Confino E, Binor Z, Molo M W, Radwanska E
Department of Obstetrics and Gynecology, Mount Sinai Medical Center, Chicago, Illinois.
Fertil Steril. 1994 Aug;62(2):286-8. doi: 10.1016/s0015-0282(16)56880-0.
To determine whether selective salpingography can accurately diagnose and treat patients with early ectopic pregnancies (EPs).
Prospective clinical case study.
Selective salpingography was performed in an outpatient setting under i.v. sedation.
Selective salpingography was performed in 10 women who had clinical presentation suggestive of EP, two consecutive abnormal hCG measurements < 2,000 mIU/mL, and inconclusive vaginal probe sonogram.
Selective salpingography was performed under fluoroscopy. A cervical cannula was placed, and the tubal ostium was cannulated with a curved selective salpingography catheter (Bard Gynecology and Radiology, Covington, GA). Methotrexate (MTX) (25 or 50 mg) was injected into the affected tube through the selective salpingography catheter.
The accuracy of selective salpingography in the diagnosis of early EP was determined by the rate of fluoroscopic imaging of an ampullary radiolucency upon injection of contrast material through the selective salpingography catheter. Resolution of the EP after injection of MTX into the tube was detected by serial declining hCG measurements.
Selective injection of contrast material into the fallopian tubes detected seven ampullary pregnancies in 10 patients. Two patients demonstrated neither tubal pregnancy nor intrauterine pregnancy. One patient with apparent bilateral proximal cornual occlusions on selective salpingography underwent laparoscopy, followed by salpingostomy of an ampullary pregnancy. All 7 patients who received MTX through the selective salpingography catheter completely resolved the EP. Four patients demonstrated patent fallopian tubes on hysterosalpingograms performed 3 to 6 months later.
Selective salpingography may diagnose early tubal pregnancies of some patients with equivocal clinical, laboratory, and sonographic findings. These patients can be successfully treated at the same time with a single dose of MTX delivered into the affected tube. Selective salpingography reduced the need for laparoscopy and operative intervention. Selective salpingography is a simple and relatively inexpensive diagnostic and therapeutic alternative in patients with suspected early tubal pregnancy.
确定选择性输卵管造影术能否准确诊断和治疗早期异位妊娠（EP）患者。
前瞻性临床病例研究。
在门诊静脉镇静下进行选择性输卵管造影术。
对10名临床表现提示为EP、连续两次人绒毛膜促性腺激素（hCG）测量值异常且<2000 mIU/mL以及经阴道探头超声检查结果不明确的女性进行了选择性输卵管造影术。
在荧光透视下进行选择性输卵管造影术。放置宫颈插管，并用弯曲的选择性输卵管造影导管（巴德妇科与放射科，佐治亚州科温顿）插入输卵管开口。通过选择性输卵管造影导管将甲氨蝶呤（MTX）（25或50 mg）注入患侧输卵管。
通过经选择性输卵管造影导管注入造影剂后壶腹部透光区的荧光透视成像率来确定选择性输卵管造影术诊断早期EP的准确性。通过连续下降的hCG测量值检测向输卵管内注入MTX后EP的消退情况。
向输卵管内选择性注入造影剂在10名患者中检测到7例壶腹部妊娠。2例患者既未显示输卵管妊娠也未显示宫内妊娠。1例在选择性输卵管造影术中显示双侧近端输卵管角明显闭塞的患者接受了腹腔镜检查，随后对壶腹部妊娠进行了输卵管造口术。所有7例通过选择性输卵管造影导管接受MTX治疗的患者的EP均完全消退。4例患者在3至6个月后进行的子宫输卵管造影中显示输卵管通畅。
选择性输卵管造影术可诊断部分临床、实验室及超声检查结果不明确患者的早期输卵管妊娠。这些患者可通过向患侧输卵管内单次注射MTX同时成功接受治疗。选择性输卵管造影术减少了腹腔镜检查和手术干预的需求。对于疑似早期输卵管妊娠的患者，选择性输卵管造影术是一种简单且相对廉价的诊断和治疗选择。
