输卵管积水介入栓堵的临床应用

Clinical Application of Interventional Embolization on Hydrosalpinx

目的：评估输卵管积水介入栓堵的疗效。方法：选择已明确诊断为输卵管积水并欲做体外受精-胚胎移植（in vitro fertilization-embryo transfer,IVF-ET）的患者900例,在数字减影血管造影机（digital subtraction angiography,DSA）下通过微导管将铂金弹簧置入输卵管的间质部和峡部,1~2个月后行常规子宫输卵管造影（hysterosalpinography,HSG）,检查输卵管栓堵是否成功。患者分为2组,对照组患者一侧输卵管里只置入1枚弹簧圈;治疗组一侧输卵管里置入多枚弹簧圈。结果：本组900例输卵管积水全部栓堵成功,共计栓堵1 645条输卵管,术后1~2个月造影复查,对照组栓堵的120条输卵管中6条输卵管弹簧圈移位而失去栓堵作用;35条输卵管弹簧圈无明显移位但栓堵部位有造影剂渗漏。治疗组的1 525条输卵管弹簧圈无移位,10条有造影剂渗漏。结论：输卵管栓堵术的成功率与采用的栓堵方式有显著关系,采取多枚弹簧圈栓堵积水输卵管的成功率明显高于采用1枚弹簧圈栓堵输卵管。介入栓堵治疗可使患者在IVF-ET时避免受到输卵管积水的影响。

Objective： To evaluate the curative effect of interventional embolization on the treatment of hydrosalpinx. Methods： A total of 900 patients with hydrosalpinx and want to do in virto fertilization-embryo transfer（ IVF-ET） were selected. Under the monitoring of digital subtraction angiography（ DSA）,micro-catheter was inserted into the tubal isthmus,then the guglielmi detachable coil was pushed into the interstitial and isthmus of fallopian tubes. In the treatment group,at least 2 to 3 pieces of guglielmi detachable coils were inserted into one side of the fallopian tubes. In the control group,only 1 guglielmi detachable coil was inserted. Lastly,the regular hystero-salpingography was conducted to confirm the success of fallopian tube embolism. Results： All the 900 patients with hydrosalpinx were successfully embolized. A total of 1 645 fallopian tubes were embolized. During the 1st and 2nd months after the surgery,in 120 fallopian tubes in control group,6 cases shifted and 35 cases without obvious shift,but there was leakage of contrast agent at the embolized position. In 1 525 fallopian tubes in treatment group,10 cases had leakage of contrast agent at the embolized position. Conclusion： Interventional embolization shows significant advantages and can help the patients with hydrosalpinx to avoid the negative effects of hydrosalpinx when going through IVF-ET.