Interventional surgery for blocked fallopian tubes

Interventional operation is the use of ultrasound, computed tomography (CT), nuclear magnetic resonance (MRI), X-ray, laparoscopy and other modern medical imaging technology to perform targeted surgery on the organs and tissues of the lesion for diagnosis and treatment. purpose. The law has now become an indispensable part of comprehensive treatment. Due to its advantages of micro-trauma, accurate positioning, safety and effectiveness, and fewer complications, it has developed rapidly in the past 20 years. Generally divided into two major categories of vascular interventional surgery and non-vascular interventional surgery. Curing disease: Indication 1, fallopian tube obstruction caused by chronic salpingitis, tubal tuberculosis, fallopian tube endometriosis and other diseases. 2, fallopian tube angiography confirmed with or without adhesions, distortion or intra-articular debris in the fallopian tube, concentrated mucus fine fiber filaments caused obstruction. 3, angiography can be used to flush the contrast agent, but because the hydrostatic pressure of the uterine cavity is quite large, the passage to the fallopian tube is weak, so this dredge is more fragile. 4. It has been reported that the patients with obstruction of the tubal interstitial to the estuary junction have the best efficacy. Contraindications 1, iodine allergy. 2, acute attacks of genital tract inflammation, should first carry out anti-inflammatory treatment. 3, fever with systemic symptoms. 4, menstrual period. 5, severe heart failure. 6, active tuberculosis. 7, after tubal ligation. 8, tuberculous tubal obstruction, severe occlusion of the uterine horn scar, severe hydrops of the fallopian tube umbrella is a relative contraindication. Surgical procedure 1, routine disinfection vulva, vagina, disinfection towel. 2. The patient takes the bladder lithotomy position. 3, cannula can be performed under fluoroscopy, B-ultrasound, hysteroscopy. 4, simple catheter-guided method with the aid of a vasodilator tube, a 3F polyethylene catheter, the front end of the hook shape, the head gently into the opening of the fallopian tube, and then gently forward slowly, through the catheter test A contrast agent is injected to confirm that the catheter head is in the obstruction of the fallopian tube. Then send a straight wire with a diameter of 0,018in into the fallopian tube, and push forward slowly to gradually clear the lumen of the adhesion. 5, vacuum suction cup catheter guiding method According to the size of the cervix, select the corresponding type of cervical suction cup, put it on the cervix, form a negative pressure to make the cup and the cervix tightly combined. Straighten the uterus and insert the 5, 5F catheter through the suction cup catheter to the corner of the palace. Then insert the 3F catheter and the 0,015in guide wire into the obstruction of the fallopian tube, and slowly advance to make the fallopian tube recanal. 6. The catheter-guided catheter has a spherical front end and contains a metal ball that can be marked under fluoroscopy. Transvaginal, cervix into the uterine cavity, the bulbous end of the catheter naturally bends into the opening. A 2F or 3F catheter and a 0,015in guidewire were used, and the bulbous end catheter was inserted into the fallopian tube obstruction. 7. The balloon catheter guiding method consists of a DBH-100 double balloon and an FTC-500 catheter. First insert the double balloon catheter into the cervix, and inject two balloons into the gas or liquid in the inner and outer cervix to fix the catheter. The 5,5F catheter was inserted through the double balloon catheter into the uterine horn, and the 3F catheter was used with 0.15in guide wire for interventional surgery. 8. After the oviduct is dredged for 10 minutes, it can be injected with antibiotics or traditional Chinese medicine preparations (combination of drugs for clearing away heat and detoxifying and promoting blood circulation and removing blood stasis) to improve the curative effect. complication 1. Postoperative abdominal pain Caused by the manipulation of different types of catheters, the degree of pain caused by different types of catheters is also related to the severity of tubal obstruction. 2, fallopian tube inflammation Generally less common, manifested as pain or fever in the basin. The reason for the analysis is that the fallopian tube is recanalized, and a potentially infected fallopian tube segment is opened, which is considered to be the reactivation of the original lesion. Therefore, routine examination and control of inflammation before treatment. 3. Chemical complications Contrast agents or drugs may stimulate the oviduct mucosa to cause inflammatory edema, or iodine allergic reactions. 4, pay attention to the radiation dose During interventional therapy, the doctors and patients are exposed to the X-ray radiation field and receive the dose prescribed by the International Commission on Radiological Protection. The dose is 0,014msV during normal operation. Therefore, the dose is strictly controlled during the operation. 5, tubal pregnancy The proportion of tubal pregnancy after tubal obstruction is close to 10%, and the proportion of microsurgical fallopian tube anastomosis is 3% to 20%, which is common in the ampulla of the fallopian tube and slightly far from the proximal intubation. 6, fallopian tube perforation Generally less, there are individual reports below 10%. The analysis is related to the original disease state and operation technique of the fallopian tube, and generally has no adverse consequences. If the platinum soft guide wire is used, the operation is gentle and can be avoided.

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