tubal adhesions
Introduction
Introduction to tubal adhesion Tubal adhesion is one of various types of fallopian tube diseases. Due to the chronic infection, the umbrella part is blocked, and the fallopian tube fluid and inflammatory exudate accumulate in the ampulla. The wall thickness of the isthmus is narrow. If there is adhesion and blockage, the effusion in the tube is difficult to discharge, it is not easy to absorb, and a cystic effusion is formed, which has no adhesion or slight adhesion to adjacent tissues. Because the adhesion causes the fallopian tube to become blocked, affecting the normal passage of sperm, so that the sperm eggs can not be combined to form a fertilized egg, leading to the emergence of female infertility. The most common is the occurrence of appendicitis, peritonitis, because they are adjacent to the female internal reproductive organs, inflammation can be directly spread, causing pelvic inflammation in women. In the case of chronic cervicitis, inflammation can also pass through the lymphatic circulation, causing pelvic connective tissue inflammation. Infection of the pelvis causes adhesion around the fallopian tube, which attaches the fallopian tube to the pelvic wall. basic knowledge The proportion of illness: 0.002-0.005% Susceptible people: women Mode of infection: non-infectious Complications: infertility abdominal pain endometriosis
Cause
Tubal adhesion cause
Postpartum or post-abortion infection (40%):
Patients with postpartum or small postpartum physique weakness, the cervix has not been well closed after expansion, at this time, the bacteria present in the vagina and cervix may infect the pelvic cavity; if there is a placenta or residual membrane in the uterine cavity, the chance of infection is even more Big.
Post-gynecological infection (30%):
If abortion is not strict or chronic inflammation of the original reproductive system, if the abortion is not strict or the prosthetic system is removed, or if the disinfection is not strict or the original reproductive system is chronically inflamed, abortion or ring surgery, tubal fluid, fallopian tube angiography, endometrial polypectomy, or submucosal uterine myomectomy That may cause postoperative infection. Some patients do not pay attention to personal hygiene after surgery, or do not follow the doctor's advice after surgery, have sex, can also cause bacterial infection, causing pelvic inflammatory disease.
Menstrual period does not pay attention to hygiene (10%):
Endometrial exfoliation during menstruation, uterine sinus opening, and clots, which is a good condition for bacterial growth. If you do not pay attention to hygiene during menstruation, use sanitary napkins or toilet paper with unqualified hygiene standards, or have sex, it will provide bacteria with a chance of retrograde infection, leading to pelvic inflammatory disease.
Disease factor (10%):
The most common is the occurrence of appendicitis, peritonitis, because they are adjacent to the female internal reproductive organs, inflammation can be directly spread, causing pelvic inflammation in women. In the case of chronic cervicitis, inflammation can also pass through the lymphatic circulation, causing pelvic connective tissue inflammation. Infection of the pelvis causes adhesion around the fallopian tube, which attaches the fallopian tube to the pelvic wall.
Prevention
Tubal adhesion prevention
1. Most of the fallopian tube adhesions are caused by chronic salpingitis. Therefore, in daily life, women must avoid the occurrence of salpingitis. Once inflammation occurs, they should go to a regular hospital for appropriate examination and treatment.
2, women in daily life must pay attention to the menstrual period, pregnancy, puerperium and post-abortion hygiene, these special periods are very easy to cause infection of the period of time, must pay attention, in addition, if long-term in the womb If the birth control ring is placed, it will easily cause the fallopian tube to adhere.
3, if you want to carry out gynecological surgery or abortion surgery, etc., you should carefully choose the hospital, because if the operation is improperly caused by infection, causing inflammation, it is easy to cause tubal adhesions. Therefore, female friends should avoid infection after surgery.
Complication
Tubal adhesion complications Complications infertility abdominal pain endometriosis
1, infertility caused by patients with tubal adhesions:
The most harmful consequence of tubal adhesions is the infertility of women. The fallopian tube plays an important role in the female fertility function. It is located in the "fortress" where the sperm passes through the sperm and the fertilized egg. Once the fallopian tube adhesion occurs, even if the egg has been fertilized, it cannot enter the uterus, and it cannot be conceived. Development in the fallopian tube may become a dangerous ectopic pregnancy.
2. Ectopic pregnancy in patients with tubal adhesions:
Many women are prone to tubal adhesions. If there is complete adhesion, female patients will not have a chance to get pregnant, but if they are partially adherent, female patients have a chance of getting pregnant, but the chance of ectopic pregnancy is very high.
3, causing abdominal pain in patients with tubal adhesions:
In general, many patients with tubal adhesions may have pain in the lower abdomen. Some patients with tubal adhesions may have an anal bulge. The severe ones are restless and have difficulty in exercising. The pain usually lasts for 3-7 days and is a periodic attack.
4. Inflammation episodes in patients with tubal adhesions:
Inflammation caused by tubal adhesions, female patients will also have sticky, purulent leucorrhea, which contains a lot of white blood cells, and white blood cells will swallow sperm, so that sperm can not enter the uterine cavity and egg binding.
5, chronic pelvic inflammation:
Chronic pelvic inflammatory disease is due to the patient's history of pelvic inflammatory disease. Under normal circumstances, there will be lower abdominal pain or low back pain. Generally, after menstrual sex or tiredness, the pain will be aggravated, the usual menstrual volume will increase, and menstrual time will be prolonged. Waiting for irregular menstruation. However, the symptoms of the whole body are not very obvious. The effects of this pelvic inflammation are caused by the adhesion of the fallopian tubes.
6, cavity tuberculosis:
Tuberculosis in the pelvic cavity is caused by pelvic tuberculosis caused by the fallopian tube. This condition is mostly abdominal pain and swelling of the lower abdomen and a sense of falling pain. It is usually mild and has no particularly irritating pain.
7, endometriosis:
Pain in the endometrium is the most important manifestation. It is generally divided into dysmenorrhea and pelvic pain. The pain caused by endometriosis is typical of menstruation. One is secondary dysmenorrhea, and the other is progressive additive, usually occurs in the lower abdomen, where the lumbosacral bones slowly radiate to the vagina and anus.
Symptom
Tubal adhesion symptoms Common symptoms Female infertility Menstrual cycle changes Sexual intercourse pain Lower abdomen pain Menstrual blood clots
First, irregular menstruation: patients with tubal adhesions will have irregular menstruation, patients with severe menstrual irregularities will have two menstrual periods within one month, and the patient's menstrual blood clots.
Second, pain: patients with tubal adhesions will have lower abdominal pain, the most common patients have back pain and other housewife pain.
Infertility: Infertility is the most obvious symptom of female fallopian tube adhesion. Women who have found that they have not been pregnant for a long time have to go to the hospital for related examinations.
Examine
Tubal adhesion examination
Tubal adhesions can be divided into adhesions of the fallopian tube lumen and adhesions around the fallopian tubes. Tubal adhesions are divided into proximal tubal adhesions and distal tubal adhesions.
First, "three mirrors and one wire" joint examination for the treatment of fallopian tube diseases
1. Hysteroscopy:
One of the commonly used methods for the diagnosis of tubal adhesions is to understand the internal conditions of the uterine cavity, especially to understand the opening of the fallopian tube. At the same time, you can intubate the fluid, can determine whether the fallopian tube is smooth, but can not determine the obstruction of the fallopian tube. The location and extent of the fallopian tube is a tube structure that continually emerges from the uterus.
2. Laparoscopic tubal patency check and treatment:
Laparoscopic tubal endostomy, adhesion around the fallopian tube, etc. can only be performed after the angiographic examination determines that the obstruction of the fallopian tube is the obstruction of the fallopian tube and the adhesion around the fallopian tube.
3. Fallopian tubeoscopy:
It is an endoscopic examination instrument for microscopic examination of the internal structure of the fallopian tube lumen. The local microscopic lesions in the fallopian tube lumen can be directly observed through the fallopian tube mirror, such as the lesion of the fallopian tube mucosa and the fallopian tube ciliary immobility syndrome. An endoscopy used to rule out the internal structure and function of the fallopian tube lumen.
Second, fallopian tube angiography and recanalization
Experts said that not only can the specific blockage and nature of the fallopian tube blockage be clarified, but also the recanalization of the fallopian tube obstruction site can be accurately understood, but there is no understanding of whether there is any adhesion around the fallopian tube and the surrounding area of the fallopian tube. Clinically, the diagnosis rate of fallopian tube angiography and recanalization is over 98%. It is the most commonly used and advanced inspection technology in the world.
Diagnosis
Diagnosis of tubal adhesion
diagnosis
The diagnosis of the fallopian tube lumen is mainly through X-ray hysterosalpingography. The proximal tubal adhesion is mainly characterized by stenosis of the lumen and rough wall. The adhesion of the distal end of the fallopian tube is mainly characterized by thickening and expansion of the ampulla or umbrella end, distortion of the distal end, and residual film of the fallopian tube.
Adhesion around the fallopian tube needs to enter the abdominal cavity to confirm the diagnosis. It can be done by open surgery or laparoscopy. Many doctors have seen the film saying that adhesions around the fallopian tube or pelvic adhesions are inaccurate.
