不同部位輸卵管不孕的臨床循證治療_《華西醫學》

作者：

許旭 ,  許良智

四川大學華西第二醫院婦產科（成都，610041）;

關鍵詞：

輸卵管疾病不孕循證治療

DOI：

10.7507/1002-0179.20130301

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近年來，據WHO統計不育夫婦占已婚年齡夫婦的7%～15%，其中女方因素占40%，主要包括排卵障礙、輸卵管因素、子宮因素及宮頸因素，輸卵管疾病所致的不孕占25%～35%，其中輸卵管阻塞占輸卵管疾病的80%。根據阻塞部位的不同可分為近端輸卵管不孕和遠端輸卵管不孕。近端輸卵管不孕治療方法包括選擇性輸卵管造影和經宮頸插管、輸卵管子宮植入、絕育后復育者的輸卵管吻合術、輔助生育技術；遠端輸卵管不孕治療方法包括外科手術治療、輸卵管通液及輔助生育技術。此外，中醫及物理治療可作為輸卵管不孕的輔助治療。但近幾年并無有關以上各種治療方法妊娠率及臨床療效比較的報道，臨床決策仍有一定困難。本文根據近年有關輸卵管不孕不同治療方法的相關臨床研究證據，對其效果及妊娠率進行綜述，以期全面了解各種治療方案的優略。

引用本文： 許旭,許良智. 不同部位輸卵管不孕的臨床循證治療. 華西醫學, 2013, 28(6): 963-966. doi: 10.7507/1002-0179.20130301 復制

1.	黃茜, 鄒彥, 劉峰.女性不孕癥病因及相關因素的研究進展[J]. 檢驗醫學與臨床, 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.	許良智, 胡麗娜主編婦產科疾病臨床循證治療手冊[M].第1版. 北京: 人民衛生出版社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.	馮長征, 郭慶祿, 葉志球, 等. 選擇性輸卵管造影和輸卵管阻塞介入再通治療[J]. 江西醫學院學報, 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.	張帝開, 李艷秋, 李秀云, 等. 藥物黏堵絕育術后近端輸卵管閉塞的手術復通效果分析[J].中華婦產科雜志, 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.	顧華, 辛麗嘉. 婦炎湯保留灌腸治療輸卵管阻塞性不孕的臨床觀察[J].中國現代藥物應用 , 2010, 4(8): 155-156.
36.	譚毅, 李杰, 鮑玉榮等.過氧化碳酰胺加中藥治療輸卵管阻塞性不孕30例臨床觀察[J].南華大學學報, 2010, 38(1): 90-91,95.
37.	王靜.中藥治療輸卵管堵塞300例臨床觀察[J].中國社區醫師綜合版, 2010,12 (9): 104.
38.	牟巧花.輸卵管通液加中藥內服聯合恒頻磁共振理療治療輸卵管阻塞性不孕癥臨床觀察[J].中國醫藥導報, 2010, 7(1): 87-88.
39.	元媛, 李光榮. 穴位注射配合微波治療輸卵管不通32例[J].中國針灸, 2009, 29(1): 63.

1. 　黃茜, 鄒彥, 劉峰.女性不孕癥病因及相關因素的研究進展[J]. 檢驗醫學與臨床, 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. 　許良智, 胡麗娜主編婦產科疾病臨床循證治療手冊[M].第1版. 北京: 人民衛生出版社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. 　馮長征, 郭慶祿, 葉志球, 等. 選擇性輸卵管造影和輸卵管阻塞介入再通治療[J]. 江西醫學院學報, 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. 　張帝開, 李艷秋, 李秀云, 等. 藥物黏堵絕育術后近端輸卵管閉塞的手術復通效果分析[J].中華婦產科雜志, 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. 　顧華, 辛麗嘉. 婦炎湯保留灌腸治療輸卵管阻塞性不孕的臨床觀察[J].中國現代藥物應用 , 2010, 4(8): 155-156.
36. 　譚毅, 李杰, 鮑玉榮等.過氧化碳酰胺加中藥治療輸卵管阻塞性不孕30例臨床觀察[J].南華大學學報, 2010, 38(1): 90-91,95.
37. 　王靜.中藥治療輸卵管堵塞300例臨床觀察[J].中國社區醫師綜合版, 2010,12 (9): 104.
38. 　牟巧花.輸卵管通液加中藥內服聯合恒頻磁共振理療治療輸卵管阻塞性不孕癥臨床觀察[J].中國醫藥導報, 2010, 7(1): 87-88.
39. 元媛, 李光榮. 穴位注射配合微波治療輸卵管不通32例[J].中國針灸, 2009, 29(1): 63.

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不同部位輸卵管不孕的臨床循證治療

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《華西醫學》

不同部位輸卵管不孕的臨床循證治療

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