| BackgroundOviducts are places available not only for picking up eggs, transporting sperms and embryos but also for normal fertilization.Tubal factor infertility(TFI) is one of the most common factors of female infertility.Diagnosis and treatment on TFI is still a problem being explored.ObjectiveTo make a retrospective clinical study on patients with TFI admitted to the Gynecology and Obstetrics Hospital of FuDan University from 1998 to 2007.Simultaneously,a new classification system on tubal injury was introduced in this research,which would be discussed on its influencing factor,correlation with HSG(hysterosalpingogram),capacity of diagnose extent of tubal injury and evaluating the curative effect of salpingoplasty.It is most important to figure out whether the classification is able to define which group of patients would be benefit mostly from surgery by follow-up investigation.Subjects and methodsA retrospective clinical study was performed on 1290 chosen patients with TFI admitted to the Gynecology and Obstetrics Hospital of Fudan University from 1998 to 2007.A self-designed follow-up-questionnaire was used to investigate on the information including diseases history, operation records and productive outcome after surgery among the patients from 2003 to 2007 by telephone.Mann-Whitney U test,chi-square test,and Binary Logistic regression were performed in data analysis.Results1290 cases were analysized,in which 1055(81.8%) cases undergone salpingoplasty by laparoscopy,215(16.7%) cases undergone the surgery by hysteroscope and laparoscope,while 20(1.6%) cases were by laparotomy. The average age of patients was 29.6 years old,ranging from 20 to 44 years old.Pelvic inflammatory disease(PID) history was found in 196 cases.No difference was indicated between PID group and no PID group using the new tubal classification system,while AFS-r adhension calssification system seemed to be scored higher in PID group.643 cases(49%) got induced abortion before.Our research showed that induced abortion has considerable influence on both tubal classifications. The induced abortion group got higher score.87 cases were reported ectopic pregnancy before.Salpingectomy group got higher score in the new tubal classification system than other two treatments.HSG was performed in 1120 cases including 1878 tubes.1418(91.6%) tubes were diagnosed as fimbria adhension or occlusion,30(1.9%) tubes were blocked in ampulla or isthmic portion and 100(6.45%) tubes at the proximal end.1168 tubes were diagnosed as totally occlussion.Another 59 tubes can't be figured out in HSG.Laparoscopy diagnosed 1206(91.6%) tubes as fimbria adhension or occlusion,11(0.9%) blocked in ampulla or isthmic portion and 69(5.4%) at the proximal end.1184 tubes(68.9%) were totally blocked.As an examination before surgery,HSG has high accuracy(83%) on diagnosis of tubal patency.The sensitivity of HSG was 86%and the specify of it was 89%,but there's still 10%of false positive on occlusion.When fallopian tube appears to be less patent in HSG,its possibility of getting higher score in the new classification system is bigger.469 cases(45%) were called and offered the information after surgery 1 to 6 years later.133(27.9%) cases got spontaneous conception in 1 to 46 months,93.2%of which in two years.59(13%) cases got ectopic pregnancy in 1 to 47 months,93.4%of which in two years.There were still 291 cases infertile in two years.The way of operating salpingoplasty shows no difference comparing their prognosis.The new tubal classification system was connected with prognosis of surgery mostly,distinguishing patients into pregnancy and infertility groups more reliably than AFS-r adhension classification system.However both systems showed no distinct advantage on distinguishing normal pregnancy from ectopic pregnancy.Fimbria structure,configuation of fallopian tubes and their patency have a notable impact on prognosis of salpingoplasty.ConclusionsThe new tubal classification system reveals the true condition of fallopian tubes during surgery.Pre-operation score is related to tubal patency diagnosed by HSG to a certain extent,while pro-operation score and D-value showed salpingoplasty' s capacity to reform tubal structure. Pre-operation score of the new tubal classification system can predict prognosis of salpingoplasty more reliably than AFS-r adhension classification system,especially in groups of normal pregnancy and infertility after the surgery.HSG showed high accuracy on screening of TFI,which is still the most useful method of screening patients with TFI diseases.Salpingoplasty is of great significance on treating TFI.469(27.9%) cases which were followed up 1 to 6 years after surgery were reported normal pregnancy after the surgery.Prospective trials are needed to validate and assert the usefulness of the new tubal classification system. |
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