tubal infertility
Introduction
Introduction to tubal infertility The fallopian tube has an important role in transporting sperm, picking up eggs and transporting fertilized eggs to the uterine cavity. The fallopian tube or dysfunction is the main cause of female infertility. The cause of fallopian tube dysfunction or dysfunction is acute and chronic fallopian tube inflammation. Severe tube inflammation can cause the fallopian tube to be completely impenetrable. Some inflammations may not be examined, and CT scan or MRI imaging may be used as appropriate. The image shows the thickening of the fallopian tube. Attachment mass, tubal effusion change. The fallopian tube is usually routinely treated with fluid or laparoscopic surgery, but in many cases, attention should be paid to the repair of the postoperative fallopian tube microenvironment. 3D gestation microenvironment therapy is currently the method commonly used for adhesion after multiple tubal dredge. basic knowledge The proportion of illness: 0.003% Susceptible people: women Mode of infection: non-infectious Complications: infertility, dysmenorrhea, irregular menstruation
Cause
Tubal infertility
Tubal obstruction (20%):
Tubal obstruction can generally be divided into primary and secondary. Primary is also congenital, born at the time of birth, but very rare. Secondary causes of acquired effects are also the main cause of illness. Secondary is further divided into mechanical and pathological. Infertility caused by tubal blockage generally has no special symptoms, mainly caused by inflammation of the fallopian tubes. In the early stages of the disease, patients do not show obvious symptoms, often found after two or three years of marriage without children.
In most cases, patients with tubal obstruction have developed chronic infection status at the time of hospital confirmation, which is characterized by chronic interstitial salpingitis. At this time, the wall of the fallopian tube has been infiltrated by lymphocytes, and the epithelial cells of the mucosa have become hypertrophied. The prolonged period of time causes fibrosis of the tissue, thickening of the fallopian tube, or distortion.
The pathogenesis is not clear, and the umbrella part may be blocked due to chronic infection. The oviduct 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.
Fallopian tube effusion (26%):
When the pathogen is infected with the fallopian tube, the fallopian tube will form a swollen intima under the action of leukocyte infiltration, interstitial edema, mucosal epithelial shedding, if not timely and effective treatment, it will form tubal empyema. After the inflammation subsided, the effusion in the cavity gradually changed from purulent to serous.
After the female fallopian tube is infected, if it is not diagnosed early, the infection will last for a long time, the spread will spread more, and even lead to tubal infertility.
Fallopian tube inflammation (25%):
1, gonococcal salpingitis
With the increase of the proportion of pelvic inflammatory disease caused by chlamydia and mycoplasma infection, the effect on the fallopian tube is the same as that of gonococcus. The infection is along the mucosa, through the endocervix, endometrium, and endometrium of the fallopian tube to the pelvic peritoneum, but there is no acute phase. And the initial symptoms of infection are mild, so it does not cause attention, which leads to obstruction of the fallopian tubes.
2, suppurative salpingitis
Common in incomplete abortion, induced abortion and puerperal infection. The pathogenic bacteria are Staphylococcus aureus, Streptococcus, Escherichia coli and Pseudomonas aeruginosa, causing interstitial salpingitis, isthmic nodular salpingitis, hydrosalpinx and fallopian tube empyema.
3, tuberculous salpingitis
Mostly secondary to tuberculosis or peritoneal tuberculosis, accounting for 10% of the cause of infertility. It is mainly infected by blood, and partly infected by lymphatic system and direct spread. Mycobacterium tuberculosis first infects the muscular layer or submucosa, and then develops into the mucosa and serosal layer, which causes the oviduct to enlarge slightly, the wall of the tube to thicken, and most miliary nodular lesions on the surface, adhesion to the surrounding area, tuberculosis of the fallopian tube Infected with bacteria, the mucous membrane is destroyed to form tonsil-like necrosis and adhesion.
The lesion is mainly caused by invasion of the distal end, the mucosa of the umbrella is swollen, and the valgus is funnel-shaped, which may not be blocked. If a secondary infection occurs, the contents of the tube can become purulent, and tuberculous peri-pancreatic inflammation can also form, which can be widely adhered to surrounding organs. The superficial lesions continue to develop and can penetrate deep into the wall and the mucosal tissue, resulting in no pregnant.
Prevention
Tubal infertility prevention
1. Prevention of vaginal infections
There is a process in the occurrence and development of the disease. There is a reason for the infection of the fallopian tube. It should mainly be used in the prevention of vaginitis and endometritis, especially vaginal infection. It is the key portal for many reproductive diseases. "It is extremely important to pay attention to the protection of the reproductive system, pay attention to sexual hygiene, and prevent sexually transmitted diseases."
2. Be cautious about abortion
Abortion is also the main cause of fallopian tube obstruction: due to mechanical or drug stimulation during artificial abortion, uterine smooth muscle contraction, the contents of the uterine cavity not only move toward the cervix, but also enter the fallopian tube cavity, the tissue entering the fallopian tube cavity is easy Staying in the machine, if the tubal cavity is completely blocked, it will form infertility. If the semi-blocking state is formed, the fallopian tube will not form smoothly and it will form an ectopic pregnancy. Therefore, you should be careful to abort before giving birth. On the other hand, it is found that there are germline inflammation and pelvic and abdominal inflammation should be actively sought by specialists for effective treatment. There are many cases of fallopian tubes that are caused by improper and excessive treatment during the diagnosis and treatment of infertility. Such as repeated in some small clinics for tubal fluid and clear palace treatment.
3. Prevent inflammation
The main cause of tubal blockage is inflammation, including blockage of the fallopian tube lumen caused by salpingitis and umbrella blockage caused by pelvic inflammatory disease. Therefore, attention to the cleanliness of the reproductive system and prevention of infection by various pathogens (especially sexually transmitted diseases) are the most critical. In addition, most of the ectopic pregnancy is caused by inflammation, which causes partial obstruction of the fallopian tube. After the occurrence of ectopic pregnancy, the fallopian tube resection should be avoided. Laparoscopic fallopian tube fenestration should be used. If possible, conservative treatment can be used. Keep the fallopian tubes.
4. Timely diagnosis and treatment as soon as possible
There are many ways to diagnose in time. Tubal ventilation test, tubal water test, hysterosalpingography, uterine fallopian tube ultrasound, endoscopy (laparoscopic, hysteroscopic, fallopian tube), radionuclide hysterosalpingography, etc., general specialist hospitals can carry out, if necessary It is also possible to carry out open exploration, in short, it is possible to confirm the diagnosis in time. Early diagnosis is a certain benefit to the continued development of the disease.
Complication
Tubal infertility complications Complications, infertility, dysmenorrhea, irregular menstruation
1. Infertility after marriage
After the female fallopian tube is blocked, the fallopian tube itself will be invaded by the disease, which will form a blockage, which will eventually lead to infertility. Generally, secondary infertility is more common.
2, duna
Because the pelvic congestion, and the resulting dysmenorrhea of blood stasis, most of them start in the first week before menstruation, abdominal pain will occur, the more severe the menstrual period will be, until the menstrual cramps.
3, abdominal discomfort
Patients have different degrees of pain in the lower abdomen, most of which are recessive discomfort, and there are also back and back, and soreness in the ankle, and swelling or falling feeling, which is often more serious due to fatigue.
4, irregular menstruation
The fallopian tube and the ovary are adjacent. In general, the disease of the fallopian tube does not affect the function of the ovary. It has no effect on the amount of menstrual flow. However, when inflammation spreads to the ovaries, it damages the function of the ovaries. At the time, the occurrence of menstrual abnormalities will occur.
Symptom
Tubal infertility symptoms Common symptoms Female infertility Fallopian tube mass Dysmenorrhea Chronic abdominal pain Lower abdomen bulge constipation
1, the symptoms of tubal infertility:
Tubal obstruction symptoms: patients generally have no obvious clinical symptoms, mainly infertility, and some patients with hydrosalpinx have chronic abdominal pain.
Acute tubal inflammation: acute episodes of lower abdominal pain, bulging, frequent urination, vaginal discharge, pus and blood, may be associated with chills and fever, and may also have bloating, constipation or diarrhea. If the disease occurs during the menstrual period or after abortion, the amount of bleeding increases and the menstrual period is prolonged. Questioning may have a history of gynecological or sexually transmitted diseases.
Chronic fallopian tube symptoms: can be treated with primary or secondary infertility without obvious discomfort. Some patients have lower abdominal pain, lumbosacral pain, pain during menstruation, sexual intercourse or fatigue, increased on weekdays, more menstrual flow, prolonged menstruation, dysmenorrhea. May have a history of pelvic inflammatory disease and cervicitis.
2, tubal infertility signs
Check the body to see the lower abdomen pressure. Double-consultation sees the uterus backward, the activity is poor, the weight is completely fixed, the movement of the cervix or the body is painful, and the uterus can be paralyzed and the rented tube or mass is overwhelmed. Hydrosalpinx can be detained with a cystic mass and can be active without tenderness.
Examine
Tubal infertility check
(1) Fallopian tube ventilation, fluid
Compared with the rough examination method, the results are not very accurate. It can not be judged whether the fallopian tube is patency on one side or bilateral patency when the fallopian tube is unobstructed. Sometimes, when the tissue around the distal end of the fallopian tube is partially adhered, although the fallopian tube is still unobstructed, it also affects pregnancy. When the fallopian tube is filled with water, it can also contain more than 20ml of liquid to produce the illusion, and it can be judged only by the surgeon's feeling of resistance when the liquid is injected and the patient has abdominal pain. It is blind, and the gas is reversed into the blood vessel during ventilation. The risk of gas embolism, therefore, these two methods of checking the patency of the fallopian tube have been basically not used, and the liquid medicine is still used as a treatment method because of its certain therapeutic effect on salpingitis.
(2) Uterine tubal lipiodol angiography (HSG)
The results of HSG are relatively reliable and non-invasive. It is a simple and commonly used method for the examination of uterine fallopian tubes. With HSG, uterine position, uterine morphology, endometrial condition, fallopian tube morphology, fallopian tube endometrial condition and tube can be used. Whether the cavity is unobstructed or not, it is also possible to know whether there is adhesion of the tissue around the distal end of the fallopian tube according to the degree of diffusion of the contrast agent in the pelvic cavity, and to have a certain therapeutic effect on mild fallopian tube inflammation and adhesion.
(3) Tubal ultrasound patency test and hysterosalpingography
With the development of ultrasonic diagnostic technology, ultrasound-guided tubal fluid has been widely used in clinical practice. It has good sensitivity and specificity for tubal patency detection. Its superiority is simple, safe, non-invasive and time-consuming. Without being affected by radiation, it can be repeated continuously and dynamically. The liquid used was warm saline plus gentamicin, dexamethasone, -chymotrypsin and lidocaine. After the patient was treated with fluid, B-ultrasound was taken to observe the uterus filling and whether there were uterine horns on both sides. The dynamic liquid image is spread to both sides, and the presence or absence of thickening of the fallopian tube and the uterine rectum sulcus are observed. According to the liquid in the uterine cavity, the shunt and the accumulation, the image through the fallopian tube and the attachment area and the uterus rectal fossa Combined with the clinical judgment of resistance, reflux and other factors during the injection, it can accurately diagnose the tubal patency. The method of uterine fallopian tube contrast-enhanced ultrasound is the same as that of the fallopian tube ultrasound patency test, except that 1.5% hydrogen peroxide is added into the uterine cavity as a contrast agent in the liquid used for the fluid, and the intrauterine fluid, gas filling and operation through the fallopian tube are observed by ultrasound. The dynamic image of the bubble overflow can accurately determine the smoothness of the fallopian tube, and sometimes the process of change from obstruction to patency can be observed. Therefore, hydrogen peroxide fallopian tube angiography can improve the smoothness of the fallopian tube and the diagnostic accuracy of the obstruction site.
Diagnosis
Diagnosis and diagnosis of tubal infertility
1, the patient can have no obvious discomfort, but with primary or secondary infertility. Some patients have lower abdominal pain, lumbosacral pain, pain during menstruation, sexual life or fatigue, increased on weekdays, prolonged menstruation, more menstrual flow, dysmenorrhea. May have a history of pelvic inflammatory disease and cervicitis.
2, imaging examinations mostly with B-ultrasound, mainly with old ectopic pregnancy, endometriosis, ovarian cysts.
3, the symptoms of tubal infertility are: the fallopian tube infertility patients can be seen in the lower abdomen tenderness. Double-combination sees the uterus backward, the activity is poor, the weight is completely fixed, the movement of the cervix or pain, the bladder can be thickened with the oviduct or mass, there is tenderness. Hydrosalpinx can be detained with a cystic mass and can be active without tenderness.
