選擇性輸卵管造影和再通術(shù)

1、Dept. of Interventional Radiology, Union Hospital, HUST,子宮輸卵管的解剖,概 述,Dept. of Interventional Radiology, Union Hospital, HUST,碘油子宮輸卵管造影術(shù)：30%的假陽性腹腔鏡檢剖腹探查術(shù),抗炎治療通液試驗(yàn)手術(shù)治療,輸卵管性不孕是不孕癥的診治難題,診斷,治療方法,概 述,Dept. of Interve

2、ntional Radiology, Union Hospital, HUST,碘油子宮輸卵管造影,正常表現(xiàn),Dept. of Interventional Radiology, Union Hospital, HUST,碘油子宮輸卵管造影,慢性炎癥—閉塞,Dept. of Interventional Radiology, Union Hospital, HUST,碘油子宮輸卵管造影,慢性炎癥—閉塞,Dept. of Interv

3、entional Radiology, Union Hospital, HUST,碘油子宮輸卵管造影,慢性炎癥—傘端積水,Dept. of Interventional Radiology, Union Hospital, HUST,選擇性輸卵管造影及再通術(shù),1985年P(guān)latia等首先對(duì)選擇性輸卵管造影及再通術(shù)作報(bào)道Thurmond和Rosch等 (1987，1988和1990年)采用真空負(fù)壓吸引裝置的同軸導(dǎo)管進(jìn)行了較大組的臨床應(yīng)

4、用研究1992年詹曉星、楊建勇等利用自制同軸導(dǎo)管裝置進(jìn)行70例臨床應(yīng)用研究。,Dept. of Interventional Radiology, Union Hospital, HUST,治療機(jī)理,輸卵管內(nèi)炎癥碎片、濃稠的粘液及細(xì)小的纖維絲均可引起輸卵管閉塞。部分病例可在加壓造影或通液時(shí)疏通，但對(duì)大多數(shù)病人而言，由于輸卵管的截面積小，宮腔施加的靜水壓傳導(dǎo)到間質(zhì)部的壓力微弱，難以疏通。采用細(xì)導(dǎo)絲可以奏效。,Dept. of Inter

5、ventional Radiology, Union Hospital, HUST,適應(yīng)證,各段輸卵管阻塞均可試行選擇性輸卵管造影術(shù)與通液試驗(yàn)間質(zhì)部、峽部、壺腹部阻塞可試行選擇性輸卵管再通術(shù)。常規(guī)子宮輸卵管造影因?qū)m頸太松而未完成者,Dept. of Interventional Radiology, Union Hospital, HUST,禁忌證,壺腹遠(yuǎn)端、傘段阻塞者不宜行再通術(shù) (可行選擇性造影術(shù))子宮角部嚴(yán)重閉塞者、原結(jié)扎輸

6、卵管處作再通術(shù)后又發(fā)生阻塞者以及結(jié)核性輸卵管阻塞者亦不適宜行導(dǎo)絲再通術(shù)。嚴(yán)重心力衰竭、活動(dòng)性肺結(jié)核。碘過敏者生殖器炎癥急性發(fā)作者發(fā)熱、月經(jīng)期,Dept. of Interventional Radiology, Union Hospital, HUST,術(shù)前準(zhǔn)備,時(shí)間選擇：月經(jīng)干凈后3～7日內(nèi)了解病史：妊娠情況，既往史（盆腔炎、結(jié)核），檢查情況查血常規(guī)及出、凝血時(shí)間和血小板計(jì)數(shù)值碘過敏試驗(yàn)術(shù)前談話,Dept. of

7、 Interventional Radiology, Union Hospital, HUST,Dept. of Interventional Radiology, Union Hospital, HUST,自制同軸導(dǎo)管技術(shù),同軸導(dǎo)管7F外套管4F內(nèi)套管3F微導(dǎo)管。導(dǎo)絲 0.025、0.015英寸超軟頭導(dǎo)絲。雙腔氣囊導(dǎo)管,器 械,Dept. of Interventional Radiology, Union Hospi

8、tal, HUST,Dept. of Interventional Radiology, Union Hospital, HUST,步 驟,病人仰臥在造影床上、取截石位,消毒鋪巾上窺陰器,消毒陰道及宮頸宮頸鉗固定宮頸將雙腔氣囊導(dǎo)管送入宮腔行常規(guī)子宮輸卵管造影，60%泛影葡胺7ml,Dept. of Interventional Radiology, Union Hospital, HUST,Dept. of In

9、terventional Radiology, Union Hospital, HUST,在7F外套管導(dǎo)向下將4F內(nèi)套管插至輸卵管口部行選擇性輸卵管造影,Dept. of Interventional Radiology, Union Hospital, HUST,導(dǎo)絲通過閉塞段，試行再通治療。,Dept. of Interventional Radiology, Union Hospital, HUST,復(fù)查造影，成功后輸卵管內(nèi)注入再

10、通液（慶大霉素8萬單位、α-糜蛋白酶5mg、地塞米松5mg、生理鹽水20ml） 。,Dept. of Interventional Radiology, Union Hospital, HUST,3F微導(dǎo)管的應(yīng)用拔出導(dǎo)管，患者平臥，觀察1~2小時(shí)。,Dept. of Interventional Radiology, Union Hospital, HUST,術(shù)后處理,口服抗生素1周；術(shù)后3天、第2、3月經(jīng)周期，月經(jīng)干凈3~7天行通

11、液治療；第2、3月經(jīng)周期爭(zhēng)取懷孕；術(shù)后6個(gè)月未懷孕者可能未再堵塞或其他原因不孕。,Dept. of Interventional Radiology, Union Hospital, HUST,病例一,Dept. of Interventional Radiology, Union Hospital, HUST,病例二,Dept. of Interventional Radiology, Union Hospital, HUST,病

12、例三,Dept. of Interventional Radiology, Union Hospital, HUST,效果評(píng)價(jià),診斷方面,,選擇性輸卵管造影（SSG）明顯優(yōu)于傳統(tǒng)的碘油造影（HSG）,Dept. of Interventional Radiology, Union Hospital, HUST,選擇性輸卵管插管再通成功率為92%~100?？偟慕Y(jié)果提示近端阻塞的再通率遠(yuǎn)高于中遠(yuǎn)段輸卵管阻塞；局部給與抗炎藥，增強(qiáng)了抗炎效

13、果；術(shù)后半年受孕率達(dá)33%，略低于手術(shù)治療（36%~50%）。便于開展輸卵管成形術(shù)、輸卵管人工授精術(shù)、輸卵管粘堵術(shù)，輸卵管妊娠的介入治療。,效果評(píng)價(jià),治療方面,Dept. of Interventional Radiology, Union Hospital, HUST,并發(fā)癥及處理,嘔吐、疼痛見于造影時(shí)宮腔及輸卵管擴(kuò)張，再通時(shí)輸卵管刺激。感染 少見，與原先存在的感染有關(guān)，注意嚴(yán)格器械消毒，急性炎癥時(shí)禁止手術(shù)。陰道出血