Fallopian tube stenosis
Introduction
Introduction to tubal stenosis Tubal stenosis is one of the pathological changes caused by chronic pelvic inflammatory disease (mainly salpingitis). In addition to causing physical and mental discomfort to the patient, the biggest impact is that it may lead to infertility and ectopic pregnancy. When chronic salpingitis occurs, it often causes tubal enlargement, partial or complete atresia of the fallopian tube, and adhesion to surrounding tissues to form scar adhesion, tubal distortion, stenosis or atresia, and formation of hydrosalpinx or empyema, and Pelvic congestion or pelvic fluid or empyema. Because tuberculosis is a destructive disease, after tubal tuberculosis, the tissue will be destroyed, about 1/3 is tubal pregnancy (a type of ectopic pregnancy), even if cured, the lesions often form calcification or scar, leading to the lumen Stenosis, which seriously affects fertility, is one of the common causes of infertility in women. basic knowledge The proportion of illness: 0.24% Susceptible people: women Mode of infection: non-infectious Complications: endometriosis ectopic pregnancy infertility
Cause
Causes of fallopian tube stenosis
Fallopian tube empyema (24%):
There are also tubal stenosis caused by the fallopian tube empyema. The pus cells and necrotic tissues in the lumen were decomposed and cleared by phagocytic cells, and the pus gradually turned into a clear water sample.
Tubal ligation (20%):
Oviductal stenosis may also form after long-term fallopian tube ligation. There are also tubal stenosis caused by inflammation of the fallopian tube, but secondary to tubal sterilization.
Fallopian tube inflammation (20%):
When chronic salpingitis occurs, the umbrella end of the fallopian tube can be blocked by inflammation, and the leakage and exudate in the lumen of the fallopian tube gradually accumulate.
The fallopian tube is one of the important components of the female reproductive system. It is a pair of slender and curved pipes. The inner side is connected to the uterine horn and the outer end is free. It is similar to the ovary and has a total length of about 8-14 cm. It has the functions of transporting sperm, eggs and fertilized eggs as well as providing sperm storage, capacitation, acrosome reaction and fertilization sites. The fallopian tube is 6-15 cm long and consists of mucosa, ring smooth muscle and serosa. The umbrella part, the ampulla, the isthmus and the interstitial part are connected between the ampulla and the isthmus, and the ampulla and the interstitial part are called the uterus and the fallopian tube. The wall of these joints is thicker and the lumen changes greatly.
The fallopian tube is the place where the egg meets the sperm. The egg discharged from the ovary is sucked into the fallopian tube by the end of the fallopian tube, and stays in the tube for fertilization. The sperm passes from the vagina through the cervix and the uterus to the fallopian tube and the egg meets to form the fertilized egg. After that, the fertilized egg is moved from the fallopian tube to the uterine cavity by means of the fallopian tube peristalsis and cilia, and returns to the uterine cavity for implantation.
Some tubal stenosis can be treated surgically, but if the surgery is unlikely or the surgery is unsuccessful, in vitro fertilization can be used. The operation of the fallopian tube is large and requires general anesthesia. The operation time often takes several hours and needs to be done with a microscope. If the obstruction is in the interstitial part (near the uterus), the surgical success rate is 45%; if it is blocked in the umbrella (near the ovarian end), the success rate is 20%-25%. After most fallopian tube surgery, the risk of ectopic pregnancy increases.
There are many reasons for tubal stenosis, although it can be caused by tubal dysplasia, endometrial transposition in the fallopian tube or polyp in the fallopian tube, but the main cause is caused by inflammation of the fallopian tube. There are two common types of inflammation: The type is suppurative fallopian tube stenosis, mostly caused by inflammation during childbirth, abortion or surgery, or due to inflammation of adjacent organs, such as appendicitis and peritonitis. The other is tuberculous fallopian tube stenosis, mostly due to the spread of tuberculosis and peritoneal tuberculosis.
pathology:
Fallopian tube stenosis, the name of modern medical disease. The combination of Chinese and Western medicine is also commonly used today. It is a more common type of chronic fallopian tube inflammation. After salpingitis, or due to adhesion and atresia, the secretion of mucosal cells accumulates in the lumen, or due to the isthmus and umbrella end adhesion due to tubal stenosis, obstruction forms the fallopian tube empyema, when the pus cells in the lumen are absorbed, It eventually becomes a watery liquid. Some fluids are absorbed and leave an empty shell, which shows a narrow shadow when used for angiography.
When tubal stenosis occurs, it often causes swelling of the fallopian tube, partial or complete atresia of the fallopian tube, and adhesion to the surrounding tissue to form scar adhesion, tubal distortion, stenosis or atresia, and formation of hydrosalpinx or empyema, and Pelvic congestion or pelvic fluid or empyema. All of the above lesions can affect the operation of fertilized or fertilized eggs.
Fallopian tube stenosis is more common in women with unclean sex, and can also be caused by bacterial infection during childbirth or abortion. Bacteria enter the fallopian tube through the vagina, cervix, and uterine cavity, usually bilateral infection of the fallopian tube, but often the lesion of one side of the fallopian tube is heavy, and the infection can spread into the abdominal cavity, causing peritonitis. Pathogens are generally mixed infections of aerobic and anaerobic bacteria.
Prevention
Prevention of tubal stenosis
1) When artificial abortion, childbirth, intrauterine device, and other intrauterine operations are required, strict disinfection should be carried out to avoid the bacteria from being brought into the vagina and uterus by surgery, causing infection.
2) Women should pay attention to their own nutrition and health care, strengthen the nutrition during menstruation, post-abortion, and after childbirth, enhance their physical fitness, increase their resistance, immunity, and reduce the chance of illness.
3) When women are sexually active, they should pay attention to the personal hygiene of themselves and their sexual partners. Before the trip, it is necessary to clean the external genitalia of both men and women to prevent the smooth invasion of germs. When women have bleeding symptoms in the vagina, they should refrain from sexual life.
4) Women should pay attention to their own vulva hygiene and personal hygiene, pay attention to prevent infection from sanitary ware and toilets.
5) Female patients with acute tubal stenosis should take a semi-recumbent rest to prevent and limit the flow of inflammatory fluids due to changes in body position. Eat high-nutrient, digestible, vitamin-rich foods.
6) Once a woman has an attachment disease, she should abide by the principle of treatment, take a positive attitude, thoroughly treat, and control the condition as soon as possible to prevent chronic changes.
Complication
Tubal stenosis complications Complications Endometriosis ectopic pregnancy infertility
1, ovulation disorders: due to excessive mental stress, systemic diseases such as hyperthyroidism, polycystic ovary syndrome, prolactinemia, hyperandrogenism, ovarian failure and so on.
2, the fallopian tube is not smooth or dysfunctional: often due to inflammation, tuberculosis or endometriosis. Caused by tubal ligation.
3, uterine factors: endometrial tuberculosis, intrauterine adhesions, uterine submucosal fibroids, uterine polyps, endometritis and other effects on the implantation of fertilized eggs.
4, cervical factors: chronic cervicitis, cervical polyps, uterine stenosis and so on.
5, endometriosis: patients are easy to merge with infertility.
6, unexplained infertility: 10% of infertile couples can not find abnormalities through various examinations.
Fallopian tube stenosis causes swelling of the fallopian tube, part of the fallopian tube is completely or completely blocked, and adhesion to the surrounding tissue to form scar adhesion, stenosis, tubal distortion or atresia, and the formation of tubal empyema or stagnant water, and pelvic congestion or pelvic fluid Or empyema. All of the above lesions can affect the operation of fertilized or fertilized eggs, in addition to bringing physical and mental discomfort to the patient, the biggest impact is that may lead to infertility and ectopic pregnancy.
Symptom
Symptoms of fallopian tube stenosis Common symptoms Chronic pelvic pain tubal adhesions Fallopian tube enlargement Vagina outflow yellow or... Vaginal secretions increase female infertility abdominal pain
Abnormalities of tubal development and stenosis are rare, and are not easy to be found. They often coexist with genital dysplasia, leading to infertility or ectopic pregnancy. Fallopian tube stenosis is mainly manifested in the following aspects in clinical practice.
Loss of the fallopian tube, loss of one fallopian tube and monocular uterus simultaneously, due to the failure of the early stage of the embryonic Mullerian tube. True orthotopic malformation may not form the fallopian tube on the testis or the ovary. Because the supporting cells of the testis tissue are affected by the HY antigen in the early stage of embryonic differentiation, the anti-Mullerian tube factor is produced, so that the ipsilateral Mullerian tube cannot form or inhibit its differentiation and development. Bilateral fallopian tubes are absent, and most of them coexist with congenital absence of uterus or only residual uterine malformations. Because the bilateral Mullerian tube is not formed or the development is blocked.
Tubal dysplasia The fallopian tube is slender, the muscle layer is weak, the contraction force is poor, and the sperm, egg or fertilized egg is transported slowly, and it is prone to infertility or ectopic pregnancy. A solid fallopian tube with a partial or no lumen of the fallopian tube. The double or fallopian tube or the unilateral double fallopian tube may enter the uterine cavity, or there may be a small uterus called the parasitic fallopian tube. The cause is unclear. In the embryonic development, the middle and middle kidney tubes are pierced to form a plurality of fallopian tubes. The fallopian tube diverticulum tubal diverticulum is more likely to occur in the ampulla. It is prone to tubal pregnancy.
Patients with salpingitis may have fever in the acute phase (body temperature can be up to 39 °C), chills and abdominal pain, nausea and vomiting, increased vaginal discharge and even purulent secretions with odor, or frequent urination, dysuria, bloating, diarrhea. Laboratory tests can increase white blood cells. In the chronic phase, the abdominal and lumbosacral pains are the main symptoms. When the menstrual period or sexual life is aggravated, the vaginal discharge increases, and local tissue hyperplasia can be caused. During the gynecological examination, one or both sides of the fallopian tube can be thickened, even touching the inflammation. Sexual mass and tenderness.
Examine
Tubal stenosis examination
Congenital malformations of the fallopian tube are not easy to be found. The first reason is that they are often neglected with congenital malformations of the reproductive tract, and the second is deep in the pelvic side. Commonly used diagnostic methods, uterine fallopian tube angiography found unilateral fallopian tube or double fallopian tube. Abdominal examination may reveal various malformations. A laparotomy can provide a clearer diagnosis.
Diagnosis
Diagnosis and differentiation of fallopian tube stenosis
First, the fallopian tube fluid (ventilation)
The tubal fluid (ventilation) has a large blindness. It is judged only by the surgeon and the patient's feeling. It has certain subjectivity, and the method can not judge the function and shape of the fallopian tube. In 1984, Richmen et al. pioneered the use of ultrasound diagnostic techniques to examine tubal patency. In recent years, tubal perfusion under ultrasound has been widely used in clinical applications. Under the ultrasound, the tubal fluid is under the ultrasound monitoring, and the sound changes of the bubbles or liquids flowing through the fallopian tubes after the injection of liquid are observed to provide a reliable judgment. . The advantages are:
1. Most scholars believe that ultrasound diagnosis of tubal patency has better sensitivity and specificity. Heikinen et al. reported that the ultrasonographic tubal patency was close to the total compliance rate of laparoscopic fluid examination, and ultrasound diagnosis of uterine attachment was made. This aspect is superior to uterine tubal lipiodol angiography (X-HSG) under TV fluoroscopy.
2, the saline used for the fluid is safe, no allergic or embolism and other adverse reactions, no damage to the fallopian tube mucosa and uterus.
3, can reduce the blindness of traditional liquid.
4. Ultrasound examination of radiation damage and iodine allergy compared with HSG.
The disadvantage is that the pelvic cavity is not as clear as the laparoscope, and the exact location of the fallopian tube and obstruction cannot be clearly indicated. Ultrasound diagnosis is also difficult when the fallopian tubes are stuck and cause distortion. Sometimes ultrasound can't observe the whole appearance of the fallopian tube on a scanning plane, and can't display the dynamic process, so it is not easy to get a satisfactory image.
However, in general, the technique of diagnosing tubal patency under ultrasound is more accurate, safe, and easy to operate. This test can be used as the first choice for primary screening of tubal patency, especially in infertility treatment centers with concentrated disease sources. It meets the needs of outpatient diagnosis quickly and is worthy of clinical application.
Second, uterine tubal iodine angiography (HSG)
Uterine tubal lipiodol angiography is simple to operate, and can directly look at the internal structure and morphology of the uterus and fallopian tubes under the screen. The advantages are:
1, the diagnosis is rapid, accurate, intraoperative can determine the cause of the uterus or the cause of the fallopian tube, the location is exact. Studies have shown that HSG judges that the obstruction site is superior to laparoscopy.
2, can increase the pressure under direct vision to separate mild intrauterine adhesions.
3, safety, due to direct operation, you can find accidents during surgery, such as iodized oil into the blood vessels, lymph, stop injection in time to prevent oil plugs from causing adverse consequences.
However, the contrast agent (such as lipiodol) used in the treatment has a large adverse reaction, which is easy to stimulate the mucosa to cause allergy, and the oily contrast agent is thick and difficult to pass through the narrow part of the fallopian tube, and it is difficult to judge the infarction site.
Third, hysteroscopy
Hysteroscopy can directly look at the uterine cavity shape and the opening of the fallopian tube, directly intubate the fluid, avoid the drawbacks of blind fluid, overcome the fallopian tube fistula, and observe the dredge at any time. And because hysteroscopic tubal intubation can be inserted into the tubal interstitial 4-Smm, it can mechanically drench the uterine horn and interstitial infarction, plus direct compression on the fallopian tube. It acts as a separation for mild obstruction. Therefore, hysteroscopy is the most reliable method for diagnosing tubal interstitial obstruction.
Fourth, laparoscopic
With the continuous advancement of medical technology, laparoscopic surgery has made the diagnosis of tubal infertility less traumatic and more accurate. Laparoscopy can directly look at the pelvic organs, comprehensively, accurately and timely to determine the nature and extent of the lesions and the size of the lesions: puncture injections are carried out under direct vision, more accurate. Under the microscope, the degree of tubal patency can be observed. At the same time, the fallopian tube can be irrigated, and the membranous adhesion of some umbrella ends can be separated, which avoids the pain of laparotomy and also plays an active therapeutic role. It is recommended by WHO. One of the best means of routine examination of infertile women but requires anesthesia, trauma, high technical equipment requirements, and complications, such as gas embolism, subcutaneous emphysema, intraoperative bleeding.
Five, other
There are also methods such as B-ultrasound combined with uterine cavity, hysteroscopy and laparoscopy in the treatment of infertility. B-superconductor hysteroscopic fluid-passing is a relatively new and effective method in the 1980s, especially for the diagnosis and dredge of proximal tubal obstruction. It can directly observe whether there are liquid dark areas in the fallopian tube and the presence or absence of effusion and its changes in the uterus rectum, and can find the fallopian tube stenosis in time, avoiding the illusion of smoothness and timely aggravating the fallopian tube stenosis, while hysteroscopy and abdominal cavity Mirror combined diagnosis and treatment of tubal infertility is a more advanced diagnosis and treatment method, and the recanalization rate of tubal obstruction is high, and it needs to be further promoted and applied nationwide.
