blocked fallopian tubes
Introduction
Introduction to tubal obstruction Most of the fallopian tube obstruction is caused by inflammation. The most common causes are infection. There are general bacterial infections and special pathogen infections, such as Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Protozoa and so on. According to the location, it was divided into proximal tubal obstruction, middle tubal obstruction and distal fallopian tube obstruction. The degree of obstruction is divided into incomplete obstruction of the fallopian tube and complete obstruction of the fallopian tube. In general, there are no typical symptoms, the most common manifestation is infertility. The fallopian tube plays an important role in transporting sperm, ingesting eggs and transporting fertilized eggs to the uterine cavity. Oviduct obstruction blocks the passage of sperm and fertilized eggs, resulting in no Pregnancy or ectopic pregnancy, if it is caused by pelvic inflammation of the fallopian tube obstruction, may be associated with lower abdominal pain, low back pain, increased secretions, sexual pain. The fallopian tube inflammation that causes obstruction of the fallopian tube is mainly chronic inflammation. Therefore, most of the drugs are treated with drugs, especially traditional Chinese medicine, and the effect is excellent. basic knowledge Sickness ratio: 0.1% Susceptible people: women Mode of infection: non-infectious Complications: irregular menstruation, infertility
Cause
Causes of fallopian tube obstruction
There are three types of tubal blockage:
The first type is that the fallopian tube is not smooth, causing the tube debris, exfoliated cells or blood clots to block; or the fallopian tube is too thin and curved; or the fallopian tube adheres to the basin wall and adjacent organs, pulling the fallopian tube activity. Treatment can be performed using a laparoscope. For the adhesion outside the tube, it can also be cut and decomposed by laparoscopy to "unbundle" the fallopian tube. After treatment, most patients can become pregnant.
In the second case, the fallopian tube is occluded and the damage is mild, but most of the fallopian tubes are normal. In this case, tubal dredge or 24-hour catheterization can be performed by combined laparotomy. If there is water in the fallopian tube, you can open a mouth on it, let go of the liquid and suture it to prevent re-adhesion. In general, the surgical effect is better, and the success rate can reach more than 90%.
In the third case, the fallopian tube is completely impassable and the lesion is severe. This situation is mostly caused by long-term delay in treatment or tubal tuberculosis infection, due to scar formation, contracture, stiffness, and irreversible changes in function of the fallopian tube. Even if the dredge is successful, it is difficult to naturally conceive. It is generally necessary to perform IVF after pregnancy.
Causes of tubal blockage:
Gynecological inflammation (25%):
Such as vaginitis, cervicitis, pelvic inflammatory disease, salpingitis, annex inflammation, etc., often because these gynecological inflammation has not been treated in time or treatment is not complete, the condition is not cured. Due to long-term inflammatory stimulation, the fallopian tube is congested and edema, thickened, hardened, luminal adhesion, stenosis and blockage, resulting in tubal occlusion infertility.
Abortion (25%):
Abortion is the main cause of blockage of the fallopian tubes. Due to mechanical stimulation, improper operation or abortion in abortion, it often leads to various inflammatory infections in women. With the successive invasion of various pathogenic bacteria, the uterus spreads to the pelvic cavity and fallopian tubes, causing infection of the fallopian tubes. , causing blockage of the fallopian tubes.
Long-term vaginal bleeding (25%):
Often due to gynecological tumors, dysfunction, uterine lesions and other reasons lead to menorrhagia, long menstrual period, menstrual leaching, or even two months of menstruation and other irregular vaginal bleeding, but not timely treatment, over time, secondary inflammation Infection, resulting in ulceration, adhesion, and blockage of the inner wall of the fallopian tube.
Unclean sex life (10%):
Unclean sex is the fuse of many diseases. Patients often suffer from various diseases such as gynecological diseases and sexually transmitted diseases due to unclean sex. These diseases are secondary to tubal inflammation, which causes blockage of the fallopian tubes to varying degrees.
Other factors (15%):
Such as fallopian tube endometriosis, abdominal surgery, appendicitis surgery, access to birth control rings, tuberculosis, etc., can cause secondary infection of the fallopian tube, resulting in congestion of the fallopian tube wall, edema, adhesion and blockage.
Prevention
Fallopian tube obstruction prevention
prevent disease
(1) Pay attention to the cleanliness of the reproductive system and prevent the infection of various pathogens (especially sexually transmitted diseases). The most important ones are artificial abortion, childbirth, placement of intrauterine devices, and other intrauterine operations. Strict disinfection, avoid inappropriate uterine operation, avoid unclean sex life, avoid menstruation in the same room, repeated tubal fluids and so on.
(2) Actively cure tuberculosis and lymphatic tuberculosis to prevent infection of pelvic tuberculosis.
(3) Once a woman has an attachment disease, she should abide by the principle of treatment, adopt a positive attitude, thoroughly treat, and control the condition as soon as possible to prevent chronic changes.
(4) Strengthen exercise and enhance disease resistance.
Complication
Tubal obstruction complications Complications, irregular menstruation, infertility
Irregular menstruation
The fallopian tube is adjacent to the ovary. When the fallopian tube inflammation affects the ovaries, it will cause different degrees of damage to the ovarian function, resulting in abnormal menstruation. Among them, the frequency of menstruation and excessive menstrual flow are the most common.
Infertility
The fallopian tube plays an important role in transporting sperm, ingesting eggs and transporting fertilized eggs to the uterine cavity. When the fallopian tube is damaged by the disease, it forms a blockage, hindering the passage of sperm and fertilized eggs, leading to infertility.
Symptom
Tubal obstruction symptoms Common symptoms Fallopian tube distorted sexual intercourse pain Diffuse lower back pain Female infertility Vaginal secretions increased lower abdominal pain Abdominal discomfort
In general, there are no typical symptoms, the most common manifestation is infertility. The fallopian tube plays an important role in transporting sperm, ingesting eggs and transporting fertilized eggs to the uterine cavity. Oviduct obstruction blocks the passage of sperm and fertilized eggs, resulting in no Pregnancy or ectopic pregnancy, if it is caused by pelvic inflammation of the fallopian tube obstruction, may be associated with lower abdominal pain, low back pain, increased secretions, sexual pain.
1, infertility: the fallopian tube itself is affected by the disease, resulting in obstruction and infertility, secondary to infertility is more common.
2, dysmenorrhea: due to pelvic congestion caused by blood stasis dysmenorrhea, mostly in the first week before menstruation, there is abdominal pain, the closer to the menstrual period, the more menstrual cramps.
3, other: such as increased vaginal discharge, painful intercourse, gastrointestinal disorders, fatigue, labor affected or not durable, mental symptoms and depression.
4, abdominal discomfort: the lower abdomen has different degrees of pain, mostly hidden discomfort, waist and back pain and abdomen, swelling, falling feeling, often exacerbated by fatigue. Due to pelvic adhesions, there may be bladder, rectal filling pain or pain when emptying, or other bladder rectal irritation symptoms, such as frequent urination, urgency and so on.
5, irregular menstruation: the fallopian tube and the ovary adjacent, the general fallopian tube disease does not affect the function of the ovary, the amount of menstrual flow has no effect, but when the inflammation affects the ovarian function of the ovary damage, menstrual abnormalities will occur.
Examine
Tubal obstruction examination
1. Fallopian tube fluid :
It is injected into the uterine cavity from the cervix by using methylene blue solution or normal saline, and then flows into the fallopian tube from the uterine cavity. According to the magnitude of the resistance when the drug is injected and the reflux of the liquid, it is judged whether the fallopian tube is unobstructed. Because of the advantages of simple equipment, simple operation and low price, the method of tubal fluid inspection was widely used before the 1980s. However, because the whole process relies on the doctor's subjective sensory judgment, and can not judge the location of the fallopian tube blockage, the tension during the examination will lead to fallopian tube paralysis, resulting in false positives. In recent years, surgery can be performed under ultrasound monitoring, which improves the accuracy, but In the actual clinical work, it is found that the method has a high rate of misdiagnosis, so it is not an ideal check.
2. Hysterosalpinography (HSG):
It has been used in the 1920s to inject high-specific gravity substances (such as iodine, diatrizoate, etc.) composed of high atomic number into the uterine cavity through the cervical canal, and form an X-ray film with surrounding tissues. Obvious artificial contrast, visualization of the lumen, can be found in fallopian tube occlusion, fallopian tube motor function, mucosal damage caused by previous infection or fallopian tube endometriosis, hydrosalpinx, tubal isthmus nodules, adhesions and fallopian tube abnormalities (such as attachment Valves and diverticula) are quick, economical and less dangerous to check. The sensitivity of HSG to fallopian tube occlusion and adhesion is 65%, but pain-causing fallopian tube fistula can cause false positives, and pain, infection, and contrast agent invasion into the vascular system are rare complications.
3. Fallopian tube mirror :
It is a method for imaging the intraluminal structure of the fallopian tube. It is necessary to apply a rigid fallopian tube mirror to evaluate the entire length of the fallopian tube and the mucosa and patency of the whole fallopian tube. The fallopian tube is feasible during the examination. Recanalization, therefore, has a potential therapeutic effect on proximal tubal obstruction, but the fallopian tube mirror has higher requirements on technology and equipment, so the current use is not very extensive, in addition, fallopian tubeoscopy can also enter through the transvaginal water-filled laparoscopic path. Abdominal cavity.
4. Laparoscopy :
Injecting methylene blue into the uterine cavity through the uterine catheter, and observing the urinary cavity of the fallopian tube through the laparoscopic laparoscopic cavity, which is smooth; if there is blockage of the proximal end of the fallopian tube (the tubal interstitial and isthmus), then the Meilan fluid is not seen. The fallopian tube end of the fallopian tube overflows into the abdominal cavity. If the distal end of the fallopian tube is blocked (the ampulla of the fallopian tube and the umbrella part), the umbrella end of the fallopian tube and the ampulla are enlarged and blue-stained, but no blue fluid flows from the end of the fallopian tube and flows into the abdominal cavity. Laparoscopy can directly observe the adhesion of the fallopian tube obstruction and its surrounding adhesion and can separate the adhesion treatment. It is the gold standard for the diagnosis of fallopian tube obstruction, but it needs general anesthesia and needs surgery. It is not commonly used at present. It is only used for tubal fluid. Or angiography suggests patients with abnormal fallopian tubes.
5. Water injection laparoscope :
It is a new technology developed in recent years. It uses a small endoscope to probe the entire pelvic cavity from the posterior iliac crest. During the operation, the patient is required to take a bladder lithotomy position. The water-soluble bulking agent used in the examination can sufficiently expose the structure of the uterus and the fallopian tube-ovary at the back view. During the entire operation, the ovaries and fallopian tubes are always in suspension due to continuous infusion of saline. The advantage of this technique is that it may be used in outpatient clinics and is more minimally invasive; the disadvantage is that it cannot assess the condition of the entire abdominal cavity and pelvis, in addition to the possibility of damaging the intestine, with an incidence of about 0.65%.
Diagnosis
Diagnosis and differentiation of fallopian tube obstruction
Diagnostic criteria
Medical history and physical examination can reveal important risk factors, with the aim of focusing on the underlying causes listed above, as well as physical examinations. The guiding questions outline the relevant aspects of the patient's medical history.
Physical examination should check the signs of infection, should check for cervicitis, carefully check the signs of PID including cervical lift pain and attachment pain; leucorrhea should not be ignored, cervical secretion culture is a good choice; Or patients with nodular signs of endometriosis should undergo a rectal vaginal examination; if the patient has had the disease, the examination of chlamydial antibody (CAT) should be performed, and many studies support the relationship between CAT and fallopian tube disease. The sensitivity and specificity of sexual analysis were 92% and 70%, respectively.
