Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Efficacy of Transcervical Fallopian Tube Catheterization in Infertility Patients with Fallopian Tube Occlusion

난관 폐쇄에 기인한 불임 환자에서 난관 개통술의 효용성

  • Park, Chan-Woo (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Cha, Sun-Hwa (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Yang, Kwang-Moon (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Han, Ae-Ra (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Yoo, Ji-Hee (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Song, In-Ok (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Kim, Hye-OK (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Kang, Inn-Soo (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Koong, Mi-Kyoung (Department of Obstetrics & Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine) ;
  • Lee, Kyung-Sang (Department of Radiology, Cheil General Hospital and Women's Healthcare Center, Kwandong University School of Medicine)
  • 박찬우 (관동대학교 의과대학 제일병원 산부인과) ;
  • 차선화 (관동대학교 의과대학 제일병원 산부인과) ;
  • 양광문 (관동대학교 의과대학 제일병원 산부인과) ;
  • 한애라 (관동대학교 의과대학 제일병원 산부인과) ;
  • 유지희 (관동대학교 의과대학 제일병원 산부인과) ;
  • 송인옥 (관동대학교 의과대학 제일병원 산부인과) ;
  • 김혜옥 (관동대학교 의과대학 제일병원 산부인과) ;
  • 강인수 (관동대학교 의과대학 제일병원 산부인과) ;
  • 궁미경 (관동대학교 의과대학 제일병원 산부인과) ;
  • 이경상 (관동대학교 의과대학 제일병원 영상의학과)
  • Received : 2010.11.11
  • Accepted : 2010.12.17
  • Published : 2010.12.31
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Abstract

Objective: To evaluate the significance and efficacy of trans-cervical fallopian tube catheterization (TFTC) in diagnosis and optimal treatment modality for tubal blockage. Methods: The retrospective study was performed in those underwent TFTC from January 2005 to December 2009. A total of 342 fallopian tubes in 215 patients which showed tubal blockage in hysterosalpingography (HSG), were subjected to TFTC. Recanalization rate (RR) was compared according to portion of tubal blockage; proximal, isthmic and distal portion and blockage type; tapering, concave, and convex type. Results: In total, RR was 72.5% (248/342 tube). According to the portion of tubal blockage, RR was 83.8% in proximal, 45.6% in isthmic and 100% in distal portion. RR was 92.3% in tapering, 80.2% in concave and 25.5% in convex type, respectively. There were 98 pregnancies in 156 patients after successful recanalization, which shows 62.7% pregnancy rate. Conclusio: TFTC were capable of recanalizing tubal blockage in 248 of 342 tubes in 156 of 215 patients (72.5%). The RR was increased with proximal portion and tapering type tubal blockage.

목적: 불임을 주소로 내원한 환자들을 대상으로 자궁 난관 조영술을 이용한 난관 불임 선별검사에서 난관 막힘의 소견을 보인 경우 선택적 난관 조영술을 시행 후 실패 시 난관 개통술을 시행하여 난관 불임치료에 있어 난관 개통술의 효용성을 알아보고 난관 막힘 부위 및 형태에 따른 난관 개통률을 비교하고자 하였다. 연구방법: 난관 불임 선별검사로서 자궁 난관 조영술을 시행하였으며 자궁 난관 조영술 상 난관 막힘 소견을 보인 215명의 342개의 난관을 대상으로 후향적 연구를 진행하였다. 결과: 난관 개통술을 시행하여 342개의 난관 가운데 248개의 난관이 개통되어 72.5%의 난관 개통률을 보였다. 막힘 부위에 따른 난관 개통률은 근위부 83.8% (197/235예), 협부 45.6% (47/103예), 원위부 100% (4/4예)를 보여 자궁-난관 접합부에 가까운 막힘 일수록 높은 개통률을 보였다. 막힘 형태에 따른 개통률은 점진형은 92.3% (157/170예), 오목형은 80.2% (69/86예), 볼록형은 25.5% (22/86예)의 난관 개통률을 보였다. 난관 막힘 부위와 형태를 종합하여 볼때 난관 근위부 점진형 막힘의 경우 91.6% (143/156예)의 높은 개통률을 보인 반면 난관 협부 볼록형 막힘의 경우에는 개통률이 11.3% (6/53예)에 불과하였다. 난관 개통에 성공한 156명 가운데 98명에서 임신에 성공하여 62.7%의 임신율을 보였다. 결론: 난관 개통술은 자궁 경부를 통한 시술로 수술적 방법이나 체외수정시술의 난자 채취에 비해 덜 침습적인 방법으로 입원치료가 필요하지 않으며 비교적 적은 비용으로 불임의 원인을 극복할 수 있는 장점이 있어 난관 원인에 의한 불임 환자에서 우선적으로 시행해 볼 수 있는 효과적인 치료 방법이라 할 수 있다.

Keywords

References

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