Tubal obstruction

　　How is tubal obstruction caused? Briefly described as follows:

　　1. Many women suffer from tubal obstruction due to inflammation, such as pelvic inflammatory disease, which is a common condition. If the inflammation spreads to the fallopian tube, it can lead to tubal obstruction in women.

　　2. In addition to the above, there are also some other reasons that can lead to tubal obstruction, such as congenital tubal obstruction, which is present at birth in women. Such obstructions are extremely rare.

　　3. In addition, many other reasons can also lead to tubal obstruction, such as artificial factors, as well as common clots, such as endometrial fragments and blood clots during the menstrual period.

　　Generally, tubal obstruction may mainly lead to four diseases.

　　1. Dysmenorrhea.Long-term chronic inflammation of the fallopian tube can lead to pelvic congestion, thus causing clotted dysmenorrhea. The dysmenorrhea phenomenon often starts one week before the menstrual period with abdominal pain, which becomes more severe as the menstrual period approaches, until menstruation arrives.

　　2. Irregular menstruation.The fallopian tube is adjacent to the ovary. When the inflammatory focus of the fallopian tube affects the ovary, it may cause varying degrees of damage to the ovarian function, resulting in abnormal menstruation, with frequent menstruation and excessive menstrual bleeding being the most common.

　　3. Infertility.The fallopian tube plays an important role in transporting sperm, absorbing ova, and transporting the fertilized egg to the uterine cavity. When the fallopian tube is damaged by disease, it forms an obstruction, hindering the passage of sperm and the fertilized egg, leading to infertility.

　　4. Severe tubal obstruction.In addition to infertility and dysmenorrhea, symptoms such as increased leukorrhea, pain during sexual intercourse, gastrointestinal disorders, fatigue, affected labor, or intolerance to prolonged labor, and mental and neurological symptoms, as well as depression, may also occur.

　　Generally, there are no typical symptoms of tubal obstruction, and the most common manifestation is infertility. The fallopian tube plays an important role in transporting sperm, absorbing ova, and transporting the fertilized egg to the uterine cavity. Tubal obstruction hinders the passage of sperm and the fertilized egg, leading to infertility or ectopic pregnancy. If the tubal obstruction is caused by pelvic inflammation, it may be accompanied by symptoms such as lower abdominal pain, lumbar pain, increased secretion, pain during sexual intercourse, and so on.

　　How to prevent tubal obstruction? Briefly described as follows:

　　1. Pay attention to the cleanliness and hygiene of the reproductive system. Preventing the infection of various pathogens (especially sexually transmitted diseases) is the most critical. During artificial abortion, delivery, insertion or removal of intrauterine devices, and other intrauterine surgeries, strict disinfection should be performed to avoid inappropriate intrauterine procedures, avoid unclean sexual life, avoid sexual intercourse during menstruation, and repeated hydrotubation procedures.

　　2. Actively treat pulmonary tuberculosis and lymphatic tuberculosis to prevent the infection of pelvic tuberculosis.

　　3. Once a woman has an accessory disease, she should adhere to the principles of treatment, adopt a positive attitude, undergo thorough treatment, control the condition as soon as possible, and prevent it from becoming chronic.

　　4. Strengthen physical exercise and enhance the ability to resist diseases.

　　What examinations should be done for fallopian tube obstruction? Briefly described as follows:

　　1. HydrotubationIt is a method of injecting methylene blue solution or physiological saline into the uterine cavity from the cervix, and then flowing into the fallopian tube from the uterine cavity. The patency of the fallopian tube can be judged according to the size of the resistance during injection of the drug solution and the condition of fluid reflux. Due to its simple equipment, simple operation, and low cost, this method was widely used before the 1980s. However, since the entire process relies on the doctor's subjective sense of judgment and cannot determine the location of fallopian tube obstruction, the tension during the examination can cause fallopian tube spasm, resulting in false positives. In recent years, it can be performed under ultrasound monitoring, which improves the accuracy, but in clinical practice, it has been found that the misdiagnosis rate is high, so it is not an ideal examination.

　　2. Hysterosalpingography(hysterosalpingography, HSG): This technique has been used since the 1920s. It involves injecting a high atomic number, high-density substance (such as iodine, iohexol, etc.) into the uterine cavity through the cervical canal. Under X-ray imaging, it forms a clear artificial contrast with surrounding tissues, making the lumen visible. It can detect fallopian tube obstruction, fallopian tube motility function, mucosal damage caused by previous infection or endometriosis, hydrosalpinx, fallopian tube isthmus nodules, adhesions, and abnormal fallopian tubes (such as accessory valves and diverticula). It is a rapid, economical, and low-risk examination. HSG has a sensitivity of 65% for fallopian tube obstruction and adhesions, but pain-induced fallopian tube spasm can cause false positives. Pain, infection, and contrast medium entering the vascular system are rare complications.

　　3. Fallopian tube scope:It is a method of imaging the luminal structure of the fallopian tube. During the examination, a rigid fallopian tube scope is required, which can evaluate the entire length of the fallopian tube and the mucosal condition of the entire fallopian tube. The reanastomosis of the fallopian tube can be performed during the examination, so it has a potential therapeutic effect on proximal fallopian tube obstruction. However, the fallopian tube scope has high requirements for technology and equipment, so it is not widely used at present.

　　4. Laparoscopic examination:A blue dye is injected into the uterine cavity through a uterine catheter, and under laparoscopic observation, the blue dye overflows into the pelvic cavity through the fimbria of the fallopian tube, indicating patency; if there is a blockage near the proximal end of the fallopian tube (interstitial and isthmus), the blue dye fluid cannot be seen overflowing into the abdominal cavity through the fimbria of the fallopian tube. If there is a blockage at the distal end of the fallopian tube (ampulla and fimbria), the fimbria and ampulla can be seen to be dilated and thickened and stained blue, but there is no blue dye fluid flowing from the fimbria into the abdominal cavity. Laparoscopy can directly visualize the site of fallopian tube obstruction and the adhesions around it, and can also perform adhesion separation and treatment simultaneously, which is the gold standard for diagnosing fallopian tube obstruction. However, it requires general anesthesia and surgical treatment, and is not commonly used at present, but is only used for patients with abnormal fallopian tube patency indicated by hydrotubation or hysterosalpingography.

　　5. Fluid-filled laparoscopy:It is a new technology developed in recent years, which uses a small endoscope to explore the entire pelvic cavity from the posterior fornix, and requires the patient to adopt a lithotomy position during the operation. The water-soluble diluent used during the examination can fully expose the uterine and tubal-ovarian structures when observed from the back. Throughout the operation, due to the continuous infusion of normal saline, the ovary and fallopian tube are always in a suspended state. The advantage of this technology is that it may be applied in outpatients and is more minimally invasive; however, the disadvantage is that it cannot evaluate the condition of the entire abdominal and pelvic cavity, and there is also a possibility of intestinal tract injury, with an incidence rate of about 0.65%.

　　How to maintain health through diet for patients with tubal obstruction? A brief description is as follows:

　　1. Patients with this disease should eat light foods and pay attention to dietary regularity.

　　2. Eat less salty and spicy foods.

　　3. Eat more fruits and vegetables, have a reasonable schedule, and keep a cheerful mood.

　　The following is a brief description of the treatment methods for tubal obstruction:

　　FirstMedication

　　The tubal inflammation causing tubal obstruction infertility is mainly chronic inflammation, so most people use drugs, especially traditional Chinese medicine, to regulate the menstrual cycle and treat infertility, with excellent efficacy.

　　SecondSurgical treatment

　　1. Tubal hydrotubation: It can be started 3 days after the menstrual period is clean. Gentamicin 160,000 units, 2% procaine 2 ml, dexamethasone 5 mg, α-chymotrypsin 5 mg, dissolved in 20 ml normal saline, and injected into the uterine cavity through the tubal hydrotubation catheter. Treatment once every other day, stop treatment before ovulation. This therapy can be continuously treated for 2 to 3 menstrual cycles. This therapy is still used by most medical institutions, but the efficacy is poor, and the false positive rate is high.

　　2. Conventional surgical treatment: Tubal ostomy, adhesion separation, tubal anastomosis, uterine-tubal implantation, and other operations are performed on the lesioned fallopian tube. Conventional surgical incisions are large, and postoperative recovery is slow.