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02 July 2015, Volume 31 Issue 7 Previous Issue    Next Issue

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Advances in the treatment of twin-twin transfusion syndrome and its pregnancy outcomes. SUN Lu-ming. 2015, 31(7): 592-597.  DOI: 10.7504/fk2015060105 Abstract ( )   Abstract:Twin-twin transfusion syndrome （TTTS） is a severe complication occurring in 10%～15% of monochorionic twins. Fetoscopic laser photocoagulation （FLP） of anastomoses is first-line treatment for severe twin-twin transfusion syndrome and can significantly improve perinatal outcome . The purpose of this paper is to evaluate the efficacy of different FLP techniques and introduce the pregnancy outcome of TTTS patients who have accepted FLP treatment.

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Discordance of twin pregnancies: screening， diagnosis and management. ZHOU Yi， ZHANG Ai-qing. 2015, 31(7): 597-602.  DOI: 10.7504/fk2015060106 Abstract ( )   Abstract:Twin pregnancy is frequently complicated with maternal and fetal complications than singleton pregnancy. Twin discordance has been observed in monochorionic diamniotic (MCDA) twins and dichorionic diamnotic (DCDA) twins. The clinical manifestations of twin discordance include growth discordance， chromosomal or gene discordance and anomaly discordance. In order to improve the counseling and management approach， the screening， diagnosis and treatment of discordant twins are reviewed in this paper.

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Se1ective multifetal pregnancy reduction in second trimester. *LI Hong-yan，LI Shan-ling，WANG Xie-tong，LIU Cai-xia. 2015, 31(7): 602-607.  DOI: 10.7504/fk2015060107 Abstract ( )   Abstract:Selective multifetal pregnancy reduction in second trimester aims to improve pregnancy outcomes by reducing the numbers of fetus or abnormal fetus. Intracardiac injection of KCl usually managed from 11 to 24 weeks is proven relatively safe，but this method is not suitable for monochorioic twin pregnancies. Its successful pregnancy rate is close to spontaneous pregnancy twins. Multifetal reduction of monochorioic twin pregnancies is managed with vascular occlusion technique from 15 to 27 weeks，and radiofrequency ablation is more widely used in China.Pregnancy outcomes are related to surgical indications，surgical times，surgical procedures and performers' experience. Assessment of chorionicity，early diagnosis of fetal abnormalities and identification of twin pregnancy complications should be done by ultrasonography before pregnancy reduction.

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Prenatal screening and prenatal diagnosis of aneuploidy in twin pregnancy. LIU Jun-tao，ZHOU Xi-ya. 2015, 31(7): 607-609.  DOI: 10.7504/fk2015060108 Abstract ( )   Abstract:Prenatal aneuploidy screening is more complicated in twin pregnancy than in singleton pregnancy.Gestational age，chorionicity and NT should be determined at first trimester.Combined screening test at first trimester is better than second trimester screening，but the detection rate is lower than that of singleton pregnancy.NIPT in twins is still under research.Vanishing twins will surely affect the accuracy of prenatal screening.It is important to distinguish each twin when doing prenatal diagnosis.

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The anticoagulation measures in twin pregnancy with fetal growth discordance and growth restriction. YANG Zi. 2015, 31(7): 609-613.  DOI: 10.7504/fk2015060109 Abstract ( )   Abstract:Nowadays，discussion focuses more on the monitoring and delivery time concerning onset of fetal growth discordance and growth restriction in twin pregnancy. Whether it be a dizygotic twins or monozygotic twins，it is remarkably related to the maternal-placenta-umbilical cord factors.In this article，targeted monitoring and anticoagulation measures related to factors of maternal-placen- umbilical cord were elaborated. In addition to passive monitoring，the aim is also to demonstrate initiative option of prevention and intervention.

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Maternal and perinatal pregnancy management and monitoring in multiple pregnancy. DU Juan，LIU Xue-min. 2015, 31(7): 613-617.  DOI: 10.7504/fk2015060110 Abstract ( )   Abstract:Multiple pregnancy is not only more likely to have common complication such as pregnancy hypertensive disorders in pregnancy，intrahepatic cholestasis of pregnancy，premature rupture of membranes，preterm labor，fetal malformation than single births，but there are still many special complications and a significant increase in maternal and perinatal mortality. Early diagnosis of multiple pregnancy，pregnancy management and monitoring is important to improve the adverse pregnancy outcomes.

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Timing and mode of delivery of twin pregnancy. LI Jun-nan, QI Hong-bo. 2015, 31(7): 617-621.  DOI: 10.7504/fk2015060111 Abstract ( )   Abstract:The conduct of a twin delivery remains one of the most challenging events in the daily practice of obstetrics. Timing and mode of delivery of twins should be decided by gestational age, local medical level and maternal –fetal conditions （ complicated twins,chorionicity,and so on）,and individualized optimum mode and timing of delivery should be planned.Chorionicity is the most important determinant of pregnancy outcome in twin pregnancy. Induction of labor at 37 to 38 weeks’ gestation should be routinedly considered in uncomplicated monochorionic twins .Uncomplicated dichorionic twins should be planned between 38 and

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Essentials to reduce iatrogenic multifetal pregnancy. LI Rong，YANG Rui. 2015, 31(7): 621-623.  DOI: 10.7504/fk2015060112 Abstract ( )   Abstract:Iatrogenic multiple pregnancy （IMP） refers to multiple pregnancy obtained by medical intervention.With the development of assisted reproductive technology （ART），the incidence of IMP increased.Control ovarian stimulation and multiple embryo transfer are main risk factors of IMP.It increases the maternal burden and perinatal complication rate.Multifetal reduction is the main remedial measure.The prevention of IMP is the most important task,and we should strictly control the indication of ovulation induction and ovarian hyperstimulation,drug use,and control the number of embryos transfer.

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Ultrasound in multiple pregnancy. CHEN Min，WANG Jia-yan，LI Nan,CHEN Dun-jin. 2015, 31(7): 623-631.  DOI: 10.7504/fk2015060113 Abstract ( )   Abstract:Ultrasound has played an important role in the diagnosis of multiple pregnancies，determination of chorionicity，surveillance of the fetal growth，diagnosis of complicated twins and screening for preterm birth.The clinical application of ultrasound could guide the management of multiple pregnancies and reduce the perinatal morbidity and mortality.

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Expression and significance of FK506 binding protein 52 in chorionic villi of patients with recurrent spontaneous abortion. CHEN Hong-yan*，LI Ou-yang，PANG Li-hong*，FAN Xiao-jing*，LIANG Hai-feng*，CHEN Xian-feng*. 2015, 31(7): 632-635.  DOI: 10.7504/fk2015060114 Abstract ( )   Abstract： Objective To investigate the mRNA and expression of FK506 binding protein 52（FKBP52） in the chorionic villi of patients with recurrent spontaneous abortion（RSA） and normal women during early pregnancy.

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The expression and significance of GPR30 in human myometrium before and after the onset of labor. NING Hui, SHI Xin，SUN Xia，WANG Sheng-lan，ZHANG Shu-ping. 2015, 31(7): 636-639.  DOI: 10.7504/fk2015060115 Abstract ( )   Abstract： Objective To research into the expression of GPR30 mRNA and protein in myometrial tissue before and after the onset of labor and their relativity with parturition. Methods Between March 2011 and March 2012, full-term pregnancy women were selected in Qingdao Municipal Hospital. Those who chose elective cesarean section at term were grouped as nonlaboring (n=40) and others who required emergency cesarean section after the active period of labor were categorized as laboring (n=50). Then, a small amount of myometrial tissue strips were collected respectively from two groups during cesarean section and tested by Real-time PCR and Western blot for the expression of GPR30 mRNA and protein. And venous blood was also extracted before operation to verify the amount of E2, E3 and P via radioimmunoassay.Results Real-time PCR showed GPR30 mRNA expressed in myometrial tissue strips of both groups. Means of △Ct for the laboring group and the nonlaboring group were 3.08±0.35 and 4.02±0.67 correspondingly, which displayed statistical significance (P<0.05) in their difference. Relative quantitative analysis made by Double △Ct revealed that the expression of GPR30 mRNA for the laboring was 1.92 times more than that of the nonlaboring. Obviously, the laboring group had higher level of serum E2 and E3 [（7882.41±921.76）pmol/L，（544.12±15.58）nmol/L] than the other group [（5210.72±873.13）pmol/L，（326.36±12.26）nmol/L].Using Western blot, we detected GPR30 protein in myometrial tissue strips of two groups. Its level in the laboring group (4.06±0.25) was apparently higher than that of the nonlaboring group (1.94±0.23), and the difference showed statistical significance (P<0.05). Conclusion The high expression of GPR30 may participate in the regulation of estrogen to uterine contraction during pregnancy and parturition.

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Study of the effect of NF-κBp65 protein and ENA-78 in the onset of endometriosis. HAO Min，HOU Yong-li. 2015, 31(7): 640-644.  DOI: 10.7504/fk2015060116 Abstract ( )   Abstract： Objective To detect the effect of κBp65 and ENA-78 in the onset of endometriosis. Methods From October 2008 to February 2009 in the Second Hospital of Shanxi Medical University,25 cases undergoing operation resection of ovarian endometriosis cyst were chosen,ectopic and eutopic endometrium tissue was taken,and they were divided into ectopic and eutopic group;select the same normal endometrium of 22 patients as the control group. The eutopic endometrium, ectopic endometrium and thenormal endometrium cells, which were in third passage，were interfered by IL-1β and IL-1β adding PDTC with different concentration. Use ELISA to detect the concentrations of ENA-78 of those three groups，explore the effect of IL-1β and IL-1β adding PDTC on the concentration of ENA-78 of each group.Use immunohistochemistry to detect the activating degree of NF-κBp65 of the endometrial cells in the three groups，and to detect the change of NF-κBp65’s activating degrees after intervention of IL-1β and IL-1β adding PDTC. Results The eutopic endometrium and the ectopic endometrium concentration of the ENA-78 in the cells culture media supernatant was remarkably higher than the normal endometrium.There was a remarkable difference（P<0.01）.The ectopic endometrium concentration of the ENA-78 in the cells culture media supernatant was remarkably higher than the eutopic endometrium.There was a remarkable difference（P<0.01）.After the intervention，the concentration of the ENA-78 in the normal endometrial cells culture media supernatant had no remarkable change.There was no remarkable difference（P>0.05）.In the eutopic endometrium and the ectopic endometrium cells culture media supernatant，the concentration of the ENA-78 in the group intervened with IL-1β was the highest.It was remarkably higher than the control group and the group intervened by IL-1β+PDTC.There was a remarkable difference（P<0.01）. In three groups，the NF-κBp65’s activating degrees of eutopic and the ectopic endometrium were remarkably higher than the normal endometrium.The difference was statistically significant （P<0.05）；for the NF-κBp65’s activating degrees in the eutopic endometrium and the ectopic endometrium cells，the IL-1β group was the highest，which was remarkably higher than the controlled group and the group intervened by IL-1β+PDTC. The difference was statistically significant）（P<0.05）. Conclusion IL-1β can induce the activation of NF-κBp65 on eutopic and ectopic endometrium cells.It can strengthen the expression of ENA-78，while PDTC inhibits this effect.It suggests that as a key controlling agent，NF-κBp65 may play a “penstock” role in the onset of EMs，and it may have a controlling effect on ENA-78 and other cytokines.

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Retrospective analysis of the clinical manifestations of 158 cases of dysfunctional uterine bleeding. LI Yu-bin，LUO Can-qiao，XIAO Shan，LONG Ling-li. 2015, 31(7): 645-648.  DOI: 10.7504/fk2015060117 Abstract ( )   Abstract： Objective To explore clinical characteristics of dysfunctional uterine bleeding in hospitalized patients of different ages. Methods Total 158 hospitalized patients from March 2009 to February 2014 in our hospital whose main diagnosis was dysfunctional uterine bleeding （DUB） were collected and retrospectively analyzed. The patients' general information,such as routine blood tests，ultrasound and clinical endometrial pathological data were collected for analysis. Results The 158 cases were divided into 3 different age groups. According to the degree of anemia，most severe anemia occurred in≤30 year-old group （46.9%），followed by ＞40 year-old group （32.9%）.in >30～40 year-old group the percentage was the lowest（27.3%）. The difference among three groups was statistically significant（P=0.03）. Blood transfusion rates of the three groups had statistically significant difference（P=0.001）.Transfusion rate in ≤30 year-old group reached 71.4%. Among different age groups，endometrial thickness and abnormal endometrial hyperplasia rates had no statistical differences （P>0.05）.However,abnormal endometrial hyperplasia rates between different endometrial thickness groups were statistically different（P = 0.014）. In the endometrial thickness ＞12 mm group，abnormal endometrial hyperplasia rate was 53.3% and in ＜5 mm group there was no case of endometrial hyperplasia. Conclusion The clinical anemia degree of DUB hospitalized patients is significantly related to age. Endometrial thickness plays an important role in predicting the abnormal endometrial hyperplasia.

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The clinical value of human epididymis secretory protein 4, carbohydrate antigen 125 combined with risk of ovarian malignancy algorithm in the prediction and diagnosis of epithelial ovarian cancer. LIU Jing*，QU Peng-peng*. 2015, 31(7): 649-652.  DOI: 10.7504/fk2015060118 Abstract ( )   Abstract： Objective To explore the clinical value of human epididymal secretory protein 4, carbohydrate antigen 125 combined with risk of ovarian malignancy algorithm in the prediction and diagnosis of epithelial ovarian cancer.

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The role of dynamic magnetic resonance imaging in the diagnosis of female pelvic organ prolapse. CHEN Yong-kang，LU Wei-dan，HAN Jin-song，ZHOU Yan，LIU Jian-yu，ZHANG Kun. 2015, 31(7): 653-656.  DOI: 10.7504/fk2015060119 Abstract ( )   Abstract： Objective To investigate the value of dynamic MRI in diagnosing female POP. Methods Totally 78 women suffering with POP underwent dynamic MRI in Peking University Third Hospital from Feb. 2012 to Mar. 2014. Analyze the measurement results and diagnoses according to POP-Q and HMO classification. Results The correlations between measurement results of POP-Q and MRI were assessed by calculation of the Spearman correlation coefficients. The correlation coefficient of Aa-bladder neck was 0.745，Ba-bladder base 0.836，and C-cervix/vaginal vault 0.867. The correlation coefficient of Bp-cul-de-sac was 0.367 and Ap-posterior vaginal wall 0.481. There was very strong correlation between clinical examination and MRI in anterior and middle pelvic cavity but moderate correlation in posterior pelvic cavity. Comparisons between positive rate of POP-Q and HMO classification was performed with Kappa tests.The Kappa values were 0.313,0.794 and 0.385，and the χ2 values were 3.368（P=0.064），5.143（P=0.016） and 15.042（P<0.01） in anterior，middle and posterior compartment respectively. The positive rate of the two methods was of no significant difference in anterior compartment，but was higher of POP-Q in the middle and of MRI in the posterior. Consistency of grading POP between POP-Q and HMO classification was poor in anterior（K=0.063），middle （K=0.328） or posterior compartment （K=0.167）. Conclusion There is excellent correlation in diagnosing POP between clinical examination and dynamic MRI in anterior and middle compartment. Dynamic MRI is more accurate than clinical diagnosis in posterior compartment. It can be an effective supplemental method to clinical examination.

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Correlation between expression of SULT1E1 and progesterone receptor protein and the incidence of uterine sarcoma. YAN Da-jing*，SONG Yan*，WANG Min*，ZHOU Ying-ying*，LENG Xu*. 2015, 31(7): 657-659.  DOI: 10.7504/fk2015060120 Abstract ( )   Abstract： Objective To analyze the expression of SULT1E1 and PRA,PRB receptor protein in uterine sarcoma in order to find their clinical significance.Methods Select paraffin biopsy in 46 cases of uterine sarcoma from 2001 to 2010 in Shengjing Hospital of China Medical University.The immunohistochemical methods was used to detect the expressions of sulfotransferases1E1 and PRA and PRB. Results There was a significant difference in SULT1E1 receptor protein expression between the endometrial stromal sarcoma groups，leiomyosarcoma groups，uterine carcinosarcoma groups and normal groups （P<0.05）.There was a significant difference of PRA and PRB receptor protein expression between the endometrial stromal sarcoma groups，leiomyosarcoma groups and uterine carcinosarcoma groups（P<0.05）.In endometrial stromal sarcoma，there was a negative correlation between SULT1E1 and PRA and PRB（r=-0.389，P=0.031；r=-0.421，P=0.018，respectively）.Conclusion The decrease or deletion of SULT1E1 receptor protein expression is related to the development of uterine sarcoma.The expression SULT1E1 and that of PRA and PRB have significantly negative correlation in endometrial stromal sarcoma.

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The role of SREBP1 in the oncogenesis and development of cervical cancer. ZHANG Zhan-xin，LOU Xue-ling，YAO Li. 2015, 31(7): 660-663.  DOI: 10.7504/fk2015060121 Abstract ( )   Abstract： Objective To research the expressions of SREBP1 in cervical cancer and explore the significances of SREBP1 in oncogenesis and development of cervical cance. Methods A total of 100 cervical samples were collected from Department of Gynaecology, Zhengzhou People's Hospital (from Jan. 2010 to Jan. 2015), including 50 cervical cancer tissues and 50 cervical noncancer tissues of the same donor as controls. The expression of SREBP1 in cervical cancer tissues and in the paired cervical noncancer tissues was evaluated by RT-PC. Its correlation with the clinicopathological parameters including tumor grade and stage was subjected to statistical analysis.Results RT-PCR showed that SREBP1 mRNA levels were significantly increased in cervical tumors（0.60±0.18 vs. 0.13±0.04，P<0.01）. Additionally， the expression levels of SREBP1 mRNA were correlated with clinical stages and tumor grade significantly（P<0.05），however,there was no correlation of SREBP1 expression with the patient’s age， tumor size and tumor type. In cervical cancer group，there was a positive correlation between SREBP1 mRNA expression and FASN mRNA expression （r=0.705，P<0.05）. Conclusion SREBP1 may play an important role in oncogenesis and development of cervical cancer，which may become new potential targets for clinical treatment of cervical cancer.

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Correlation between the TSLP gene polymorphism and preeclampsia. WANG Shuo*，GUO Chang-long，WANG Qi-di，WANG Yu-ting*，WANG Xing-yu，AN Li-sha， CAO Xiao-fang，QIU Yue，WANG Guang-yu，LI Hui*，MA Xu. 2015, 31(7): 664-667.  DOI: 10.7504/fk2015060122 Abstract ( )   Abstract： Objective To explore the correlation between gene polymorphism of the sites of thymic stromal lymphopoietin （TSLP）（rs1898671， rs2289276， rs2289278 and rs764916）and occurrence of preeclampsia in pregnant women.Methods A total of 384 pregnant women who visited Shengjing Hospital of China Medical University from November 2012 to June 2013 were enrolled.Total 181 women with preeclampsia were selected，including 97 women with mild preeclampsia and 84 women with severe preeclampsia，and 203 normal pregnant women were in cotrol group.The polymorphism of four sites（rs1898671， rs2289276， rs2289278 and rs764916） was analyzed by Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF MS）. Results The clinical characteristics was significantly different between case and control groups (P<0.05). The clinical characteristics were significantly different between mild preeclampsia and control groups except for maternal age (P<0.05). There was an obvious statistical significance between severe preeclampsia and control groups. The allele frequency and genotypes frequency of rs1898671 was significantly different between the case group and control group（P=0.043， OR=2.682， 95% CI 1.020～7.054）.Conclusion Rs1898671 of the TSLP gene is probably associated with preeclampsia.The T allele is the risk allele.

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A preliminary study on coccygeal muscles of female patients with pelvic organ prolapse. ZOU Lue，ZHANG Jun. 2015, 31(7): 668-671.  DOI: 10.7504/fk2015060123 Abstract ( )   Abstract： Objective To investigate the coccygeal muscles changes in female patients with pelvic organ prolapse （POP）.Methods From August 2014 to January 2015，female patients with pelvic organ prolapse we collected in Shengjing Hospital of China Medical University（experimental group） (25 cases)，aged from 41 to 80 years old;25 cases volunteers without pelvic organ prolapse or other diseases were included as control group，aged 45～80 years old.They were scanned under state of calm by MRI，and planes of upper and middle of hip joint，and the plane of the uterus - the coccyx were selected,then we measured and compared bilateral coccygeal muscle thickness.The change of coccygeal muscles thickness was shown by calculating the muscle thickness differences of different levels.The measurement results were made independent sample t test.Result In experimental group and control group bilateral coccygeal muscle thickness showed no significant difference. Compared with the control group，the difference of bilateral coccygeus average thickness in experimental group was not significant （P> 0.05）.In experimental group the difference between left and right coccygeal muscle thickness was （3.51±1.79）mm and （3.62 ±1.33）mm，greater than control group (2.61±0.87)mm，(2.83±1.24)mm. The difference was statistically significant （left P=0.029，right P=0.035）.Conclusion There is no significant difference between the left and right coccygeal muscle thickness. Coccygeal muscle in the pelvic floor support structure plays a limited role. In POP patients，coccygeal muscle may have anatomical change.

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Clinical application of Kangfuyan capsule in the treatment of partially obstructed fallopian tube infertility. ZHANG Yu，XU Guo-ping，SUN Li，SUN Xia. 2015, 31(7): 672-675.  DOI: 10.7504/fk2015060124 Abstract ( )   Abstract： Objective To investigate therapeutic efficiency of Kangfuyan capsule on infertile patients with partially obstructed fallopian tube infertility. Methods Total 143 mild patients and 120 severe patients with partially obstructed fallopian tube were selected according to the imaging diagnosis of hysterosalpingography. Patients with mild partially obstructed fallopian tube were randomly divided into treatment group (89 cases) and control group (54 cases)，and the combined therapy of hydrotubation and Kangfuyan capsule were used in treatment group，while the control group only received hydrotubation. Patients with severe partially obstructed fallopian tube were randomly divided into treatment group (77 cases) and control group (43 cases)，and the combined therapy of hysteroscopy-laparoscopic surgery and Kangfuyan capsule were used in treatment group，while the control group only received hysteroscopy-laparoscopic surgery.Results The rate of intrauterine pregnancy in treatment group with mild partially obstructed fallopian tube was higher than control group(70.8% vs. 51.9%)，the difference being statistically significant（P<0.05）. The rate of tubal pregnancy rate was lower than control group(1.1% vs. 7.4%)，the difference being statistically significant（P<0.05）. There was no statistically significant difference between two groups in the rate of biochemical pregnancy (4.5% to 7.4%) (P>0.05). The intrauterine pregnancy in treatment group with severe partially obstructed fallopian tube was higher than control group(37.7% vs. 20.9%)，the difference being statistically significant（P<0.05）. The rate of tubal pregnancy rate was lower than control group(5.2% vs. 16.3%)，the difference being statistically significant（P<0.05）. There was no statistically significant difference between two groups in the rate of biochemical pregnancy (6.5% vs. 9.3%) (P>0.05). Through 12 months of follow-up, among non-pregnant patients, the rate of partially obstructed fallopian tube (26.2% vs. 50%) and completely obstructed fallopian tube（4.8% vs. 22.2%) in treatment group with mild partially obstructed fallopian tube were lower than control group, the difference being statistically significant（P<0.05）;the rate of partially obstructed fallopian tube (32.1% vs. 52.2%) and completely obstructed fallopian tube（7.7% vs. 21.7%) in treatment group with severe partially obstructed fallopian tube were lower than control group, the difference being statistically significant（P<0.05）.Conclusion Kangfuyan capsule has good curative effect in auxiliary treatment of partially obstructed fallopian tube，which can improve the intrauterine pregnancy and tubal recanalization rate,and reduce tubal pregnancy rate at the same time.