What are the methods for treating hydrosalpinx?

If a woman has water accumulation in her fallopian tubes, many gynecological symptoms will appear, such as severe dysmenorrhea during menstruation, irregular menstrual cycles, and frequent lower abdominal pain. If the disease is not treated in time, it will directly lead to infertility in women. So what are the scientific methods for treating hydrosalpinx?

First, surgical treatment

Salpingostomy is suitable for patients with unobstructed proximal fallopian tubes but fluid accumulation and atresia at the distal end.

Laparoscopic salpingostomy surgery first fully frees the adhesions between the fallopian tube and other tissues. The fallopian tube is insulated through the cervix to expand the distal atretic fimbria of the fallopian tube, and the fallopian tube is fixed to the fundus of the uterus with non-destructive forceps. Whenever possible, make a cross incision at the original fallopian tube opening using a carbon dioxide laser or microscissors. If the original opening cannot be identified, a "cross" incision can be made in the thinnest avascular area of ​​the fallopian tube wall. Place the grasping forceps into the incision and open and close it several times until the incision is the desired size. The incision should be made towards the ovary as much as possible to facilitate egg collection in the future.

Use atraumatic forceps to grasp the fallopian tube lining at the new incision and turn it outward. In order to keep the incised valve in an everted state and prevent the new incision from adhering again, the serosal surface of the newly incised valve can be treated with a defocused laser or low-power micro-bipolar electrocoagulation. The surface tissue shrinks to achieve the purpose of everting the incision edge. You can also use 4-0 absorbable sutures to directly suture the everted valve to the serosa of the fallopian tube. During the operation, the wound was continuously irrigated with heparin-containing Ringer's lactate solution (5000U/L). After the operation, lactated Ringer's solution, sodium hyaluronate, antibiotics, corticosteroids, antispasmodics and other drugs can be placed in the pelvic cavity to prevent adhesion.

Second, non-surgical treatment

Get adequate rest, reduce sexual intercourse, and thoroughly treat cervicitis, inflammation of the vulva, vagina, and urethral glands, especially cervical erosion, which can cause repeated infection of the appendages and the possibility of acute attacks. In addition, the following methods are available:

1. Antibiotic treatment should be applied locally, and lateral fornix closure or intrauterine injection can be used:

(1) Antibiotic lateral fornix occlusion: once a day or every other day depending on the condition, 7 to 8 times as a course of treatment. If necessary, the injection can be repeated after the next menstruation. Generally, 3 to 4 courses of treatment are required. Dexamethasone or prednisolone can also be added and injected simultaneously.

(2) Intrauterine injection of antibiotics into the fallopian tube: The operation is the same as the method of tubal insufflation, or a double-lumen rubber catheter is inserted into the uterine cavity. The injection volume is gradually increased according to the size of the uterine cavity and the degree of fallopian tube occlusion. The initial dosage should not exceed 10 ml, and the injection solution should not be lower than room temperature to avoid causing fallopian tube spasm. The pressure should be less than 21.3 kPa and injected slowly at a rate of 1 ml per minute. After injecting the medicine, maintain the cycle for 15 to 20 minutes, remove the rubber tube, and ask the patient to lie still for half an hour. Start every month 3 to 4 days after the menstrual blood stops, once every 2 to 3 days, 5 to 6 times as a course of treatment, for a total of 3 to 4 courses.

In addition to penicillin and gentamicin, the drug should also contain hyaluronidase, chymotrypsin or dexamethasone. Hyaluronidase can hydrolyze hyaluronic acid in tissues to accelerate the penetration and absorption of the drug and increase its efficacy. Chymotrypsin can dissolve fibrin and remove necrotic tissue, hematoma and other secretions.

Adrenal cortex hormones are often used in combination with antibiotics to treat chronic salpingitis. It is reported that simply injecting antibiotics into the fallopian tube cavity can make obstruction unobstructed in 10% of cases, while adding dexamethasone can make the rate reach more than 50%. Most patients take two cycles of prednisone before the injection, that is, take 20 mg/d of prednisone for 5 days starting from the fifth day of each cycle, gradually reducing to 15 mg/d for 5 days, 10 mg/d for 10 days, a total of 20 days. Intrauterine injection is performed after the menstruation in the third cycle. The first three times use 800,000 u of penicillin, 160,000 u of gentamicin, and 1500 u of hyaluronidase (or 5 mg of α-chymotrypsin) dissolved in 10 ml of normal saline. For the next three times, use 5 mg of dexamethasone plus antibiotics. After two courses of treatment, rest for one month and repeat the injection until the tube is unobstructed.

2. Physical therapy: It can promote blood circulation and help dissipate inflammation. Commonly used methods include ultrashort wave, diathermy, infrared irradiation, etc.

Third, prevention methods

1. The prevention of hydrosalpinx focuses on clean sexual intercourse. Hydrosalpinx is caused by inflammation of the female internal reproductive organs, adnexal inflammation, and pelvic inflammation. Unclean sexual intercourse is an important pathogenic factor. Since there is no cleaning before and after sex, both men and women should pay attention to basic hygiene care.

2. Women should flush the vagina correctly. Using medicated wash to clean the vagina can easily destroy the acid-base environment of the vagina and make it easier to get candidal vaginitis. The correct way to rinse is to rinse with clean water.

3. Prevent the abuse of antibiotics and anti-inflammatory drugs. Antibiotics, whether taken orally or by injection, will inhibit the lactobacilli in the vagina, disrupt the natural ecological balance of the vagina, and change the microenvironment of the vagina, which may lead to the reproduction and eventual onset of local candidal vaginitis, and then secrete inflammatory fluid, causing hydrosalpinx.

4. Pay attention to gynecological examinations. Some diseases generally have no obvious symptoms in the early stages. 50% of non-gonococcal urethritis (mycoplasma, chlamydia infection) has no symptoms. The best way is for women to have a gynecological examination at least once a year, so that gynecological diseases can be detected and treated early.