| Part One A comparative study of the tubal patency rate between HIFU treatment and chemotherapy on ectopic pregnancyObjective In recent years the morbility of the tubal pregnancy disease have increased. The chemotherapy is one of commonly used treatments. But this method not only has the toxic effect but also possibly causes the oviduct obstruction because of the mass that has not been absorbed. High intensity focused ultrasound (HIFU)is an non-invasive, feasible and organ-preserving therapeutic method . It has been investigated as a therapeutic tool in many fields such as tumors of abdominal solid organs , uterine leiomyoma and endomentrioma etc. HIFU can terminate a pregnancy, which already obtained the confirmation in the animal study. The clinical feasibility and the security of HIFU have also been initially affirmed. Whether the tubal patency rate of HIFU in treatment of ectopic pregnancy is higher than the chemotherapy have not been confirmed yet. This research is to compare the tubal patency rate between HIFU and chemotherapy in treatment of ectopic pregnancy by carbamide peroxide hysterosalpingography and assess the prognosis of the two methods.Methods A total of 68 patients with ectopic pregnancy were divided into two groups .Group A (33 cases)was treated with HIFU , group B (35 cases)was treated with chemotherapy. We injected into the uterine cavity with 1% carbamide peroxide, observing the flowing by B- flow imagine and assessing the tubal patency. Simultaneously, we observed the injection resistance,the overflows of cervix ,and after 15 minutes whether the pelvic cavity accumulate the fluid was detected. According to all of these made the tubal patency rate .The results were inputted into the Excel2002 database, using the SPSS11.0 software.Results Before contrast imaging, we found one case in the HIFU group (group A)had a mass in adnexa uteri and in the chemotherapy treatment group (B group) 11 cases had a mass in adnexa uteri by the conventional ultrasound imaging. The masses absorption rate of the two groups had the remarkable difference(P<0.05).In group A there were 17 case(s51.52%)got tubal patency, 11cases(33.33%)got partial obstructed, 5cases (15.15%)were obstructed. In group B, there were 9cases(25.71%)were unobstructed , 12cases (34.29%)were partial obstructed ,14cases(40.0%) were obstructed. There was significant difference in the patency rate between the two groups( p<0.05 ).Conclusions Patency rate of ductus Mueller is higher in HIFU group than chemotherapy group using carbamide peroxide for ultrasonic contrast hysterosalpingography. Comparing with chemotherapy treatment, HIFU is a prominent method on treatment of ectopic pregnancy with high security and convenience.Second part Value of carbamide peroxide for ultrasonic contrast hysterosalpingography in diagnosis and treatment oviduct obstructionObjective Many reasons could cause oviduct obstruction, such as appendagitis,pelvic inflammation.There are many diagnoses methods. The traditional method is hysterosalpinography (HSG) in X-ray .But the patient and the doctor have to receive radiation. The oil may be noxious to the body .If the oil is not absorpted, it will produce granuloma or abdominal cavity infection. The fluid technique has strong subjectivity, and its localization diagnosis is not exactly accurate. Because the hydrogen peroxide solution is external using , the patient often endure hard ache. And the hydrogen peroxide solution only produce less air bubble which make localization diagnosis difficultly. Above methods are all limited to the treatment of the oviduct blocking. Some research confirmed carbamide peroxide for ultrasonic contrast hysterosalpingography could make diagnosis and treat the oviduct obstruction. This research used carbamide peroxide for ultrasonic contrast hysterosalpingography and the passing fluid technique under the ultrasound guidance to make diagnosis and cure 43 cases which had been considered to be the oviduct blocking. And we discussed the value of the carbamide peroxide for ultrasonic contrast hysterosalpingography in clinical application . Methods 43 cases with oviduct partial obstructed or obstructed were divided into two groups by random. Group A was given the passing fluid under the ultrasound guidance and goup B was given carbamide peroxide for ultrasonic contrast hysterosalpingography. Group A used 80000U cidomycin ,5mg avazyme and 10mg methylprednisolone in 20ml 0.9% NaCl. Group B used 1% carbamide peroxide. We observed the flowing condition by B- flow imagine and assessed the tubal patency. Simultaneously we observed the injection resistance , the overflows of cervix and after the 15 minutes whether the pelvic cavity accumulate the fluid was detected. After the first contrast imagine, if the two-sided or the single side oviduct was obstruction or partial obstructed we would perform the contrast imaging again. It was effective that the oviduct contrast condition improved than before, otherwise it is ineffective. The results were inputted into the Excel2002 database, using the SPSS11.0 software. The effective rate was calculated.Results Before the treatment the basic situations and the tubal patency rate had non-statistics difference in two groups. After the treatment 11 partial obstructed cases changed into patency,2 obstructed cases got partial obstructed in group A. There were 13 cases effective and 21 cases ineffective in all.The effective rate is 38.24%.In group B 19 partial obstructed cases changed into patency,3 obstructed cases got partial obstructed or patency . There were 22 cases effective and 11 cases ineffective in all. The effective rate is 66.67%.The different effective rates of two groups have statistics significance.Conclusions The carbamide peroxide for ultrasonic contrast hysterosalpingography could not only diagnosis but also could treat tubal obstruction without secondary action. It has high value in clinical application.
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