The Morphology Of Human Fallopian Tube With Hydrosalpinx And Its Application Of Diagnosis And Treatment Relevant To Infertility

Background:Infertility, refers to women failed pregnancy in childbearing age who had regular sex life without contraception with reproductive male. It can be divided into primary infertility and secondary infertility, the incidence rate:30%female, men accounted for30%, the common factors accounted for40%. The medical investigation showed that the incidence of infertility has upward trend, involving10%of couple infertility in clinical, although its not threaten the lives of patients, or harm to the patient’s body, but still belonged to the unfortunate sick. Every6couples in some developed countries, there is one pairs of infertility, referred to late marriage and late childbearing, abortion and sexually transmitted diseases.The tubal diseases in female infertility patients, are problems in the diagnosis and treatment of infertility. The cause of tubal factor infertility, were including tubal obstruction, or tubal malfunction, which accounts for25%-50%of female infertility, and the incidence is rising. Tubal disease mainly as tubal non-specific chronic inflammation, resulting in damage of the tubal structure and function. Found in clinical practice, many patients with tubal infertility performance the oviduct unilateral effusion or bilateral effusion, and distal occlusion. This not only makes them lose the chance of natural conception, even fail the test-tube baby. Many studies show that30%of IVF infertility patients were diagnosed as hydrosalpinx by laparoscopy or hysterosalpingography (Hysterosalpingography, HSG).Hydrosalpinx (Hydrosalpinx) dued to chronic infection resulting the adhesion and blocking of fimbria, tubal fluid and inflammatory exudate accumulating in ampulla, isthmus, wall thickness and cavity narrow. The hydrosalpinx obstruction due to induced abortion, spontaneous abortion, medical abortion, induced labor, dirty sex, pelvic infections and so on, and resulted in adhesions, hyperemia, edema and obstruction of tubal, leading that the sperm and egg can not be combined with, and ultimately lead to infertility.The etiology and pathogenesis of hydrosalpinx is a more complex process, not yet fully elucidated. However, it has not been reported at home and abroad that the clinical study in Hydrosalpinx in vivo of tubal anatomy combined with scanning electron microscopy, transmission electron microscopy, which fully exposed the ultrastructure of the mucosal epithelium, the oviduct internal anatomy and organizational structure.The fallopian tube is an important part of the female reproductive system, it has an important role in transporting sperm, intaking of eggs and transporting fertilized eggs to the uterine cavity. The wall of fallopian tube from inside to outside, divided into three layers:mucosa, muscularis and serosa. Mucosal fold formation of the longitudinal branch folds of the ampulla is the most developed, high and many branches, so the lumen is irregular; From the ampulla to the uterus, the folds gradually reduced, interstitial portion at least. Mucosa was composed of ciliated cells, secretory cells, wedge-shaped cells and undifferentiated cells. The tubal epithelium is mainly composed of ciliated cells and secretory cells. Ciliated cells are mainly distributed in the mucosal folds at the top. Cilia length of10microns,0.25microns in diameter, the proportion of cells gradually decreased from the isthmus (35%) to the umbrella (50%). However, the morphological study of human fallopian tube at home and abroad was reported less. In2005, Ajonuma LC suggested that the ultrastructural changes of body water oviduct:epithelial cells become flattened, exfoliative cells; thinning oviduct myometrial, fibrosis; cilia and microvilli decreasing. Although the description of the changes in the ultrastructure of mucosal epithelium, but there is no objective indicators proposed. But the present study has rarely been reported that how to change and the degree of change in mucosal epithelial ultrastructure.This study was to observe the general anatomy and lumen morphology of fallopian tube by laparoscopic and tubal microscope, and the ultrastructural changes of the mucosal epithelium by scanning electron microscopy. We will further illustrate the important role of ciliated cells and secretory cells on the mucosal epithelium in the reproductive process.Objective:To observe the epithelial ultrastructures of human fallopian tube in the normal and hydrosalpinx through scanning electron microscopy, and compare the differences with the two groups. to further clarify the tubal mucosal epithelial ultrastructure changes in hydrosalpinx patients; and the pathogenesis of hydrosalpinx from the perspective of anatomy and histologyMethods:Observation under Laparoscopy:during surgery, filming and video on the selected object under the system of laparoscopic equipment, for observe the gross morphology with hydrosalpinx patients in the endoscopy.Observation under tubal microscope:after surgery, the use of tubal microscope to observe the structure of the mucosa of the tubal lumen, and recording and filming.Observation under Scanning electron microscope:(1) the experimental group:in end of department the tube, remove the3mm×3mm tissue, specimens were immediately put into PBS, rinsed three times to remove residual blood and excess tissue, and then put into2.5%glutaraldehyde fixation;(2) the control group:in the end site of tube similar to the experimental group, in the line of hysterectomy patients, remove the3mm×3mm tissue, specimens were immediately put into PBS rinsed three times to remove residual blood and excess tissue, and then put into2.5%glutaraldehyde fixation;(3) then after fixation, rinsing, dehydration, drying, gold-plated, the two groups of specimens were observed by scanning electron microscope of the Dutch company Philips QUANTA-200;(4)using scanning electron microscopy computer to measure the length and diameter of the cilia, to count the number of ciliated cells and secretory cells in the same multiples of vision.Results:1. Observation under laparoscopyThe fallopian tube had lost the normal, slender, curved trumpet-shaped structure; distal tube was locked, disappeared finger-like structure of the normal fimbria; enlargement of diameter up to2-5cm, irregular thickening or sausage-like enlargement of the rules; the fallopian tubes adhered to the pelvic walls, which maked the relative abnormalities in position with the ovarian. All these abnormal anatomy of the structure are resulting in the direct cause of infertility with the patients.2. Observation under hysteroscopyThe normal structure of tubal mucosal folds:"track structure", folds arranged in parallel, like railroad tracks, the high folds, soft swing, rich in capillaries within the mucosa, indicating that nutrition is better. And sustained, severe hydrosalpinx, would be maked irreversible destruction of the tubal mucosa, the following unusual circumstances:①The part of the orbit levy exist, but the wrinkled folds low, flat, meager, plica spacing widens, color pan-white, indicating that mucosal nutrition is poor;②lose track structure, the formation of filamentous, membranous, polypoid adhesions;③and even then did not see the obvious fold structure, only to see the vortex structure similar to the diverticulum.3. Observation under Scanning electron microscopyTubal mucosal surface distributed ciliated cells and secretory cells in the control group, ciliated cells visible on the dense cilia, the cilia toward the same direction, no adhesion between the cilia or lodging phenomenon; secreting cells scattered between the cilia, like the lush grass arrayed a few pebbles, convex to the lumen; the top of the secretory cells visible dense, short and straight microvilli liked rod-shaped. In the experimental group, the tubal epithelium is also composed of ciliated cells and secretory cells, ciliated cells decrease in the number distribution in a single ciliated cells, cilia also reduce the number of cilia sparse, showing a small cluster phenomenon, with some short upright and some adhesion lodging certain law look messy; increase in the number of secreting cells, convex to the lumen than the normal control group, inconsistent in size, reducing the number of microvilli of the secretory cells, at the top of the sparse length than the normal. In the experimental group, it showed that some secretory cells rupture, visible section showed a "honeycomb or sieve-like ", which may be the destruction caused by microbial infection. We could saw some unknown objects like "wooden club", some stretched out pseudopodia, some ruptured, leaving the" vacuole ". it may be microbial infection such as chlamydia or mycoplasma, or destructed and swollen cilia, which are yet to defined know. In both groups, tubal mucosal epithelium can sometimes see the phenomenon of "black holes", which may be secreted cells or ciliated cells leaved off. In the experimental group, the increased number of secretory cells in mucosal epithelial, is perhaps the cause of major morphological change with hydrosalpinx.In experimental group, the number of ciliated cells and secretory cells, respectively had significant differences comparing with control group (P<0.05). The cilia length and diameter, respectively, had no significant differences with the control group (P>0.05).Conclusion:The hydrosalpinx undermine the general anatomy of the fallopian tube, resulted in lumen occlusion, distal occlusion; and the destruction of the mucosal folds within the lumen, making tubal transport weakened or loss. The cilia length and diameter did not change significantly, but the number of ciliated cells is significantly reduced and the number of cilia in each ciliated cells decrease. The significantly increasing number of secreting cells, is the major ultrastructural changes of the oviduct epithelium. The results suggest that the secretory cells increased significantly, perhaps the main cause of hydrosalpinx.