Fallopian tube stenosis

　　10. The fallopian tube is one of the important components of the female reproductive system. It is a pair of thin and curved tubes, with the inner side connected to the uterine horn, the outer end free, and close to the ovary. The full length is about 8-14 centimeters. It has physiological functions such as transporting sperm, ovum, and zygote, and providing storage, activation, acrosome reaction, and fertilization site for sperm. The length of the fallopian tube is 6-15 cm and is composed of mucosa, circular smooth muscle, and serosa. It is divided into the fimbria, ampulla, isthmus, and intramural part. The connection between the ampulla and the isthmus is called the ampulla-isthmus junction, and the connection between the isthmus and the intramural part is called the uterus-fallopian tube junction. The wall of these junctions is thicker, and the lumen changes greatly.

　　9. The fallopian tube is the place where ova and sperm meet. Each month, the ovum released by the ovary is picked up by the fimbria of the fallopian tube and enters the fallopian tube, where it stays waiting to be fertilized. Sperm pass through the vagina, cervix, and uterine cavity to reach the fallopian tube to meet the ovum and form a zygote. After fertilization, the zygote must rely on the peristalsis of the fallopian tube and the movement of cilia to move from the fallopian tube to the uterine cavity, where it implants and develops.

　　8. Certain fallopian tube stenosis can be treated surgically, but if the likelihood of surgery is low or the surgery is not successful, in vitro fertilization can be used. The surgery for the fallopian tubes is large, requiring general anesthesia, and the operation often takes several hours. It also needs to be completed with the help of a microscope. If the blockage is in the isthmus (close to the uterus), the success rate of surgery is 45%; if the blockage is in the fimbria (close to the ovary), the success rate is 20%-25%. After most fallopian tube surgeries, the risk of ectopic pregnancy will increase.

　　7. There are many causes of fallopian tube stenosis, although it can be caused by poor development of the fallopian tubes, endometrial displacement within the fallopian tubes, or polyps within the fallopian tubes. The main cause is still due to inflammation of the fallopian tubes. Common inflammation includes two types: one is purulent fallopian tube stenosis, most often caused by inflammation after childbirth, abortion, or surgery. It can also be caused by inflammation of adjacent organs, such as appendicitis and peritonitis. The other is tuberculous fallopian tube stenosis, mostly caused by the spread of pulmonary tuberculosis and peritoneal tuberculosis.

　　1. Ovulatory disorder:Due to excessive mental tension, systemic diseases such as hyperthyroidism, polycystic ovary syndrome, prolactinemia, hyperandrogenism, ovarian failure, and other factors.

　　2. Un畅通 or dysfunctional fallopian tubesCommon causes include inflammation, tuberculosis, or endometriosis of the endometrium. Tubal ligation and other factors can also lead to it.

　　3. Uterine factors:Endometrial tuberculosis, uterine cavity adhesion, submucosal uterine fibroids, uterine polyps, endometritis, etc., affecting the implantation of the fertilized egg.

　　4. Uterine factors:Chronic cervicitis, cervical polyps, uterine cervix stenosis, etc.

　　5. Endometriosis:Patients are prone to infertility.

　　6. Unexplained infertility: 10% of infertile couples cannot find any abnormalities after various examinations.

　　Tubal stenosis can cause inflammation and swelling of the fallopian tubes, partial or complete closure of the ostium of the fallopian tubes, and adhesion with surrounding tissues to form scar adhesions, tube stenosis, fallopian tube torsion or closure, forming tubal pyosalpinx or hydrosalpinx, and pelvic congestion or pelvic effusion or pyosalpinx. These lesions can affect the fertilization or movement of the fertilized egg, causing physical and mental discomfort to patients, and the greatest impact is that it may lead to infertility and ectopic pregnancy.

　　Illustration of female reproductive structure Tubal stenosis with abnormal development is rare and not easy to be discovered, often coexists with abnormal development of the reproductive tract, leading to infertility or ectopic pregnancy. The clinical manifestations of tubal stenosis are mainly reflected in the following aspects.

　　1. Absence of fallopian tubes. One-sided fallopian tube absence coexists with unicorne uterus due to the failure of one side of the primordial Müllerian duct to form in the early stage of embryo development. True hermaphroditism may not form fallopian tubes on the side with testes or ovotestis. Because in the early stage of embryonic differentiation, the supporting cells of the testicular tissue are affected by H-Y antigen, producing anti-Müllerian factor, which prevents the formation or inhibits the differentiation and development of the same-side Müllerian duct. Bilateral fallopian tube absence often coexists with congenital absence of uterus or only with remnant uterus malformation. This is related to the failure or obstruction of bilateral Müllerian duct formation or development.

　　2. Poor development of fallopian tubes. The fallopian tubes are long and thin, with a weak muscular layer and poor contractility, which delays the transport of sperm, oocytes, or fertilized oocytes, and is prone to infertility or ectopic pregnancy. Partial absence or solid fallopian tubes without lumen. Bilateral or unilateral double fallopian tubes, which may both enter the uterine cavity, or one smaller one that does not enter the uterine cavity is called accessory fallopian tube, the cause is unclear. During embryonic development, the accessory mesonephric duct penetrates to form multiple ostial fallopian tubes. Fallopian tube diverticula are more likely to occur in the ampulla. They are prone to ectopic pregnancy.

　　3. During the acute stage of salpingitis, patients may experience fever (body temperature may reach above 39℃), aversion to cold, abdominal pain, nausea and vomiting, increased leukorrhea, even purulent discharge with foul smell, or symptoms such as frequent urination, dysuria, abdominal distension, and diarrhea. Laboratory examination may show an increase in white blood cells. During the chronic stage, the main symptoms are distension and pain in the lower abdomen and lumbar sacral region, which may worsen during menstruation or sexual intercourse, with increased leukorrhea, and may cause local tissue hyperplasia. During gynecological examination, thickening of one or both fallopian tubes may be palpated, and even inflammatory masses with tenderness may be felt.

　　Pelvic tuberculosis can cause tubal stenosis in women. Due to timely medical treatment and delayed treatment, it is more difficult to cure, which can cause great harm to women's physical and mental health. Therefore, the key to reducing the incidence of this disease is to do early prevention work, take the initiative from the beginning, and do the following points to prevent the invasion of pathogens.

　　1. When women are having sexual intercourse, they should pay attention to their own and their partners' personal hygiene. Before sexual intercourse, both partners' external genitalia should be washed to prevent the smooth invasion of bacteria. When a woman has vaginal bleeding symptoms, she should control herself and refrain from sexual activity.

　　2. Women should pay attention to their external genital hygiene and personal cleanliness; prevent infections from household utensils and toilets.

　　3. Women should pay attention to their own nutrition and health care, strengthen nutrition during the menstrual period, after artificial abortion, and after delivery; enhance their physical fitness, increase their resistance and immunity, and reduce the chance of getting sick.

　　4. Strict sterilization should be carried out when artificial abortion, delivery, intrauterine device insertion and removal, and other intrauterine operations are performed to avoid bringing bacteria into the vagina and uterus through surgery, causing infection artificially.

　　5. For female patients with acute fallopian tube stenosis, they should take a semi-recumbent position for rest to prevent and limit the movement of inflammatory fluid due to changes in body position. Eat high-nutrient, easy-to-digest foods rich in vitamins.

　　6. Once a woman has附件 diseases, she should follow the treatment principles, adopt an active attitude, receive complete treatment, control the condition as soon as possible, and prevent it from becoming chronic.

　　First, hydropathy (aeropathy) of the fallopian tube

　　Hydropathy (aeropathy) of the fallopian tube has a significant degree of blindness, and can only be determined by the operator and the patient's sense of feeling, which has a certain subjectivity, and this method cannot make a judgment on the function and morphology of the fallopian tube. In 1984, Richmen et al. were the first to apply ultrasonic diagnostic technology to check the patency of the fallopian tube. In recent years, the technique of hydropathy of the fallopian tube under ultrasonic examination has been widely used in clinical practice. Hydropathy of the fallopian tube under ultrasonic examination is hydropathy under ultrasonic monitoring, observing the bubble formation or sound image changes after the injection of fluid, providing a reliable judgment. Its advantages are:

　　1. Most scholars believe that ultrasonic diagnosis of fallopian tube patency has good sensitivity and specificity. Heikinen et al. reported that the total coincidence rate of ultrasonic examination of fallopian tube patency is close to that of hydropathy under laparoscopy, and can also make ultrasonic diagnosis of uterine adnexa. In this aspect, it is superior to the X-ray hysterosalpingography (X-HSG) under television透视.

　　2. The physiological saline used for hydropathy is safe, without allergic reactions or adverse reactions such as thrombosis, and does not harm the fallopian tube mucosa or uterus.

　　3. It can reduce the blindness of traditional hydropathy.

　　4. Compared with HSG, ultrasonic examination has the disadvantages of radiation damage and iodine allergy. Its disadvantages include: it is not as clear as laparoscopy for the pelvis, and it cannot clearly show the course and exact location of the fallopian tube. When there is adhesion in the fallopian tube, causing distortion and deformation, ultrasonic diagnosis is also very difficult. Sometimes, ultrasonic examination cannot observe the whole appearance of the fallopian tube on a single scanning plane, and cannot show the dynamic process, so it is not easy to obtain satisfactory images. However, in general, the technique of diagnosing the patency of the fallopian tube under ultrasonic examination is relatively accurate, safe, and easy to operate. This examination can be used as the first choice for the initial screening of fallopian tube patency, especially in infertility treatment centers with a high concentration of disease sources, which can meet the diagnostic needs of outpatients in large volume and quickly, and is worthy of widespread clinical application.

　　II. Uterine and Fallopian Tube Iodine Oil Contrast (HSG)

　　The operation of uterine and fallopian tube iodine oil contrast (HSG) is simple and can visualize the internal structure and shape of the uterus and fallopian tube under the screen. Its advantages are:

　　1. Rapid and accurate diagnosis, the cause of the uterus or fallopian tube can be determined during the operation, and the location is precise. Some studies have shown that HSG is better than laparoscopy in judging the site of obstruction.

　　2. It can be pressure increased appropriately under direct vision to separate mild uterine cavity adhesions.

　　3. Safe, because the operation is performed under direct vision, it can detect unexpected situations during the operation, such as iodinated oil entering the blood vessels or lymph, stop the injection in time to prevent oil embolism and cause adverse consequences. However, the contrast agent used (such as iodine oil) has a large adverse reaction, is easy to stimulate the mucosa and cause allergy, and the oily contrast agent is thick and difficult to pass through the narrow part of the fallopian tube, making it difficult to judge the site of obstruction.

　　III. Hysteroscopy Hysteroscopy

　　Hysteroscopy Hysteroscopy can directly visualize the uterine cavity shape and the opening condition of the fallopian tube, directly insert the tube fluid, avoid the disadvantages of blind fluid passage, overcome tubal spasm, and observe the unblocking situation at any time. Moreover, since hysteroscopy can insert the catheter into the interstitial part of the fallopian tube 4-5mm, it can have a mechanical unblocking and perfusion effect on the cornua and interstitial obstruction, and also has a separation effect on mild obstruction by directly applying pressure to the fallopian tube. Therefore, hysteroscopy is the most reliable method for diagnosing interstitial tubal obstruction.

　　IV. Laparoscopy

　　With the continuous progress of medical technology, laparoscopy has emerged, making the diagnosis of tubal infertility less traumatic and more precise. Laparoscopy can directly visualize pelvic organs, make comprehensive, accurate, and timely judgments on the nature and degree of lesions and the size of lesions: puncture and drug injection are all performed under direct vision, which is more accurate: under the mirror, fluid passage can observe the patency of the fallopian tube, and at the same time, it can also flush and unblock the fallopian tube, and can separate the adhesions at some fimbriae, avoiding the pain of laparotomy and also playing a positive therapeutic role, which is one of the best routine examination methods recommended by WHO for infertile women, but it requires anesthesia, has trauma, high technical equipment requirements, and has complications such as gas embolism, subcutaneous emphysema, and intraoperative bleeding.

　　V. Other

　　There are also methods such as combined treatment of B-ultrasound with uterine cavity and hysteroscopy with laparoscopy for tubal infertility. B-ultrasound guided hysteroscopy is a relatively new and effective method in the 1980s, especially for the diagnosis and treatment of proximal tubal obstruction, as well as the treatment of unobstructed but not smooth conditions. It can directly observe whether there are liquid shadow areas in the fallopian tube and whether there is fluid accumulation in the rectouterine凹陷 and its changes, and can also detect tubal stenosis in a timely manner to avoid the false impression of patency and exacerbate the concern of tubal stenosis. The combined diagnosis and treatment of tubal infertility with hysteroscopy and laparoscopy is a relatively advanced diagnostic and treatment method, with a high rate of recanalization of tubal obstruction, and needs to be further promoted and applied nationwide.

　　1. Diet adjustment for fallopian tube stenosis: Patients should eat high-protein, high-vitamin nutritional diet, including lean meat, pork liver, tofu, chicken, fruits, vegetables, etc. Smoking, alcohol, strong tea, and other spicy and irritant foods should be strictly prohibited.

　　2. Foods and drinks that should be avoided in the diet of fallopian tube stenosis include chili, Sichuan peppercorns, scallions, garlic, white wine, and other irritant foods and drinks. Lean meat, chicken, eggs, crucian carp, turtle, cabbage, asparagus, celery, spinach, cucumber, winter melon, mushrooms, tofu, kelp, laver, and fruits can be eaten more.

　　3. For patients with cold and stagnation type, such as cold pain in the lower abdomen, fear of cold, and soreness in the waist, warm foods such as ginger soup, brown sugar water, and osmanthus meat can be given in diet.

　　Fallopian tube stenosis requires a combination of work and rest, and appropriately learn some strengthening exercises, such as Tai Chi and Tai Chi sword, to promote recovery. At the same time, attention should also be paid to contraception and节制sex life to reduce the opportunity for artificial abortion and other injuries to the uterine cavity, preventing the recurrence of bacteria and aggravating the condition.

　　Congenital malformations of the fallopian tube are not easy to be discovered. The reasons are first that they are often ignored because they are often associated with congenital malformations of the reproductive tract, and secondly, they are deeply hidden in the lateral side of the pelvic cavity. Common diagnostic methods include finding unilateral fallopian tube or double fallopian tubes in a single uterus after hysterosalpingography. Abdominal examination may find various malformations. Cesarean section can make a more definite diagnosis.

　　For those infertile due to fallopian tube abnormalities, laparoscopic or cesarean section fallopian tube整形手术should be performed. For those with fallopian tube pregnancy rupture or abortion, carefully check during the operation, do not easily remove repairable fallopian tube malformations, and should take microsurgical techniques for fallopian tube repair to preserve function. Those with fallopian tube stenosis who want to be healthy and smooth should only consider fallopian tube stenosis disease. In addition to hospital surgery, attention should also be paid to correct diet and eating habits in daily life.

　　1. Abalone, pigeon eggs, cuttlefish, octopus, quail, black-bone chicken, sea cucumber, shark fin, bird's nest, etc.

　　2. Hippocampus, hawthorn, other herbs, etc.

　　3. Pork pancreas, sunflower flowers, sea crabs, etc.

　　4. Dragon Egg Sugar Tea: Take 15 grams of Solanum nigrum, 30 grams of flint stone, decoct the juice and add sugar to drink as tea.

　　5.葵花楂肉:葵花托盘60 grams, decoct the juice and take the liquid, then cook pork 60 grams and hawthorn 30 grams with the liquid.