介入再通术联合药物、臭氧灌注治疗输卵管性不孕症

Interventional recanalization combined with medication and ozone injection for the treatment of fallopian tube infertility

目的 探讨输卵管介入再通术联合药物、臭氧灌注治疗输卵管性不孕症的应用价值。方法 回顾整理经子宫输卵管造影诊断的369例共665条输卵管近段阻塞或通而不畅患者资料，将导管置于患侧子宫角部输卵管开口，使用导丝成功再通后跟进导管至输卵管近端，先后经导管注入复方疏通液（庆大霉素8万u、地塞米松5 mg、糜蛋白酶4 000 u和甲硝唑200 mg溶入生理盐水10 ml）及臭氧；造影观察术后开通情况，统计开通率，随访8个月内受孕情况并作数据处理。结果 665条近段阻塞或通而不畅输卵管综合治疗后559条（84.1%）基本通畅，完全阻塞疏通率为81.1%（43/53）。随访8个月：256例患者得以宫内妊娠，其中术后4个月受孕172例，5 ～ 6个月受孕39例，7 ～ 8个月受孕13例；随访者中输卵管妊娠12例。结论 输卵管介入再通术联合药物、臭氧灌注治疗输卵管近段阻塞或通而不畅性不孕症疗效确切，值得临床推广应用。

Objective To evaluate the fallopian tube recanalization combined with medication and ozone injection in treating fallopian tube infertility. Methods A total of 369 patients with hysterosal- pingography-proved total or partial tubal obstruction were enrolled in this study. Totally or partially obstructed proximal segment of fallopian tube was found in 665 fallopian tubes. A catheter was placed at the orifice of the diseased fallopian tube （uterine horn region）, and recanalization of the tube was carried out by repeatedly pushing and pulling the guide wire through the catheter, which was followed by inserting the catheter to the proximal site of the fallopian tube with subsequent injection of dredging solution and ozone. The dredging solution was composed of gentamycin （80 000 unit）, dexamethasone （5 rag）, chymotrypsin （4 000 unit）, metronidazole （200 mg） together with 10 ml of saline. Postoperative radiography was performed to observe the pateney of the fallopian tube. The pateney rate was calculated. All the patients were followed up for 8 months, and the pregnancy rate within 8 months was estimated. The clinical data were statistically analyzed. Results Of the 665 tubes with total or partial proximal obstruction, recanalization on the whole was obtained in 559 （84.1%）, and the opening rate for complete obstruction was 81.1% （43/53）. During the follow-up period of 8 months, 224 patients had uterine pregnancy. Among the 224 patients, 172 had pregnancy within 4 months after the treatment, 39 had pregnancy in 5 - 6 months and 13 had pregnancy in 7 - 8 months. Tubal pregnancy occurred in 12 cases. Conclusion For the treatment of infertility caused by totally or partially obstructed proximal segment of fallopian tube, fallopian tube recanalization combined with medication and ozone injection has reliable effect. Therefore, this technique should be recommended in clinical practice.