不同部位输卵管不孕的临床循证治疗_West China Medical Journal

Authors：

许旭 ,  许良智

Corresponding author：

许良智, Email: liangzxu@126.com

Keywords：

输卵管疾病; 不孕; 循证治疗

DOI：

10.7507/1002-0179.20130301

Video：

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近年来，据WHO统计不育夫妇占已婚年龄夫妇的7%～15%，其中女方因素占40%，主要包括排卵障碍、输卵管因素、子宫因素及宫颈因素，输卵管疾病所致的不孕占25%～35%，其中输卵管阻塞占输卵管疾病的80%。根据阻塞部位的不同可分为近端输卵管不孕和远端输卵管不孕。近端输卵管不孕治疗方法包括选择性输卵管造影和经宫颈插管、输卵管子宫植入、绝育后复育者的输卵管吻合术、辅助生育技术；远端输卵管不孕治疗方法包括外科手术治疗、输卵管通液及辅助生育技术。此外，中医及物理治疗可作为输卵管不孕的辅助治疗。但近几年并无有关以上各种治疗方法妊娠率及临床疗效比较的报道，临床决策仍有一定困难。本文根据近年有关输卵管不孕不同治疗方法的相关临床研究证据，对其效果及妊娠率进行综述，以期全面了解各种治疗方案的优略。

Citation： 许旭,许良智. 不同部位输卵管不孕的临床循证治疗. West China Medical Journal, 2013, 28(6): 963-966. doi: 10.7507/1002-0179.20130301 Copy

1.	黄茜, 邹彦, 刘峰.女性不孕症病因及相关因素的研究进展[J]. 检验医学与临床, 2011, 8(3): 332-334.
2.	Zarei A, Al-Ghafri W, Tulandi T. Tubal surgery[J]. Clin Obstet Gynecol, 2009, 52(3): 344-350.
3.	许良智, 胡丽娜主编妇产科疾病临床循证治疗手册[M].第1版. 北京: 人民卫生出版社2008: 332-345.
4.	Tanaka Y, Tajima H. Falloposcopic tuboplasty as an option for tubal infertility: an alternative to in vitro fertilization[J]. Fertility and sterility, 2011, 95(1): 441-443.
5.	Allahbadia GN, Merchant R. Fallopian tube recanalization: lessons learnt and future challenges[J]. Women’s health, 2010, 6(4):531-549.
6.	Verma A, Krarup K, Donuru A. Selective salpingography and fallopian tube catheterization by guidewire[J]. J Obstet Gynaecol , 2009, 29(4): 315-317.
7.	Vardhana PA, Silberzweig JE,Guarnaccia M,et al. Hysterosalpingography with selective salpingography[J]. J Reprod Med, 2009, 54(3): 126-132.
8.	Rahimunnisa S, Tanwar R, Prasad S,et al.Ultrasound versus tactile cannulation in the treatment of proximal tubal obstruction[J]. Int J Gynaecol Obstet , 2009, 106(3): 216-217.
9.	Al-Jaroudi D, Herba MJ, Tulandi T. Reproductive performance after selective tubal catheterization[J]. J Minim Invasive Gynecol, 2005, 12(2): 150-152.
10.	Li Qy, Zhou XL,Qin HP ,et al. Analysis of 1006 cases with selective salpingography and fallopian tube recanalization[J]. Zhonghua Fu Chan Ke Za Zhi, 2004, 39(2): 80-82.
11.	冯长征, 郭庆禄, 叶志球, 等. 选择性输卵管造影和输卵管阻塞介入再通治疗[J]. 江西医学院学报, 2009, 49(12): 58-59.
12.	Papaioannou S, Afnan M, Girling AJ, et al. Long-term fertility prognosis following selective salpingography and tubal catheterization in women with proximal tubal blockage[J]. Hum Reprod, 2002, 17(9): 2325-2330.
13.	张帝开, 李艳秋, 李秀云, 等. 药物黏堵绝育术后近端输卵管闭塞的手术复通效果分析[J].中华妇产科杂志, 2007, 42(2): 120-123.
14.	Awartani K, McComb PF. Microsurgical resection of nonocclusive salpingitis isthmica nodosa is beneficial[J]. Fertil Steril, 2003, 79(5): 1199-1203.
15.	Dubuisson JB, Chapron C, Ansquer Y, et al. Proximal tubalocclusion: is there an alternative to microsurgery[J]? Hum Reprod, 1997, 12(4): 692-698.
16.	Dharia Patel SP, Steinkampf MP, Whitten SJ, et al. Robotic tubal anastomosis: surgical technique and cost effectiveness[J]. Fertil Steril, 2008, 90(4): 1175-1179.
17.	Bissonnette F, Lapensee L, et al.Bouzayen R. Outpatient laparoscopic tubal anastomosis and subsequent fertility[J]. Fertil Steril, 1999, 72(3): 549-552.
18.	Yoon TK, Sung HR, Cha SH, et al. Fertility outcome after laparoscopic microsurgical tubal anastomosis[J]. Fertil Steril, 1997, 67(1): 18-22.
19.	Tan HH, Loh SF. Microsurgical reversal of sterilisation-is this.still clinically relevant today[J]? Ann Acad MedSingapore, 2010, 39(1): 22-26.
20.	Rodgers AK., Goldberg JM, Hammel JP, et al. Tubal anastomosis by robotic compared with outpatient minilaparotomy[J]. Obstet Gynecol ,2007,109(6):1375-1380.
21.	Farhi J, Ben-Haroush A, Lande Y, et al. Role of treatment with ovarian stimulation and intrauterine insemination in women with unilateral tubal occlusion diagnosed by hysterosalpingography[J]. Fertil Steril, 2007, 88(2): 396-400.
22.	Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted Conception[J/OL]. Cochrane Database Syst Rev, 2008, 8(4): 1-51 CD006920[2012-7-28]http://www.ncbi.nlm.nih.gov/pubmed/18843737.
23.	Checa MA, Alonso-Coello P, Sola I,et al. IVF/ICSI with or without preimplantation genetic screening for aneuploidy in couples without genetic disorders a systematic review and meta-analysis[J]. J Reprod Genets, 2009, 26(5): 273-283.
24.	Ahmad G, Watson AJ, Metwally M, et al. Laparoscopy or laparotomy for distal tubal surgery? A meta-analysis[J]. Hum Fertil(Camb), 2007, 10(1): 43-47.
25.	Mossa B, Patella A, Ebano V, et al. Microsurgery versus laparoscopy in distal tubal obstruction hysterosalpingographically or laparoscopically investigated[J]. Clin Exp Obstet Gynecol, 2005, 32(3): 169-171.
26.	Ahmad G, Watson A, Vandekerckhove P, et al. Techniques for pelvic surgery in subfertility[J/OL]. Cochrane Database Syst Rev,2006,19(2): 1-39 CD000221[2012-8-1]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010558.
27.	Alborzi S, Motazedian S, Parsanezhad ME. Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy[J]? J Am Assoc Gynecol Laparosc, 2003,10(2): 172-176.
28.	Aboulghar MA, Mourad LM, AI-Inany HG, et al. Prospective randomized study for hydrotubation versus no hydrotubation before intrauterine insemination in unexplained infertility[J]. Reprod Biomed Online, 2010, 20(4): 543-546.
29.	Luttjeboer F, Harada T, Hughes E, et al. Tubal flushing for subfertility[J/OL]. Cochrane Database Syst Rev, 2007, 18(3): 1-49 CD003718[2012-8-3]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012261.
30.	Adsiyun AG., Cole B, Ogwuche P. Hydrotubation in the management of female infertility: outcome in low resource settings[J]. East Afr Med J, 2009, 86(1): 31-36.
31.	Duffy JM, Johnson N, Ahmad G, et al. Postoperative procedures for improving fertility following pelvic reproductive surgery[J/OL]. Cochrane Database Syst Rev, 2009, 15(2): 1-42 CD001897[2012-8-3].http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011252.
32.	VanWely M, Kwan I, Burt AL, et al. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles[J/OL]. Cochrane Database Syst Rev, 2011, 16(2): 1-165 CD005354[2012-8-5]. http://www.ncbi.nlm.nih.gov/pubmed/21328276.
33.	Youssef MA, Van der Veen F, AI-Inany HG, et al.Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles[J/OL]. Cochrane Database Syst Rev, 2009, 10 (11): 1-55 CD008046[2012-8-5]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014706.
34.	Johnson N, van Voorst S, Sowter MC, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilization[J/OL]. Cochrane Database Syst Rev ,2010,20(1): 1-68 CD002125[2012-8-9]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011415.
35.	顾华, 辛丽嘉. 妇炎汤保留灌肠治疗输卵管阻塞性不孕的临床观察[J].中国现代药物应用 , 2010, 4(8): 155-156.
36.	谭毅, 李杰, 鲍玉荣等.过氧化碳酰胺加中药治疗输卵管阻塞性不孕30例临床观察[J].南华大学学报, 2010, 38(1): 90-91,95.
37.	王静.中药治疗输卵管堵塞300例临床观察[J].中国社区医师综合版, 2010,12 (9): 104.
38.	牟巧花.输卵管通液加中药内服联合恒频磁共振理疗治疗输卵管阻塞性不孕症临床观察[J].中国医药导报, 2010, 7(1): 87-88.
39.	元媛, 李光荣. 穴位注射配合微波治疗输卵管不通32例[J].中国针灸, 2009, 29(1): 63.

1. 　黄茜, 邹彦, 刘峰.女性不孕症病因及相关因素的研究进展[J]. 检验医学与临床, 2011, 8(3): 332-334.
2. 　Zarei A, Al-Ghafri W, Tulandi T. Tubal surgery[J]. Clin Obstet Gynecol, 2009, 52(3): 344-350.
3. 　许良智, 胡丽娜主编妇产科疾病临床循证治疗手册[M].第1版. 北京: 人民卫生出版社2008: 332-345.
4. 　Tanaka Y, Tajima H. Falloposcopic tuboplasty as an option for tubal infertility: an alternative to in vitro fertilization[J]. Fertility and sterility, 2011, 95(1): 441-443.
5. 　Allahbadia GN, Merchant R. Fallopian tube recanalization: lessons learnt and future challenges[J]. Women’s health, 2010, 6(4):531-549.
6. 　Verma A, Krarup K, Donuru A. Selective salpingography and fallopian tube catheterization by guidewire[J]. J Obstet Gynaecol , 2009, 29(4): 315-317.
7. 　Vardhana PA, Silberzweig JE,Guarnaccia M,et al. Hysterosalpingography with selective salpingography[J]. J Reprod Med, 2009, 54(3): 126-132.
8. 　Rahimunnisa S, Tanwar R, Prasad S,et al.Ultrasound versus tactile cannulation in the treatment of proximal tubal obstruction[J]. Int J Gynaecol Obstet , 2009, 106(3): 216-217.
9. 　Al-Jaroudi D, Herba MJ, Tulandi T. Reproductive performance after selective tubal catheterization[J]. J Minim Invasive Gynecol, 2005, 12(2): 150-152.
10. 　Li Qy, Zhou XL,Qin HP ,et al. Analysis of 1006 cases with selective salpingography and fallopian tube recanalization[J]. Zhonghua Fu Chan Ke Za Zhi, 2004, 39(2): 80-82.
11. 　冯长征, 郭庆禄, 叶志球, 等. 选择性输卵管造影和输卵管阻塞介入再通治疗[J]. 江西医学院学报, 2009, 49(12): 58-59.
12. 　Papaioannou S, Afnan M, Girling AJ, et al. Long-term fertility prognosis following selective salpingography and tubal catheterization in women with proximal tubal blockage[J]. Hum Reprod, 2002, 17(9): 2325-2330.
13. 　张帝开, 李艳秋, 李秀云, 等. 药物黏堵绝育术后近端输卵管闭塞的手术复通效果分析[J].中华妇产科杂志, 2007, 42(2): 120-123.
14. 　Awartani K, McComb PF. Microsurgical resection of nonocclusive salpingitis isthmica nodosa is beneficial[J]. Fertil Steril, 2003, 79(5): 1199-1203.
15. 　Dubuisson JB, Chapron C, Ansquer Y, et al. Proximal tubalocclusion: is there an alternative to microsurgery[J]? Hum Reprod, 1997, 12(4): 692-698.
16. 　Dharia Patel SP, Steinkampf MP, Whitten SJ, et al. Robotic tubal anastomosis: surgical technique and cost effectiveness[J]. Fertil Steril, 2008, 90(4): 1175-1179.
17. 　Bissonnette F, Lapensee L, et al.Bouzayen R. Outpatient laparoscopic tubal anastomosis and subsequent fertility[J]. Fertil Steril, 1999, 72(3): 549-552.
18. 　Yoon TK, Sung HR, Cha SH, et al. Fertility outcome after laparoscopic microsurgical tubal anastomosis[J]. Fertil Steril, 1997, 67(1): 18-22.
19. 　Tan HH, Loh SF. Microsurgical reversal of sterilisation-is this.still clinically relevant today[J]? Ann Acad MedSingapore, 2010, 39(1): 22-26.
20. 　Rodgers AK., Goldberg JM, Hammel JP, et al. Tubal anastomosis by robotic compared with outpatient minilaparotomy[J]. Obstet Gynecol ,2007,109(6):1375-1380.
21. 　Farhi J, Ben-Haroush A, Lande Y, et al. Role of treatment with ovarian stimulation and intrauterine insemination in women with unilateral tubal occlusion diagnosed by hysterosalpingography[J]. Fertil Steril, 2007, 88(2): 396-400.
22. 　Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted Conception[J/OL]. Cochrane Database Syst Rev, 2008, 8(4): 1-51 CD006920[2012-7-28]http://www.ncbi.nlm.nih.gov/pubmed/18843737.
23. 　Checa MA, Alonso-Coello P, Sola I,et al. IVF/ICSI with or without preimplantation genetic screening for aneuploidy in couples without genetic disorders a systematic review and meta-analysis[J]. J Reprod Genets, 2009, 26(5): 273-283.
24. 　Ahmad G, Watson AJ, Metwally M, et al. Laparoscopy or laparotomy for distal tubal surgery? A meta-analysis[J]. Hum Fertil(Camb), 2007, 10(1): 43-47.
25. 　Mossa B, Patella A, Ebano V, et al. Microsurgery versus laparoscopy in distal tubal obstruction hysterosalpingographically or laparoscopically investigated[J]. Clin Exp Obstet Gynecol, 2005, 32(3): 169-171.
26. 　Ahmad G, Watson A, Vandekerckhove P, et al. Techniques for pelvic surgery in subfertility[J/OL]. Cochrane Database Syst Rev,2006,19(2): 1-39 CD000221[2012-8-1]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010558.
27. 　Alborzi S, Motazedian S, Parsanezhad ME. Chance of adhesion formation after laparoscopic salpingo-ovariolysis: is there a place for second-look laparoscopy[J]? J Am Assoc Gynecol Laparosc, 2003,10(2): 172-176.
28. 　Aboulghar MA, Mourad LM, AI-Inany HG, et al. Prospective randomized study for hydrotubation versus no hydrotubation before intrauterine insemination in unexplained infertility[J]. Reprod Biomed Online, 2010, 20(4): 543-546.
29. 　Luttjeboer F, Harada T, Hughes E, et al. Tubal flushing for subfertility[J/OL]. Cochrane Database Syst Rev, 2007, 18(3): 1-49 CD003718[2012-8-3]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012261.
30. 　Adsiyun AG., Cole B, Ogwuche P. Hydrotubation in the management of female infertility: outcome in low resource settings[J]. East Afr Med J, 2009, 86(1): 31-36.
31. 　Duffy JM, Johnson N, Ahmad G, et al. Postoperative procedures for improving fertility following pelvic reproductive surgery[J/OL]. Cochrane Database Syst Rev, 2009, 15(2): 1-42 CD001897[2012-8-3].http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011252.
32. 　VanWely M, Kwan I, Burt AL, et al. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles[J/OL]. Cochrane Database Syst Rev, 2011, 16(2): 1-165 CD005354[2012-8-5]. http://www.ncbi.nlm.nih.gov/pubmed/21328276.
33. 　Youssef MA, Van der Veen F, AI-Inany HG, et al.Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist assisted reproductive technology cycles[J/OL]. Cochrane Database Syst Rev, 2009, 10 (11): 1-55 CD008046[2012-8-5]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014706.
34. 　Johnson N, van Voorst S, Sowter MC, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilization[J/OL]. Cochrane Database Syst Rev ,2010,20(1): 1-68 CD002125[2012-8-9]. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011415.
35. 　顾华, 辛丽嘉. 妇炎汤保留灌肠治疗输卵管阻塞性不孕的临床观察[J].中国现代药物应用 , 2010, 4(8): 155-156.
36. 　谭毅, 李杰, 鲍玉荣等.过氧化碳酰胺加中药治疗输卵管阻塞性不孕30例临床观察[J].南华大学学报, 2010, 38(1): 90-91,95.
37. 　王静.中药治疗输卵管堵塞300例临床观察[J].中国社区医师综合版, 2010,12 (9): 104.
38. 　牟巧花.输卵管通液加中药内服联合恒频磁共振理疗治疗输卵管阻塞性不孕症临床观察[J].中国医药导报, 2010, 7(1): 87-88.
39. 元媛, 李光荣. 穴位注射配合微波治疗输卵管不通32例[J].中国针灸, 2009, 29(1): 63.

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不同部位输卵管不孕的临床循证治疗

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