC 是一种安全、有效的非切口手术，90%的输卵管可成功插管，宫内妊娠时间较短。
