背景与目的:输卵管病变是女性不孕症的主要危险因素,与单纯的近端疾病和远端疾病相比,远端疾病更常见。近端输卵管闭塞通常归因于上行事件,如盆腔炎。相反,虽然远端闭塞也可归因于盆腔炎疾病的上升,它也可以有骨盆起源,如子宫内膜异位症和阑尾炎破裂。这项研究的目的是确定不孕症的某些原因及其与输卵管闭塞的关系。重点是输卵管闭塞的位置,与双侧闭塞相比,和其他导致不孕的原因,包括男性因素。方法:在一项回顾性研究队列研究中,373名年龄在18至40岁之间的妇女,纳入2017年1月1日至2022年12月31日治疗。使用子宫输卵管造影术测试输卵管通畅性,子宫输卵管造影,或者腹腔镜显色管。结果:总的来说,373名妇女中有95名(25.5%)发现至少一根闭塞管,单侧闭塞比双侧闭塞更常见(60/95,63.2%vs.35/95,36.8%)。大多数输卵管闭塞发生在近端(86.2%)。根据调整后的多元回归模型,输卵管积水的存在(赔率比,OR,13.323,95%置信区间,CI:2.679-66.253,p=0.002),肌瘤(OR2.108,95CI:1.008-4.409;p=0.048),男性伴侣的精子检测结果异常(OR2.105,95CI:1.156-3.833;p=0.015)是输卵管闭塞的统计学显著相关因素。结论:输卵管通畅性测试在生育力评估中仍然具有重要意义。子宫肌瘤的存在,积水,男性因素会显著增加风险。
Background and Objectives: Fallopian tubal pathology is a primary risk factor for female infertility, with simple proximal disease and proximal disease extending more distally being more common than pure distal occlusion. Proximal tubal occlusion is often attributed to ascending events, such as pelvic inflammatory disease. Conversely, while distal occlusion can also be attributable to ascending pelvic inflammatory disease, it can also have a pelvic origin, such as through endometriosis and ruptured appendicitis. The aim of this study was to identify certain causes of infertility and their association with tubal occlusion. The focus was on the location of tubal occlusion, uni- versus bilateral occlusion, and other causes of infertility, including male factors. Methods: In a retrospective study cohort study, 373 women aged between 18 and 40 years, treated from 1 January 2017 to 31 December 2022, were included. Fallopian tube patency was tested using either hysterosalpingography, hysterosalpingo-contrast sonography, or laparoscopic chromopertubation. Results: In total, 95 of 373 women (25.5%) revealed at least one occluded tube, with unilateral occlusion being more common than bilateral occlusion (60/95, 63.2% vs. 35/95, 36.8%). The majority of tubal occlusions occurred proximally (86.2%). According to the adjusted multivariate regression models, the presence of hydrosalpinx (odds ratio, OR, 13.323, 95% confidence interval, CI: 2.679-66.253, p = 0.002), myomas (OR 2.108, 95%CI: 1.008-4.409; p = 0.048), and an abnormal sperm test result of the male partner (OR 2.105, 95%CI: 1.156-3.833; p = 0.015) were statistically significant associated factors for tubal occlusion. Conclusions: Fallopian tube patency testing is still of major relevance in fertility evaluation. The presence of uterine myomas, hydrosalpinges, and a male factor significantly increase the risk.