Bilateral hydrosalpinx and chronic endometritis treatment. Hydrosalpinx: causes, treatment without surgery and methods of operable treatment

female infertility is a very common problem. One of the main causes of infertility is obstruction fallopian tubes, including clogged pipes serous exudate. This condition is called hydrosalpinx or dropsy. fallopian tubes.

All pathologies of the fallopian tubes, which are characterized by the formation of a bladder with exudate and blockage of the tube, are called sactosalpinx. This is an inflammatory disease that requires urgent treatment.

Varieties of sactosalpinx:

• hydrosalpinx (filling the cavity with serous fluid);
• pyosalpinx (filling the cavity with pus).

Hydrosalpinx is a disease of the fallopian tubes, in which a cavity with a transudate forms in their lumen. With hydrosalpinx, the tissues of the fallopian tubes stretch and cease to perform their functions. Due to flabbiness, thinning and destruction of the villi of the epithelium, peristalsis is disturbed. Even after treatment, it is not always possible to restore the structure and function of the fallopian tubes. Pathological tissues become a source of new inflammation, so the disease often recurs.

Perhaps unilateral and bilateral accumulation of transudate. Usually hydrosalpinx develops without symptoms, blockage can reach several centimeters. Fallopian tube obstruction can be acute or chronic.

There are simple and follicular hydrosalpinx. The simple form is characterized by the presence in the pipe of one closed cavity with liquid. With follicular formation, several cavities are formed, which are separated by adhesions. There is also a valve or draining hydrosalpinx. This is a condition when the contents of the cavity are poured into the uterus and out.

Pathology is most often detected when diagnosing the causes of infertility. Hydrosalpinx is common cause tubal-peritoneal infertility. In this state, the chances of natural conception are halved, the risk of miscarriage increases and ectopic pregnancy. Even IVF success is reduced by 3-5 times.

Causes of hydrosalpinx

Such a complication of the pelvic organs as an adhesive process can contribute to the pathological transformation of the fallopian tubes. Connective tissue begins to grow in the lumen of the tube, which forms partitions and forms pseudocysts. In one area, the lumen of the tube may narrow to complete obstruction.

With obstruction, there are violations of blood circulation and lymph circulation. A cavity is formed, which is filled with transudate from secreted mucosa, plasma and extracellular fluid. Complete filling of the cavity stretches and deforms the pipe walls. The tissue gradually becomes thinner, the fluid can pour out, however, due to adhesions and inflammation, the hydrosalpinx quickly recurs.

The risk of developing hydrosalpinx is higher in patients with endometriosis. In many patients with hydrosalpinx, the cause is a local infectious and inflammatory process (endometritis, salpingitis, adnexitis). The cause of inflammation may be nonspecific local flora or pathogens of STIs (gonorrhea, chlamydia, trichomoniasis, mycoplasmosis). Women who have undergone surgery in the pelvic organs are also at risk.

Symptoms of hydrosalpinx

A small hydrosalpinx in the inactive phase of inflammation almost does not manifest itself. Usually obstruction is detected during a planned ultrasound or when determining the causes of infertility.

A feeling of heaviness in the lower lateral part of the abdomen is noted with a significant accumulation of fluid and overstretching of the tubes. Chronic pelvic pain is possible. Severe hydrosalpinx is characterized by the presence of pulling, pulsating or arching pains in the lower abdomen, copious secretions, fever and weakness. The temperature can rise to subfebrile values ​​​​(37.1-38 °).

Symptoms of acute hydrosalpinx are similar to the clinic of appendicitis, intestinal or renal colic. The temperature rises to 38-39 °, there are severe pains of a bursting or pulsating nature, radiating to the groin. With pyosalpinx, there is a pronounced malaise, chills, fever, myalgia (muscle pain). The draining form is characterized by periodic release a large number watery whites.

Hydrosalpinx and pregnancy

Violation of the patency of the fallopian tubes affects the reproductive function. When the lumen closes, the egg cannot move forward and fertilize. In the event that the lumen of the tube is not completely closed, there is still a risk of an ectopic pregnancy. With partial obstruction, the epithelium is damaged and smoothed, muscle fibers atrophy, which provokes a violation of peristalsis (reduction of the walls of the pipe).

Infertility due to hydrosalpinx is called tubal. Obstruction not only reduces the likelihood of natural fertilization, but also reduces the effectiveness of IVF. Removal of adhesions and reocclusion of the tubes does not guarantee the restoration of reproductive function, since it is not always possible to restore peristalsis.

IVF for dropsy of the fallopian tubes

In practice, the influence of hydrosalpinx on success has been proven in vitro fertilization. Obstruction of the fallopian tubes not only reduces the chances of success, but at times increases the likelihood of an ectopic pregnancy and miscarriage for early term.

Hydrosalpinx is an indication for tube removal in preparation for in vitro fertilization. Removing the tube increases the chances of successful IVF by several times.

Why hydrosalpinx reduces IVF success:

1. When the hydrosalpinx is drained, its contents enter the uterus and can wash out the embryos for early stage implementation.
2. The contents of the hydrosalpinx not only washes out the embryos, but also has a destructive effect. serous fluid contains elements that give embryotoxic and cytotoxic effects.
3. The contents of the hydrosalpinx provokes pathomorphological changes in the endometrium of the uterus. Under these conditions, worse local immunity, the expression of receptors for estradiol and progesterone decreases, subendometrial blood flow weakens, structural disturbances in the glandular and stromal components of the endometrium are noted.

Hydrosalpinx leaves little chance of conception: how naturally as well as in vitro fertilization. Functional reconstruction does not always help to get pregnant, so the removal of the tubes with an IVF cycle remains preferable.

Diagnosis of hydrosalpinx

Since at the initial stage of the development of dropsy, its symptoms are mild, most often the acute form of hydrosalpinx is diagnosed. It is possible to identify the pathology during a planned ultrasound, but usually the problem is discovered only after the appeal of a woman who cannot become pregnant.

The main diagnostic methods for suspected hydrosalpinx:

• vaginal examination (detection of a rounded or ovaloid formation between the uterus and the ovary, the formation has a stiff elastic consistency, moderate pain is noted on palpation);
• transvaginal or combined ultrasound (expanded and elongated tubes with homogeneous contents, the nearest ovary is intact, free fluid in the recto-uterine cavity);
• swab sampling;
• hysterosalpingography ( x-ray examination uterus and tubes);
• ultrasound hysterosalpingography;
• Ultrasound of the pelvic organs;
• diagnostic laparoscopy (allows you to get the most accurate information, thickened tubes with translucent watery contents are visible).

Diagnosis plays a key role in the choice of treatment. The doctor must determine the location of dropsy, the number of blisters and comorbidities pelvic organs.

First stage of treatment

It is impossible to completely cure hydrosalpinx conservatively. Often, the condition recurs, as pathomorphological prerequisites persist. Medical treatment hydrosalpinx is ineffective, but it is carried out in order to alleviate the symptoms of the disease. Only occasionally is it possible to restore the patency of the pipes with the help of medicines.

Drug therapy for hydrosalpinx:

1. When infected with a bacterial microflora of the internal genital organs, antibiotics are prescribed.
2. After systemic antibiotic therapy, antimycotic drugs are prescribed to prevent candidiasis.
3. Non-steroidal anti-inflammatory drugs help reduce swelling, reduce exudate secretion and improve microcirculation.
4. Enzyme preparations are used to combat adhesions in the uterus and fallopian tubes.
5. Immunocorrection and restorative therapy with vitamins.

Treatment of hydrosalpinx is carried out in two stages. Initially, anti-inflammatory therapy is prescribed, which helps to stop infectious process in pipes. For this, the patient is prescribed antibacterial drugs and vitamins. The effectiveness of physiotherapy (electrophoresis, laser phoresis, magnetophoresis, UVR, UHF, hirudotherapy) has been proven.

The second stage is surgical intervention. There are many different ways remove the obstruction and create a bypass for the egg. The least traumatic, but quite effective are laparoscopic methods.

Methods of surgical treatment of hydrosalpinx

In an advanced case of hydrosalpinx, surgery is often the only effective method treatment. It is recommended not to postpone the operation, because every day the woman's condition will worsen.

At the moment, in the treatment of hydrosalpinx, preference is given to minimally invasive technologies. Laparoscopic surgery involves an almost bloodless intervention with minimal tissue cutting. Endoscopic equipment reduces the number of complications, prevents intestinal paresis, and avoids circulatory disorders. The laparoscopic approach is preferred because the recovery period is much faster.

Possibilities of laparoscopy in the treatment of hydrosalpinx:

• separation or removal of adhesions, which allows you to restore patency;
• removal of pathological content;
• restoration of pipe integrity.

The specific method is chosen depending on the severity and localization of the pathology. After laparoscopic surgery, anti-inflammatory treatment of the uterus and appendages is carried out. Therapy includes antibacterial and anti-inflammatory drugs, as well as alternative methods of treatment. After the surgical stage, mud therapy, balneotherapy, electrical stimulation of the tubes are recommended.

Methods surgical treatment hydrosalpinx:

• salpingo-ovariolysis;
• salpingostomy;
• salpingoneostomy;
• fimbriolysis.

Even by surgical treatment, it is not always possible to cure hydrosalpinx. Often, the fallopian tubes cannot be restored, so doctors have to resort to their removal. Only radical methods allow you to achieve a full recovery and prevent relapse. Despite the effectiveness of the method, laparoscopic removal of the damaged tube (salpingectomy) is recommended mainly for older patients who do not plan pregnancy. After removing the tubes, you can still get pregnant, but only with the help of IVF.

In the treatment of hydrosalpinx in women reproductive age who are planning a pregnancy, choose less radical methods. In this case, preference is given to organ-preserving procedures. If the treatment is carried out with the help of organ-preserving operations, the woman still has the opportunity to become pregnant naturally. Fimbrioplasty makes it possible to improve the capture of the egg by fibrias (villi).

Salpingo-ovariolysis

The operation involves the dissection of adhesions that violate the topography reproductive organs. This operation is one of the most effective in the treatment adhesive process in the small pelvis. Intervention can be independent or be initial stage in tubal plasty.

The dissection of adhesions is carried out after endocoagulation with a point coagulator or a clamp-coagulator at a temperature of 120°C. The dissection is carried out using microscissors or peritoneal scissors. After the tubes are released from the adhesions, ovariolysis is performed, coagulating and crossing the adhesions with the ovary.

The fallopian tube is shifted upwards, adhesions near the organ are endocoagulated. With preliminary coagulation, the dissection passes without blood; if bleeding occurs, additional coagulation is performed.

In the process, it is important to raise the ovaries. Adhesions are most often localized on the surface facing the wide uterine ligament. If adhesions are found between the appendages and the omentum, they are dissected after endocoagulation. When there is a lot in the fusion area blood vessels, pre-perform omentum ligation. In case of detection of adhesions between the appendages and loops of the intestine, it is desirable to carry out a traditional intervention in abdominal cavity.

Salpingostomy

If the adhesions cannot be eliminated, a salpingostomy is resorted to. This is a procedure to create an artificial channel between the ovaries and the uterus, which allows the fertilized egg to enter the uterine cavity. This technique is preferred for occlusion of the abdominal opening of the fallopian tube. The operation is not performed in case of acute and subacute inflammation in the pelvic organs, as well as severe hydrosalpinx.

The surgeon opens the fallopian tube at the closed end, the mucosa is turned out a little and connected to the peritoneum with catgut sutures. If pathological changes expressed, the end of the tube is resected by performing a transversal salpingostomy. The hole in the tube is brought closer to the ovary by the method of lateral salvostomy: an oval hole is made in the expanded section, and the edges of the mucosa are connected to the peritoneal cover.

Even after salpingostomy, only 10-20% of patients manage to become pregnant. This is due to the inevitable fusion of the created hole, impaired tubal motility and significant changes in the mucous and muscular membranes.

Salpingoneostomy

According to the indications and technique, salpingostomy and salpingoneostomy do not differ, the only difference is that during salpingostomy, the hole is recreated in the area of ​​\u200b\u200bits usual location. With salpingoneostomy, a hole is formed in an atypical area of ​​the fallopian tube.

Laparoscopic salpingoneostomy involves the creation of an opening in the ampulla of the fallopian tube. The operation is indicated for tubal infertility with obstruction in the ampulla.

Contraindications for salpingoneostomy:

• blood clotting disorder;
• renal, hepatic, cardiovascular or respiratory failure;
• exacerbation of chronic pathologies;
• specific infections;
• pronounced adhesive process involving intestinal loops;
• oncological diseases;
• acute or subacute inflammatory process in the small pelvis.

Three punctures are made in the abdominal wall, and a probe is inserted into the uterine cavity to inject the dye. Gas is injected into the operated area to improve visibility. If necessary, adhesions are first dissected, then the tube is filled with a solution of indigo carmine or methylene blue.

A new opening is formed on the side opposite from the broad ligament of the uterus. Carry out endocoagulation using a point coagulator. The tube is grasped with tongs and pulled up. The wall of the pipe is opened in layers, forming a hole of 1.5-2.5 cm. The edges are turned inside out and sewn on each side. At the end, the cavity is washed with Ringer's solution, and the puncture sites are sutured.

Fimbriolisis

This operation involves the separation of fused fimbriae in a state of narrowed funnels of the fallopian tubes. Fimbriolysis is indicated for tubal infertility of the fimbriae.

Prior to separation of the fimbriae, chromosalpingoscopy is performed. By introducing a dye into the pipe, it is sometimes possible to achieve patency without additional intervention. If the stenosis persists, the fimbriae are separated with an atraumatic forceps.

Contraindications to fimbriolysis:

• severe disorders in the work of the respiratory and cardiovascular systems;
• renal and liver failure;
• blood clotting disorders that cannot be corrected;
• genital infections;
• acute inflammation in the reproductive system;
• malignant diseases;
• gestation.

Three punctures are made in the anterior wall of the peritoneum. The doctor examines the organs for other pathologies. If adhesions are present, salpingo-ovariolysis is performed. A dye is injected into the uterine cavity, which enters the tubes and flows out of the hole made. If hydrotubation does not help eliminate the narrowing, the tube is fixed, and the scar tissue is dissected with a needle coagulator.

The doctor introduces clamps with closed branches, opens and removes in a circular motion. After that, the doctor examines the field and coagulates minor bleeding. The dye is re-introduced to make sure the tube is patency: the fluid will freely exit into the abdominal cavity. At the end of the operation, the cavity is sanitized with Ringer's solution. The punctures are sutured and closed with napkins.

Forecast and prevention

Prevention of hydrosalpinx includes adequate treatment of pathologies of the pelvic organs and sexually transmitted diseases. It is necessary to avoid casual contacts and plan a pregnancy in order to exclude the need for an abortion. Regular follow-up with a gynecologist is important.

The prognosis for dropsy of the fallopian tubes depends on the severity of the disease and the timeliness of treatment. Often it is not possible to restore the patency of the pipes, they are completely removed. However, modern reproductive technologies allow even patients without fallopian tubes to become pregnant.

Complications of dropsy of the fallopian tubes

Pathogenic microflora can spread to other organs and provoke purulent inflammation. A pronounced process can affect not only the genitals, but also other structures of the small pelvis. This is fraught with pelvioperitonitis and related complications.

Complications of hydrosalpinx:

• infertility;
• infection of a pathologically altered tube;
• transition to pyosalpinx (suppuration).

A dangerous complication of hydrosalpinx is rupture of the tube. It is accompanied by sharp pain, tachycardia, hypotension, blanching of the skin and cold sweating. When the transudate enters the abdominal cavity, peritonitis develops - an acute inflammation, which is accompanied by edema and toxic poisoning. Rupture of the pyosalpinx is more dangerous, since the risk of peritonitis, abscess and pelvioperitonitis is higher. The pus enters bladder, rectum or vagina.

Hydrosalpinx - dangerous disease, which in severe cases treated only by complete removal of the damaged fallopian tube. This operation does not deprive a woman of the opportunity to use reproductive technologies, but makes it impossible to conceive naturally.

A disease in which the cavity of the fallopian tubes is filled with fluid is called hydrosalpinx. It most often has a transparent, slightly yellowish tint, while it does not contain pathogenic bacteria and purulent discharge.

This fluid is blood plasma that enters the lumen of the fallopian tubes through the thin walls of blood vessels, as well as natural secretion and extracellular fluid. And its accumulation is due to a violation of the patency of the pipes as a result of narrowing.

Hydrosalpinx must be treated, as this disease can later cause infertility and other pathologies, including ectopic pregnancy. In addition, the narrowing of the lumen not only leads to its filling with fluid, but also to the formation of adhesions.

Experts have well studied hydrosalpinx and the reasons that cause it. These include:

• Infectious and inflammatory processes in the female genital organs, including inflammation of the ovaries, endometritis, adnexitis;
• Adhesions in the pelvic area that occurs after the disease;
• Consequences of a surgical operation;
• Malignant and benign formations;
• The consequences of the removal and curettage of an ectopic pregnancy, in which plastic surgery of the fallopian tubes is performed.

The causes of this disease can also be due to infections that are sexually transmitted. These include chlamydia and gonorrhea, which can also cause adhesions that narrow the tubes.

The formation of serous contents can occur in the cavity of one or immediately two fallopian tubes. In the first case, the woman is able to retain the possibility of becoming pregnant, since the lumen of the second tube remains open. Wherein bilateral hydrosalpinx practically does not preserve the chances of a favorable pregnancy.

Symptoms of hydrosalpinx, despite the complexity and danger of this disease, are often mild, because it does not wear inflammatory character. In some cases, women may report no symptoms at all. However, infertility can be attributed to the main symptom of this disease.

Symptoms of the disease depend on the duration of its occurrence, therefore, for successful treatment of this pathology, timely diagnosis is important. It can prevent a number of undesirable consequences.

Hydrosalpinx on the left or right, flowing into acute form need urgent treatment. It is characterized by a sharp rise in temperature, increased weakness, fatigue, and painful sensations that occur in the lower abdomen. In this case, the pain that occurs in the fallopian tubes is most often pulsating and bursting in nature.

These signs are also characteristic of the chronic form, while a woman may not have a long-awaited pregnancy for a long time. In this case, the severity of symptoms depends on the form and nature of the course of the process.

A rarer form of the disease, such as ventral hydrosalpinx, is characterized by persistent yellowish watery discharge. It occurs when the fallopian tubes are not completely soldered, as a result, during physical activity or a sharp change in the position of the body, the fluid from the tubes pours into the small pelvis.

In the presence of the above symptoms, a woman should urgently seek advice from a gynecologist. During the examination and taking an anamnesis, he can make a preliminary diagnosis. TO additional methods surveys can include:

• Examination on a gynecological chair. The gynecologist examines the vagina with both hands, determines the size of the uterus and ovaries, and also pain in the fallopian tubes;
• Ultrasonography. This method allows you to determine the presence of fluid in the pelvic cavity;
• PCR diagnostics to detect diseases that are sexually transmitted;
• Hysterosalpingography. During this study, the patency of the pipes is determined after the introduction of a special contrast pigment into the cavity;
• Laparoscopy. The operation is not only diagnostic, but also preventive and therapeutic.

The doctor prescribes the treatment of hydrosalpinx after making an accurate diagnosis, in addition, it depends on the woman’s desire to maintain childbearing function or not. In this case, therapy can be conservative or surgical.

• Antibacterial therapy if inflammatory process or infection;
• Physiotherapy procedures.

This treatment option is effective only in the presence of salpingitis, adnexitis and salpingoophoritis, which cause narrowing of the lumen of the fallopian tubes. In an advanced situation, surgical intervention will be required to restore their patency or remove them.

To expand the lumen of the tubes and enable a woman to become pregnant in the future, it is necessary to perform a laparoscopy operation, which consists in their plasticity.

However, the outcome of surgery does not guarantee the restoration of full functionality. reproductive organs. In this case, the villi located in the cavity of the tubes lose their mobility and ability to move fertilized egg or an egg in the uterus.

If a woman does not want to maintain the ability to conceive, in this case, an operation is performed to remove the affected area. Also, such a surgical intervention is prescribed with the ineffectiveness of conservative treatment and the impossibility of eliminating the source of infection.

Hydrosalpinx on the right or left, as well as the bilateral form of this disease, can also be cured with folk recipes. Clay, juniper and cabbage steam baths allow you to get a good result.

Also, in violation of the patency of the pipes, douching and washing with decoctions of herbs from chamomile, coltsfoot, mallow, and oak bark are useful. The course of treatment in this case should not exceed one month. Douching can reduce pain and relieve inflammation so that pregnancy occurs soon.

To alleviate the condition and relieve symptoms, you can use healing herbal teas, raw vegetable juices, as well as compotes. One of the universal and effective antibacterial agents, which copes well with the symptoms of this disease is aloe juice.

However, you should not self-medicate, and before taking all folk remedies, consultation is necessary. an experienced specialist. Only a comprehensive and systematic treatment of hydrosalpinx will achieve good result and restoration of the functionality of the female reproductive organs without the need for surgery.

Hydrosalpinx can be prevented. Among the preventive measures it is worth highlighting:

• Timely treatment of all gynecological diseases accompanied by moderate pain, discharge and other unpleasant symptoms;
• Regular follow-up with a gynecologist, especially after a gynecological operation;
• Compliance with the rules of personal hygiene during menstruation;
• A healthy lifestyle, this includes quitting smoking and alcohol abuse;
• Refusal of casual sexual contacts.

Hydrosalpinx in the absence adequate treatment can lead to various complications. These include not only infertility, but also with a successful pregnancy, there is a high risk of miscarriage and spontaneous termination.

One of the consequences of inflammation of the uterine appendages, in particular its tubes, is hydrosalpinx. According to statistics, this pathology is present in 10-30% of women who are planning a pregnancy, but it does not occur, due to the fact that hydrosalpinx prevents successful conception.

However, with adequate timely treatment, a long-awaited pregnancy is possible, so there is no need to try to get rid of the pathology by resorting to self-medication. This approach will only exacerbate pathological process and delay the moment of the onset of the long-awaited conception, and especially advanced cases pregnancy may not occur at all.

The concept of hydrosalpinx

Hydrosalpinx is a disease of the fallopian tubes, which leads to a violation of their patency. The very name of the pathology comes from Latin words, where "salpinx" is a pipe and "hydro" is a liquid. The phrase that can be heard quite often from women - hydrosalpinx tubes - is incorrect, because, coming from the above, oil is obtained. A feature of this disease is that there is an accumulation of transudate (fluid) in the fallopian tubes, due to blockage of the external and inner hole oviduct. Thus, the pipe turns into a pouch-like formation.

Distinguish:

bilateral gyrosalpinx;

hydrosalpinx on the left;

right-sided hydrosalpinx.

It is also incorrect to use combinations of the type of chronic and acute hydrosalpinx. This pathology refers to the complications of the inflammatory process of the uterine tubes - salpingitis, so it can be chronic or acute.

Diagnosis example: Chronic bilateral salpingo-oophoritis. Hydrosalpinx bilateral.

Anatomy and Physiology

The fallopian tube (oviduct, fallopian tube) is a paired organ, which is a hollow tube with two gaps. The length of the oviduct is 10-12 centimeters, while the right tube is slightly longer than the left one. One end of the fallopian tube opens into the uterine cavity, while the other ends in villi (fimbriae) and opens near the ovary into the abdominal cavity. Through these holes, the abdominal cavity communicates with the external and internal genital organs, which only increases the risk of developing an ascending infection, for example, with vaginitis.

The wall of the oviduct consists of 3 layers:

internal - it is covered with ciliated epithelium, its cilia make wave-like movements that contribute to the advancement of a fertilized egg towards the uterus. In addition, the glands on the mucous tube secrete a substance that maintains the viability of the zygote, sperm and egg, as well as the constancy of the internal environment of the oviduct;

muscular - made of muscle fibers, due to which contractile movements occur, directed to the uterine cavity;

external - represented by the peritoneum, it performs the function of protecting the tube from negative effects.

The role of the fallopian tubes

The fallopian tubes are required to ensure successful conception, as well as implantation of the (fertilized) egg in the uterine cavity. The functions of the oviducts include:

transportation of the zygote to the uterine cavity, through peristaltic movements of the oviduct, as well as increased activity of the ciliated epithelium (its cilia, in particular);

maintaining the vital activity of the zygote (fertilized egg) in the tube before it enters the uterine cavity;

maintaining the viability of sperm and egg (sex cells), as well as their preparation for connection, that is, fertilization;

the egg is delivered to the ampulla of the fallopian tube, where spermatozoa are also sent from the uterine cavity;

with the help of fimbriae, the mature egg, after its release from the follicle, is captured and brought to the funnel of the tube.

The mechanism of development of pathology

The functioning of the fallopian tubes may be impaired due to inflammation, for example, against the background of salpingo-oophoritis or salpingitis. Pathological proliferation of connective tissue begins, adhesions and scars are formed. The inflammatory process, as well as adhesions, are introduced into all layers of the fallopian tube, only the degree of severity of the process differs.

The villi of the ciliated epithelium die, and the muscle layer stops contracting. Adhesions grow in the lumen of the fallopian tube, the patency of the oviduct is disturbed, the fimbriae of the funnel stick together. When both lumens of the fallopian tube are closed with adhesions, fluid begins to accumulate in the formed clogged cavity, which occurs due to increased secretion of mucus by the glands of the epithelium in response to inflammation. This leads to the expansion of the tube and the formation of a sactosalpinx, or hydrosalpinx. If there is suppuration of the serous-mucous contents in the tube, a pyosalpinx appears.

Sometimes incomplete soldering of the fimbriae of the tube occurs. In such cases, they speak of a "valve hydrosalpinx", which tends to periodically break through under the pressure of the fluid accumulated in the cavity of the pipe. An increase in pressure occurs due to a change in body position, in the process of hysterosalpingography, straining. There is an outflow of transudate into the small pelvis. With “valve hydrosalpinx”, the oviduct is emptied systematically. The inflammatory fluid that pours into the small pelvis provokes the occurrence of adhesions - thus, a kind of vicious circle, which supports the hydrosalpinx.

Causes of hydrosalpinx

The formation of hydrosalpinx occurs due to the closure of the middle (ampullar) section of the oviduct, this occurs in response to a local infectious-inflammatory reaction. Infectious agents penetrate into the cavity of the fallopian tube both along the ascending path, from the lower organs of the reproductive system (cervix, uterus, vagina), and downstream, namely with the blood flow from the appendix, intestines, tonsils, kidneys, bladder. Inflammation can be aseptic, occur in the presence of gynecological diseases. Hydrosalpinx is formed due to such reasons:

diagnostic curettage of the uterine cavity and abortion;

frequent hypothermia (activation of opportunistic microflora against the background of weakened immunity);

wearing an intrauterine contraceptive;

disorderly sex life And frequent change partners (sexual infections: gonococci, trichomonas, ureaplasma, chlamydia);

endometritis (inflammation of the uterus);

inflammation of the appendages, ovaries, tubes (andexitis, oophoritis, salpingitis);

damage to the oviducts during laparoscopy with the occurrence of aseptic inflammation;

sexual infantilism (coiled, long, thin tubes);

myomatous node located in the area of ​​​​the entrance of the oviduct into the uterine cavity;

adenomyosis;

external endometriosis (causes aseptic inflammation and the formation of adhesions in the pelvic area);

inflammation cervical canal and cervix;

vaginal dysbacteriosis and prolonged vaginitis.

Predisposing factors that increase the risk of developing hydrosalpinx:

endocrine pathologies: diseases thyroid gland, diabetes(weaken the body's defenses);

emotional stress, stress;

neglect of the rules of personal intimate hygiene.

It is worth noting that not always treated and transferred andexitis or salpingitis ends with the occurrence of hydrosalpinx. In the presence of strong immunity, as well as adequate timely treatment inflammatory processes in the fallopian tube disappear without consequences.

Symptoms

The clinical picture of the pathology depends on what disease led to it. If hydrosalpinx arose against the background acute inflammation fallopian tubes, its symptoms are more pronounced. The patient suffers from signs of intoxication: weakness, lethargy, loss of appetite, arching pain in the groin (right or left), febrile temperature. If the transudate quickly accumulates in the middle part of the fallopian tube, then the pain can be described as pulsating and bursting.

If hydrosalpinx occurs against the background of the presence chronic form salpingitis, quite often patients do not experience any discomfort. Most often, the only complaint is the inability to get pregnant, and the pathology itself is detected already in the process of research on infertility. However, there may also be complaints of discomfort in the iliac region, pain during intercourse, sensation of a foreign body in the groin area. With valve hydrosalpinx, a woman notes the appearance of periodic watery discharge from the vagina (provided that the breakthrough of the formations has occurred in the uterine cavity).

With the outflow of fluid into the cavity of the small pelvis, the processes of adhesion formation intensify, this manifests itself in the form of chronic pelvic pain syndrome. In some cases, a mass with fluid in the fallopian tube may behave like an acute surgical pathology (intestinal or renal colic, appendicitis).

Typical signs of the presence of chronic salpingitis with attached hydrosalpinx are:

no pregnancy;

discharge from the genital tract of a pathological nature;

menstrual disorders;

insignificant It's a dull pain or discomfort in the iliac region.

Pregnancy with hydrosalpinx

Against the background of hydrosalpinx, pregnancy can occur, but only if the tube is affected only on one side. Thus, it is easy to calculate that the chances of pregnancy are reduced by 50%. At the same time, the risk of tubal pregnancy and subsequent spontaneous abortion increases significantly. Ectopic pregnancy occurs due to damage to the ciliated epithelium and impaired peristalsis of the tube. Thus, a fertilized egg stays in the fallopian tube for up to 4 or more days, then it implants, begins to grow and develop.

Spontaneous abortion against the background of hydrosalpinx can be explained with the help of several points:

decreased sensitivity of endometrial receptors to the effects of female sex hormones. This leads to a violation of the hormonal background of the uterine mucosa and the process of egg implantation;

possible toxic effect of the transudate on the embryo, with its damage and subsequent death;

the inflammatory fluid of the hydrosalpinx affects the uterine mucosa, which leads to the development of endometritis, and, accordingly, the impossibility of implantation of the embryo;

mechanical effect: periodic outpouring of fluid during valve hydrosalpinx simply washes the zygote from the endometrium, preventing its implantation.

If hydrosalpinx of both tubes is diagnosed, then natural pregnancy is impossible. In this scenario, assisted reproductive technologies, such as IVF, are required. It should be noted that the effectiveness of in vitro fertilization and gestation is reduced by 2-5 times.

If pregnancy does occur with saccular expansion of the tube, then its spontaneous termination can occur at a late or early date. Therefore, all pregnant women diagnosed with hydrosalpinx are classified as a group of very high risk of abortion. Treatment during pregnancy is postponed to the postpartum period.

Diagnostics

Usually, the diagnosis of such a complication begins with a gynecological examination. During bimanual palpation, the hydrosalpinx is palpated as an oblong, tightly elastic formation on one or both sides. There may be slight pain during palpation of the appendages, at the same time, pain may be absent. If the expansion of the fallopian tube is insignificant, then the doctor may not detect complications during palpation, in such cases additional studies are prescribed:

Ultrasound transvaginal probe.

Allows you to determine the saccular formation on both or only one side, to establish its localization (between the ovary and uterus), shape and size. Visualization of the septa (follicular hydrosalpinx) is also possible. The formation has its own thick capsule, which is filled with a hypoechoic fluid.

Hysterosalpingography.

This method consists in the introduction of a contrast agent into the uterine cavity through the cervical canal (under pressure). This is followed by a series of x-rays. This method allows you to determine the patency of the fallopian tubes - the contrast is determined in the small pelvis, visualizing the hydrosalpinx. If there is a complication, the fallopian tube is displayed as thickened and tortuous, with accumulated contrast visible in the enlarged middle section.

Laparoscopy.

It is carried out for the purpose of diagnosis and treatment. During laparoscopy, a thickening of the fallopian tube, hyperemic and edematous fimbriae at the ends are detected, at the same time, the wall of the oviduct itself is translucent and thinned, and its cavity is filled with liquid.

Except instrumental methods diagnostics, you also need to be tested for the presence of genital infections (herpes virus, HPV, cytomegalovirus, myco-and ureaplasma, chlamydia).

Treatment

When diagnosing hydrosalpinx, a woman must undergo treatment, because the neglect of the process of adhesion formation in the small pelvis depends on the time of existence of such a complication, which in turn is a factor that increases the risk of ectopic pregnancy, miscarriage and reduces the possibility of conception.

Unfortunately, some patients are not serious about this pathology, thinking primitively - it does not hurt, therefore it is not dangerous. This attitude leads to a delay in a visit to a gynecologist, and in some cases, delay leads to irreversible changes: the absolute impossibility of getting pregnant naturally, which can only be solved with the help of IVF.

Treatment of hydrosalpinx is performed in two stages. At the first stage, conservative therapy is carried out. In the presence of an acute inflammatory process in the appendages, or during exacerbation chronic process need to take a course of antibiotic therapy. The duration of the course, as well as the dosage of the drug is selected in a purely individually, taking into account the sensitivity to medicines and the nature of the pathogen (with a positive result for STIs).

Main stage line conservative therapy is to stimulate the immune system. For this, immunomodulatory drugs are prescribed:

autohemotherapy (introductions of one's own venous blood intramuscularly);

"Immunal";

"Aloe injections";

"Taktivin";

"Timalin";

"Imudon";

"Likopid";

"Immunofan".

Also, in order to stimulate the immune system, it is recommended to take vitamins or their parenteral administration. Physiotherapeutic procedures are widely used, which, although they do not allow to completely recover from hydrosalpinx, but have favorable conditions for healing:

endovaginal vibromassage;

electrical stimulation of the fallopian tubes;

electrophoresis of electrolytes (magnesium, calcium);

magnetorez.

Hirudotherapists claim that this pathology can be eliminated with the help of leeches. However, such a statement is not only scientific evidence but also confirmed statistics.

Folk methods

Many patients with hydrosalpinx believe that they will be helped to recover folk remedies. Doctors also allow the use folk methods, but only as additional treatment to the main conservative stage of therapy. Preparations traditional medicine do not relieve complications, but act as liquidators of symptoms: slightly normalize menstrual cycle, inhibit the formation of adhesions in the pelvis, relieve pain. Of the recommended folk remedies can be used:

infusion of herbs (St. John's wort, sage, currant leaf, pharmaceutical camomile);

infusion of adonis;

taking juniper baths (an infusion of juniper branches and berries is poured into the water, the water in the bath should be warm);

taking oatmeal;

taking a mixture of honey, butter and aloe leaves;

microclysters with medicinal herbs (oak bark, calendula, pharmacy chamomile);

reception of nettle, potato and pumpkin juice(mixed or singly).

Surgery

The second stage of treatment consists in the surgical elimination of this complication during the operation. Treatment of hydrosalpinx, which does not end with surgery, is meaningless. Until the focus of inflammation is eliminated, adhesions will continue to form in the pelvis, respectively, the pain persists, and the chances of natural fertilization are reduced.

Today as a method surgical removal hydrosalpinx is used laparoscopy. Laparoscopic therapy of oviduct formation is an effective and most sparing method of surgical intervention. During the operation, different kinds surgical intervention in the structure of the fallopian tube, the technique is determined depending on the condition of the patient, the condition of the tubes and the desire to become pregnant.

Tubectomy - resection of one or both tubes (performed if there is no other way to eliminate the pathology, as well as for women who are over 35 years old).

Salpingoneostomy and salpingostomy - the formation of a new hole in the middle section of the oviduct, or the release of the anatomical hole from adhesions (the minus of salpingoneostomy is that the new hole quickly overgrows).

Fimbrioplasty and fimbriolysis - release of adhesions of the fimbriae of the final section of the oviduct at the point of their junction with the ovary, fluid is also removed from the tube. If necessary, fimbria plastic surgery is performed.

Salpingo-ovariolysis - adhesions around the ovary and oviduct are dissected, their normal position is restored, adhesions are separated in the lumen of the fallopian tube.

It is worth noting that even if the operation ended successfully, the tube was saved and successfully restored its patency, the oviduct will not be able to function normally. The cilia of the ciliated epithelium may lose their mobility, or the epithelium itself atrophies, the muscle layer ceases to contract normally, peristalsis is disturbed, therefore, patients after surgery to eliminate hydrosalpinx are at risk of ectopic pregnancy. In such cases, fertilization with IVF is recommended.

Frequently Asked Questions About Hydrosalpinx

What is the danger of this pathology?

The presence of hydrosalpinx in a woman significantly increases the risk of an ectopic pregnancy. In addition, pathology can cause infertility. An increase in saccular formation, if left untreated, ends with a rupture of the tube and suppuration.

Is it necessary to introduce any restrictions in the presence of a diagnosis of "hydrosalpinx"?

Yes. First, you need to avoid heavy physical activity(jumps, tilts, somersaults, straining, vibration). Secondly, excessive activity should be avoided during sex, especially if pain is present. In addition, it is necessary to exclude overheating of the body, it is forbidden to take hot baths, visit saunas. Baths, solariums, as well as sunbathing. The fact is that heating leads to an exacerbation of the inflammatory process. It is also undesirable to swim in open water bodies and pools, since hypothermia can also cause an exacerbation. It is forbidden to drink alcohol, including low-alcohol drinks, because alcohol suppresses the immune system.

What is the prognosis when planning a pregnancy after laparoscopy for such a complication?

If the patency of the tube is restored and the hydrosalpinx is completely removed, then conception in a natural way with subsequent gestation occurs in 60-75% of cases, and the risk of developing a tubal pregnancy is less than 5%. If the tube has been removed, then the effectiveness of in vitro fertilization is 30-35%.

For 3-4 weeks, physical exertion should be avoided and complete sexual rest should be observed. You also need to go on a diet, which involves limiting canned food, fast food, fatty and fried foods, salty and pickled foods, spicy foods and dishes.

Hydrosalpinx is a pathology that occurs in the fallopian tubes and is characterized by a violation in their patency. Hydrosalpinx, the symptoms of which are manifested due to the accumulation of fluid in the lumen of the tube, mainly occurs as a result of salpingitis (inflammation of the fallopian tube).

general description

First, consider the features of the fallopian tubes. They represent a hollow two-lumen tube, one of the ends of which is open directly into the uterine cavity, and the other ends with fimbriae opening into the abdominal cavity. Inner surface tubes is presented in the form of a mucous membrane covered with many villi and cells that produce mucus. Further, there is a muscular coat, extremely pronounced in its features. The outer side of the tubes is covered with peritoneum.

The fallopian tubes themselves are more than important in conception. So, from the moment of ovulation (exit from the ovary), the egg is captured by fimbria, after which it ends up in the lumen of the fallopian tube. Here her meeting with the sperm takes place, after which she is fertilized. Further, the already fertilized egg (that is, the zygote) due to the peristaltic movements produced by the fallopian tube (during muscle contraction), as well as due to the vibrations produced by the villi of the mucosa, is moved by the mucus current to the uterine cavity, where the zygote is introduced into its mucosa.

In the same case, if the patency of the fallopian tubes is disturbed, fertilization simply becomes impossible, which determines the diagnosis. In addition, if the villi of the mucosa or the tubal muscular membrane are damaged, respectively, the progress to the uterine cavity is greatly hampered. This, in turn, may lead to attachment of the zygote to the tube, which occurs, in particular, when it is in it for more than four days. This process is defined as tubular, that is, .

Mostly, those functions that the fallopian tubes perform are violated due to the transfer of the inflammatory process, which may be, for example, salpingitis, or salpingo-oophoritis. Due to these pathologies, the proliferation of connective tissue begins with the formation of adhesions and scars. In this case, all departments and layers of the fallopian tubes are affected with varying degrees of their severity. Death comprehends the villi of the mucosa, in addition to this, the muscular membrane loses the ability to contract, which is characteristic of it. Additionally, the lumen of the tube gradually begins to grow with adhesions, due to which the patency is disturbed, while the fimbria begin to “stick together”.

In the event that both openings in the tube are closed with spikes at once, its lumen will gradually accumulate in itself the mucus produced by the cells, after which the tube begins to expand and, in fact, a hydrosalpinx is formed, which is otherwise defined as a sactosalpinx.

Following the suppuration of the contents in the tube, the development of pyosalpinx occurs. In some cases, the so-called “valve” hydrosalpinx is formed - if the adhesions have a slight density, they break through due to the pressure exerted by the accumulated fluid. In this situation, this leads to a systematic emptying of the pipe.

Considering that the fluid in the tube undergoes inflammation, and the tube wall stretches and disrupts contractile activity in it, along with structural damage provoked in the fallopian tube, inflammation of the wall in the tube leads to an increase in the adhesive process in the small pelvis. Thus, it can be argued that such a course of the process follows a vicious circle.

Hydrosalpinx: symptoms

Oddly enough, the symptoms accompanying such a serious internal process are characterized by relative scarcity, if not ambiguity and inconsistency of their own manifestations, moreover, in some cases, an asymptomatic course of the disease is possible. The severity of the pathology, as well as the duration of the disease, determines the severity of these clinical manifestations. In particular, they include weakness, fever and pains of a pulling nature that occur in the lower abdomen. Also, the pain can be pulsating or bursting in nature. Against the background of this manifestation, it may develop.

Besides actual symptom is infertility, which is noted in the futility of attempts to achieve pregnancy, as well as when making this diagnosis on the basis of an examination.

Valve hydrosalpinx is characterized by the systematic appearance of abundant watery secretions from the genital tract.

Diagnosis of hydrosalpinx

Diagnosis of the disease we are considering is carried out in several stages. Among them are the following:

• Gynecological examination. In this case, it is possible to determine between the ovary and the uterus a tight-elastic formation of an ovoid or rounded shape, which, as a rule, is painless or slightly painful.
• ultrasound. Ultrasound examination determines the presence of a liquid formation between the ovaries and uterus.
• Hysterosalpingography. The nature of the x-ray picture may be similar to the nature of the obstruction of the fallopian tubes. In the case of valve sactosalpinx, filling the tube with a contrast agent determines its external resemblance to a twisted "sausage".
• Laparoscopy. As in a number of other gynecological diseases, this method is not only diagnostic, but also therapeutic.

Treatment of hydrosalpinx

Current treatment methods this disease are reduced to two, namely, conservative and operational methods treatment.

Conservative treatment

The first stage involves focusing treatment on eliminating the inflammation that led to the appearance of hydrosalpinx. In addition, physiotherapy and antibiotic therapy. On the whole conservative treatment has an effect only with adnexitis, salpingoophoritis and salpingitis already listed by us.

Conservative treatment of hydrosalpinx with the achievement of proper efficiency is practically an excluded option. It is for this reason that the development of hydrosalpinx provides for the need for surgical intervention. The remaining methods in the form of microclysters and other things are only supportive methods of therapy, and, accordingly, do not lead to a cure.

Surgical treatment

Laparoscopy is the preferred surgical treatment for hydrosalpinx. During the operation, attempts are made to carry out plastic surgery of the affected fallopian tube, which involves restoring its patency by separating adhesions from its outer and inner sides.

In the absence of the desired effect, the pipe is removed, because it is an active source of chronic infection while lacking proper functionality in it. In case of ineffective treatment with the removal of the fallopian tubes, pregnancy becomes possible only when using reproductive technologies auxiliary type. In particular, this includes IVF (or “test tube baby”).

With the restored efficiency through the surgical intervention of the fallopian tubes, we are not at all talking about restoring their usefulness. In this case, the villi of the mucosa have already lost their own mobility, while the contraction of the muscular membrane is not as good as it is necessary to ensure the required mobility of the egg. Given this feature, women who have undergone an operation to restore the patency of the fallopian tubes belong to the risk group regarding the possibility of developing an ectopic pregnancy in them.

Pregnancy with hydrosalpinx, preservation of fallopian tubes

In the case of pregnancy planning, the preservation of the fallopian tubes during the surgical treatment of the hydrosalpinx we are considering is recommended only for women whose age is up to 35 years. Wherein important condition is the absolute state of health of the husband in the relevant area. Otherwise, as a measure to increase efficiency for IVF, it will be necessary to remove the tube later, because the inflammation in it becomes an obstacle to the implantation of the egg, which is fertilized for this. Accordingly, in this case, there is a serious risk of an ectopic pregnancy.

If there is indicated symptoms characteristic of hydrosalpinx, as well as in the absence of results in trying to get pregnant, you should, without delay, contact a gynecologist.

Is everything correct in the article with medical point vision?

Reply only if you have confirmed medical knowledge

Diseases with similar symptoms:

Ovarian apoplexy is a sudden rupture (that is, a violation of the integrity) that forms in the tissue of the ovary. Ovarian apoplexy, the symptoms of which are bleeding passing into the abdominal cavity, is also accompanied by an intense pain syndrome.

Hydrosalpinx (from Greek) is a pathological condition characterized by an excessive accumulation of exudate (fluid leaking from small blood vessels during inflammation) in the cavity of the fallopian tube.

Hydrosalpinx occurs when the outflow of fluid is impossible due to blockage of the lumen of the tube and can be localized both on the left and on the right, or on both sides. In case of violation of blood and lymph circulation, the fallopian tube becomes impassable in a certain area, adhesions form in it due to acute salpingitis (inflammation of the tube).

Isolated damage to only the fallopian tubes is quite rare. Typically, the ovaries and uterus also become inflamed.

Salpingitis is an inflammation of the uterine (fallopian) tubes as a result of penetration of infection from the uterine cavity and other organs of the small pelvis. Salpingitis follicularis can be caused by sexually transmitted infections, usually gonorrhea and chlamydia.

Distinguish simple hydrosalpinx when one closed cavity appears in the pipe as a result of the adhesion process, and follicular hydrosalpinx if the pipe lumen is divided into several cavities.

After the formation of cavities in the presence of an inflammatory process, exudate (liquid) begins to accumulate in the fallopian tubes. The wall of the pipe stretches (up to several cm in diameter), becomes so thin that liquid can see through it. At times, the fluid in the fallopian tubes is absorbed by the wall of the tube, while the hydrosalpinx decreases. But after a while, due to the presence of adhesions, it reappears. Therefore, the disease is characterized by a chronic relapsing (recurring) course. As a rule, the pathological process occurs on both fallopian tubes.

Sactosalpinx is the same hydrosalpinx , but exudate (serous, bloody or purulent fluid seeping into the fallopian tube from small blood vessels) can pour out through the uterus from the cavity formed as a result of adhesions in the fallopian tube. The disease occurs due to the inflammatory process and the formation of adhesions in the ampullar part of the fallopian tube and, as a rule, only on one side.

Pyosalpinx Thisaccumulation of pus in the fallopian tube as a result of overgrowth of the ampullar and uterine part of the tube with purulent salpingitis. Over time, the walls of the pyosalpinx thicken, the mucosa is destroyed. The pyosalpinx is almost always surrounded by extensive adhesions to neighboring bodies- ovary, omentum, back wall uterus, loops of intestines. The pus in the pyosalpinx is initially liquid, but becomes thick over time.

Pus from the pyosalpinx can break into the rectum (good prognosis), less often - into the bladder, into the vagina (with the formation of a tubo-vaginal fistula) and into the abdominal cavity. In this case, infection may develop diffuse peritonitis, requiring urgent laparotomy.

Symptoms of hydrosalpinx (sactosalpinx)

One of the symptoms of hydrosalpinx is an increase in body temperature. With acute salping if the secret (exudate) secreted in the tube is serous, then the disease proceeds with subfebrile temperature body 37.5ºС, serous-purulent - 38ºС, purulent - up to 39ºС.

The inflammatory process is accompanied by weakness, throbbing pain in the groin. Tachycardia (rapid heartbeat) may occur.

In chronic (long-term and sluggish) salpingitis gluing of fimbriae (fallopian tube fimbriae) can occur painlessly. In this case, the inflammatory exudate gradually accumulates in the tube. A small accumulation of fluid in the fallopian tube during an inactive process, as a rule, does not cause pain and may be discovered incidentally during pelvic ultrasound.

Symptoms of hydrosalpinx (sactosalpinx) can be cramping pains in the pelvic region , accompanied by a copious outflow of fluid from the vagina (with a breakthrough and outpouring of exudate). The liquid is clear, may have a yellowish tint.

More often, a woman may notice periodic or persistent watery discharge from the genital tract - when the sactosalpinx is emptied into the uterus and vagina. When a pipe breaks, sharp pain in the abdomen, with fluid suppuration (pyosalpinx) - weakness, intoxication, fever (pain may be absent, because sensitivity decreases in strongly stretched walls of the fallopian tube). A woman's inability to conceive is also noted.

Hydrosalpinx can form in the fallopian tubes on the left, on the right, and also on both sides. With a significant increase in the fallopian tube, there is a constant feeling of heaviness, a feeling of a foreign formation in the corresponding inguinal region (left or right). With chronic sluggish salpingitis body temperature and basal temperature, as a rule, are not increased.

Diagnosis of the disease

Hydrosalpinx (sactosalpinx) usually diagnosed by hysterosalpingography (HSG). This is an x-ray procedure in which a radiopaque fluid is injected into the uterine cavity and the shape of the uterus and the patency of the fallopian tubes are assessed. If the pipes are not passable, then the liquid accumulates in the pipe. With the patency of the fallopian tubes, the fluid from the final section of the tubes pours into the abdominal cavity.

During the ultrasound of the pelvic organs, the presence of a smooth-walled unilateral or bilateral tumor-like formation in the region of the uterine appendages is diagnosed. Diagnostic laparoscopy is performed to confirm the diagnosis. In the abdomen do small puncture(5-10 mm) and a thin optical instrument is inserted into the abdominal cavity - a laparoscope, with which the fallopian tubes, ovaries and uterus are examined.

If a hydrosalpinx (sactosalpinx) is detected, microsurgical instruments are inserted through additional incisions, with the help of which necessary operations removal of pathologically altered sections of the tubes, reconstruction of the fallopian tubes, dissection of adhesions, etc.

Treatment of hydrosalpinx (sactosalpinx)

Early detection and treatment hydrosalpinx(sakto salpinx) due to the risk of atrophy of the ciliated (ciliated) epithelium of the fallopian tubes . The rhythmic movements of the cilia, which are lined with the fallopian tube, contribute to the advancement of the egg through the fallopian tubes into the uterine cavity. With atrophy of the cilia, the risk of ectopic (tubal) pregnancy and infertility increases significantly.

Besides, this pathology is a source of constant infection, where, as in an incubator, ideal conditions are created for the reproduction of bacteria. With the long-term existence of the pathological process and the lack of adequate treatment, adhesions are formed that limit the focus of inflammation. Thus, an adhesive process is formed in the small pelvis, causing chronic pain(plastic peritonitis), which increases the risk of ectopic pregnancy and infertility.

In acute salpingitis and the formation of hydrosalpinx (sactosalpinx, pyosalpinx), hospitalization is necessary. Prescribe antibiotics, antihistamines, cold on the pelvic area.

Treatment methods for hydrosalpinx

Treatment of hydrosalpinx (sactosalpinx) with conservative methods is almost impossible. Operative laparoscopy with the use of endovideosurgical instruments is shown, which allows the most effective restoration of the patency of the fallopian tube. Reconstructive plastic surgery of the fallopian tubes is performed. With rupture or suppuration (pyosalpinx), the fallopian tube can be removed partially or completely, because. exudate is a breeding ground for bacteria. Control hysterosalpingography is performed.

Immediately after the operation, a course of physiotherapy is carried out to prevent the development of the adhesive process. Physiotherapeutic procedures (magnetophoresis, laser phoresis, electromagnetophoresis) allow you to enter the drug directly into the focus of inflammation. Mud therapy, ultrasound, diathermy are also used.

Hydrosalpinx and pregnancy

Women planning a pregnancy in the presence of a long-term hydrosalpinx (sactosalpinx), after preliminary physiotherapeutic preparation, laparoscopy is performed with the restoration of patency of the fallopian tubes. Unfortunately, when the patency of the pipes is restored, their function is damaged.

In the tube with hydrosalpinx, the folding of the mucous tube necessary for normal function is disturbed. The ciliated cilia inside the tube that promote the egg are not restored, and scars may form on the tube. In addition, the number of receptors for the main hormones estradiol and progesterone is sharply reduced. These factors can often lead to an ectopic pregnancy.

In the presence of this pathology in one fallopian tube and another passable tube, pregnancy is theoretically possible. However, the presence of a focus of chronic infection in the pelvis significantly reduces the chance of pregnancy, because. the inflammatory process is toxic to the embryo.

With a removed fallopian tube and the presence of a passable other fallopian tube, regular ovulation, the chance of getting pregnant on your own is about 50%.

Removal of one or both fallopian tubes using laparoscopy does not reduce a woman's sexual desire, does not cause a violation of menstrual function, hormonal levels, and does not entail negative consequences to other bodily functions.

At bilateral hydrosalpinx conception in a natural way is impossible. Tube removal before IVF is shown. If there is a hydrosalpinx on the left or on the right, it is recommended to first remove it, and only then try to get pregnant.

Hydrosalpinx and IVF

Scientists have proven that the fluid that accumulates in the cavity of the altered fallopian tube is toxic to the embryo, because. it contains microorganisms, dead cells of the fallopian tube mucosa, lymphocytes and other toxic agents. Flowing from the cavity of the tube into the uterine cavity, this fluid inhibits the further development of the embryo. The exudate flowing from the fallopian tube contains prostaglandins, cytokines that disrupt normal functioning endometrium, its ability to implant an embryo.

With a pronounced disease, a more meager response of the woman's ovaries to the stimulation of superovulation in the IVF cycle occurs.

Removal of fallopian tubes with hydrosalpinx before IVF procedure leads to sharp increase pregnancy rates - from 10% on average with hydrosalpinx to 30 - 35% after removal of diseased tubes. Moreover, the prognosis is significantly improved precisely in the case of removal of the tubes, and not ongoing attempts to restore the patency (tubostomy, fimbrioplasty) of the affected tubes. Therefore, IVF with hydrosalpinx is indicated only after the removal of the fallopian tubes.

Previously, there were concerns that the removal of the tubes, even if modified, could lead to disruption of the blood supply and nervous regulation ovaries. Conducted studies on the removal of affected tubes before the procedure did not reveal any difference in the condition of the ovaries, as well as in the response of the ovaries to stimulation, the quality of the eggs obtained, the fertilization rate and the quality of the embryos obtained between groups of women, in one of which hydrosalpinx was removed, and in the other tubes were removed initially were normal.

The conducted studies indicate the need to remove the fallopian tubes with hydrosalpinx (sactosalpinx) before the IVF procedure.