选择性输卵管造影及输卵管再通术中并发症及预防对策

Complications and preventive measures of in selective salpingography and fallopian tube recanalization

【目的】探讨选择性输卵管造影(SSG)及输卵管再通(FTR)术中并发症及预防。【方法】182例不孕症患者行SSG及FTR术,观察术中并发症并及时处理。【结果】122支输卵管行SSG。输卵管积水Ⅰ度患者出现轻度恶心、呕吐(1/49);输卵管积水Ⅱ度患者出现腹胀、恶心、呕吐,出虚汗(3/32),经对症处理均缓解;输卵管积水Ⅲ-Ⅳ度患者,出现严重的血管迷走神经反应(2/15),血压下降至50/20 mmHg,经及时皮下注射阿托品0.5 mg及积极抗休克处理,生命体征恢复正常。236支输卵管行FTR,峡部阻塞出现输卵管穿孔(2/41)。宫角部阻塞出现宫角部内膜损伤(27/195),造影剂在宫角部浓聚成团,其中18例出现子宫静脉显影。出现过敏性皮疹4例,无腹腔出血发生。【结论】SSG中,明确为输卵管积水,进一步加压则应慎重,以预防严重血管迷走神经反应。FTR术中并发症发生率低,输卵管穿孔及宫角部内膜损伤均无需特殊处理,只要严格掌握适应症、操作正规、动作轻柔,为安全的检查和治疗方法。

[Objective] To study the complications of selective salpingography （SSG） and fallopian tube recanalization （FTR） and preventive measures. [Methods] SSG and FTR were taken in 182 infertile cases and the comphcations were observed. [Results] SSG were taken in 122 fallopian tubes. Light nausea and vomiting occured in 1/49 in hydrosalpinx （Ⅰ）, abdominal distension, vomiting and cold sweating in 3/32 occured in hydrosalpinx （Ⅱ） and two serious vasovagal reaction were occued in 2/15 in hydrosalpinx （Ⅲ -Ⅳ） cases, blood pressure dropped to 50/20 mmHg. They were norreal after subcutaneous injection of atropine and antishock therapy timely. FTR were executed in 236 proximal fallopian tube obstruction cases. Tubal perforation occurred in 2/41. More often perforation was submucosal （27/195） and was manifested as an extraluminal aggregation of contrast agent or intravasation of contrast agent into the pelvic veins. There was found in 4 cases. No abdominal bleeding was found. [Conclusions] In hydrosalpinx cases （SSG）, pressurized injection should be careful to preventive seriousy vasovagal reaction. Incidence of complication in FTR is low, fallopian tube perforation and horn submucosal hurt need no special disposal even if it happened. It＇ s a safe examination and operation when indications is carefully controlled and regularty manipulaed.