The Grades HSG Of Incomplete Patency Oviduct And Comprehensive Therapy Of Traditional Chinese Medicine

World Health Organization (WHO)statistics about10%of couples experience infertility in China. In recent years, along with sex concept and the environment change, the rate of infertility has increased year by year.Tubal factor infertility accounts about67%of female infertility.Oviduct blockag has attracted people’s attention by leading to infertility. Incomplete patency oviduct can not only lead to infertility, but also can cause ectopic pregnancy. Tubal ectopic pregnancy accounts about95%ectopic pregnancy. Hysterosalpingography (HSG) has become the preferred method for screening of female infertility fallopian tube. At present, tubal and HSG imaging diagnosis of incomplete patency oviduct is too simple, does not accurately reflect the tubal function. Some patients were unfitly treated by operation. Diagnosis of incomplete patency oviduct should reflect the different function of fallopian tube for making more reasonable treatment decisions, improving the normal intrauterine pregnancy rate of infertility patients, reduce the ectopic pregnancy rate. We observed through analysis of HSG tubal pliability, intratubal mucosa, patency and adhesion in distal or pelvic and compare with the results of laparoscopic of incomplete patency oviduct.The treatment of incomplete patency oviduct should consider the simple, fecundity, cost-effective and patient compliance and other factors. But repeatedly pass solution will destroy the ability to swing tubal peristaltic and cilia, every time the chance of infection do a pass liquid. Laparoscopic surgical treatment is not only expensive, but some of the effect of surgery is not ideal. TCM Tubal Infertility has many years of experience, but also made a good effect. TCM Comprehensive treatment of incomplete patency oviduct can improve intrauterine pregnancy, reduce tubal pregnancy rate.This study is divided into two parts:These grades of HSG of incomplete patency oviduct[Objective]To research the grade method of HSG of incomplete patency oviduct and its clinical significance.[Method]472patients with infertility induced by incomplete patency oviduct were divided into three grades according to hysterosalpingography diagnosis and laparoscopic diagnosis.The patients were regularly followed up to observe the patient’s pregnancy ratio and tubal patency ratio for12months.Standard of hysterosalpingographyHysterosalpingography begin after30minutes injection of atropine sulfate0.5mg. HSG was done by real-time dynamic with automatic injection system. Six films was radiographied at before the injection of contrast agent KUB, cervical canal phase, the uterus phase, tubal filling phase, the tubal mucosal phase and dispersed phase.Tubal evaluation criteria:(1) the standards of tubal patency,(2)the criteria of tubal pliability,(3) the criteria of tubal lumen mucosa, and (4) the criteria of tubal fimbria status,(5) the criteria of pelvic diffuse.Laparoscopic diagnosis and treatment Tubal and pelvic were observed and treated by the laparoscopic.Tubal patency checking and prevention of adhesions processing were done by laparoscopic. Laparoscopic tubal patency,indexing adhesions tightness and adhesions, hydrosalpinx evaluation, tubal ratings standards. Image diagnosis Image reports were written by three advanced radiologists, and the final results of the diagnostic imaging has been a common recognition. The observation and analysis of the image of the cervix, uterus, fallopian tubes and pelvic condition, tubal patency, softness, lumen mucosa umbrella side conditions, pelvic dispersion, tubal lumen mucosa, softness, umbrella-side situation were the keys.The follow-up observation patients were followed up for12months, recording diagnosis of intrauterine pregnancy or ectopic pregnancy; while non-pregnant patients were followed up for tubal patency.Statistical analysis SPSS13.0statistical package for analysis, significant at P<0.05. Segment information using χ2test or Fisher’s exact. Between the two groups for multiple comparisons using the split method.[Results]Manifestation of Imaging of the grade Ⅰ:(1) tubal patency:contrast agent enter and outflow smoothly the fallopian tube;(2) tubal pliability:tubal wall smooth, pliability, natural streamlined;(3) lumen mucosa:natural change morphology mucosal;(4) fimbria status:natural peristaltic umbrella;(5) pelvic dispersion:a little residual contrast agent shadow on the tubal trip, evenly cloudy contrast agent dispersion.followed up for12months intrauterine normal pregnancy rate of56.8%(84/148), tubal pregnancy rate of2.0%(3/148). tubal patency rate of98.4%(120/122), blocking rate of1.6%(2/122).Manifestation of Imaging of the grade Ⅱ:(1) tubal patency:contrast agent enter and outflow slowly the fallopian tube,sometimes pressure fallopian tube contrast agent outflowing from the umbrella;(2)tubal pliability:loss of natural streamlined, peritubal venous or lymphatic countercurrent;(3) lumen mucosa:mucosal morphology, less the morphological changes;(4) fimbria status:a few contrast overflow agents;(5) pelvic dispersion:little residual contrast agent shadow on the tubal trip, contrast agent reaches the pelvic floor, uneven the contrast agent dispersion.followed up for12months intrauterine normal pregnancy rate of19.9%(31/156), tubal pregnancy rate of10.3%(6/156). tubal patency rate of81.5%(194/238), blocking rate of18.5%(44/238).Manifestation of Imaging of the grade Ⅲ:(1) tubal patency:tubal filling slowly, varying thickness,contrast agent required pressure overflowing from the umbrella;(2)tubal pliability:wall irregular thickening stiff like; position fixed;(3) lumen mucosa:mucosal structure is unclear, rough edges, fixed mucosal morphology, irregular development, diverticulum, sinus, mucosal number less;(4) fimbria Status: need pressure from the umbrella side overflow, the umbrella end morphology stiff;(5) pelvic dispersion:tubal stroke have little residual contrast agent shadow on the tubal trip, contrast agent did not reach the basin bottom, unevenly dispersed, some lumps. followed up for12months intrauterine normal pregnancy rate of13.7%(23/168), tubal pregnancy rate of13.1%(22/168) tubal patency rate of70.7%(174/246), blocking rate of18.5%29.3%(72/246).Ⅰ and Ⅱ, Ⅰ and Ⅲ grade intrauterine normal pregnancy rate and tubal pregnancy, P<0.0125, a statistically significant difference between the two groups; Ⅱ and Ⅲ the intrauterine normal pregnancy rate and tubal pregnancy rate, P>0.0125, no statistically significant difference between the two groups. Ⅰ and Ⅱ, Ⅰ and Ⅲ grade blocking rate, P<0.0125, a statistically significant difference between the two groups; Ⅱ and grade Ⅲ P>0.0125, the difference between the two groups was not statistically significant.Grade Ⅰ display slight early mucous functional lesions, good tubal function.Grade Ⅱ display tubal local mild disease, mild impairment of reproductive function of the fallopian tubes.Grade Ⅲ display oviduct severe disease, damage to the reproductive function of the fallopian tube.[Conclusion]The grades method of HSG of incomplete patency oviduct can show tubal dysfunction state and provide an important reference for clinical development of treatment programs.The comprehensive therapy of traditional Chinese Medicine of incomplete patency oviduct[Objective]The clinical efficacy of comprehensive therapy of TCM for incomplete patency oviduct.[Research methods] 661patients with incomplete patency oviduct infertility were divided into three levels according to classification tubal passable. Each grade of the three levels were divided into integrated TCM treatment group, western medicine treatment group and the control group.(1) the comprehensive treatment TCM group were received treatment of Chinese herbs by oral,enema and external application. Each month continuous use for10days as a course of treatment, continuous use of the three courses.(2) Western medicine treatment group Perfuse the mixed the drugs, including gentamicin80,000units, dexamethasone2.5mg hyaluronidase1500U, lidocaine. Monthly three times in a row as a course, continuous use of the three courses.(3) the control group without any treatment.The follow-up12months, recording intrauterine pregnancy, ectopic pregnancy, tubal patency.Statistical analysis SPSS13.0statistical package for analysis, significant at P<0.05. Segment information using χ2test or Fisher’s exact. Between the two groups for multiple comparisons using the split method.[Results]The grade Ⅰ intrauterine pregnancy TCM group78cases, intrauterine normal pregnancy rate was68.4%(78/114); cases of tubal pregnancy,tubal pregnancy rate was0.9%(1/114). Follow-up of12months tubal patencyr rate of100%, no tubal reobstruction. Western medicine treatment of intrauterine pregnancy the intrauterine normal pregnancy rate was54.2%(32/59); tubal pregnancy rate was3.3%(2/59). Follow-up of12months tubal tubal patencyr rate of98.0%, tubal reocclusion rate of2.0%. control group of intrauterine pregnancy of intrauterine normal pregnancy rate of53.7%(22/41); tubal pregnancy rate was4.9%(2/41). Follow-up of12months tubal patency of91.2%, tubal reocclusion rate of8.8%.The grade Ⅱ TCM treatment group intrauterine intrauterine normal pregnancy rate of31.7%(40/126); tubal pregnancy rate was2.4%(3/126). Follow-up of12months tubal poor rate of95.2%, tubal reocclusion rate of4.8%. Western medicine treatment group intrauterine normal pregnancy rate of22.1%(15/68); tubal pregnancy six cases, tubal pregnancy rate of8.8%(6/68). tubal patency rate of80.9%, tubal reocclusion rate of19.1%. control group intrauterine normal pregnancy rate was17.1%(6/35); tubal pregnancy rate was11.4%(4/35), tubal patency rate of78.0%, tubal reocclusion rate of22.0%.The grade Ⅲ TCM group intrauterine normal pregnancy rate was20.2%(24/119), tubal pregnancy rate was2.5%(3/119). Follow-up of12months tubal patency rate of93.5%, tubal reocclusion rate of6.5%. Western medicine treatment the intrauterine normal pregnancy rate of13.4%(9/67), tubal pregnancy rate was11.9%(8/67), tubal patency rate of72.0%, tubal reocclusion rate of28.0%. control group of intrauterine pregnancy rate was12.5%(4/32), tubal pregnancy rate was15.6%(5/32), tubal patency rate of65.2%, tubal reocclusion rate of34.8%.Ⅰ and Ⅱ grade intrauterine pregnancy rate, tubal pregnancy rate, tubal poor rate and tubal occlusion rate of TCM group and Western medicine treatment group and the control group Ⅲ grade level pairwise comparisons (P<0.05), The difference between the two groups is statistically significant. Grade Ⅱ and Ⅲ grade TCM group and Western medicine treatment group and the control group compared intrauterine pregnancy rate, tubal pregnancy rate, tubal poor rate and tubal occlusion rate twenty-two P>0.05, no statistical difference between the two groups significance. Ⅰ, Ⅱ and Ⅲ grade three within TCM group and Western medicine treatment group, TCM group and the control group of intrauterine intrauterine pregnancy, tubal pregnancy rate, tubal poor rate and tubal reocclusion rate twenty-two comparison P<0.05, significant difference between the two groups. Grade Ⅰ, Ⅱ stage and grade Ⅲ three intrauterine pregnancy, tubal pregnancy rate, tubal poor rate and tubal occlusion rate within Western medicine treatment group and the control group pairwise comparisons P>0.05, between the two groups was not statistically significance.Chinese medicine treatment of grade Ⅰ tubal passable have a good effect, does not recommend surgery. Grade Ⅱ tubal poor comprehensive treatment of traditional Chinese medicine has a certain effect. Ⅲ level tubal passable TCM treatment less efficacy. Integrated TCM treatment can shorten the course of treatment, improve efficacy, improve infertility patients with normal intrauterine pregnancy and tubal patency rates, reduce tubal pregnancy rate and reocclusion rate.[Conclusion]Integrated TCM treatment can improve all grades of incomplete patency oviduct patient’s intrauterine pregnancy and tubal patency rate, reduce tubal pregnancy rate and blocking rate.