女性不育输卵管检查法评估

Evaluation of methods for tubal patency in female infertility

分析了我院女性不育门诊为了解输卵管情况进行的输卵管通液、子宫输卵管碘油造影及腹腔镜检查法。结果3种检查方法的准确率分别为83％、92％和90％。认为3种方法各有优缺点,输卵管通液只能了解输卵管通畅与否,无助于病因诊断;子宫输卵管碘油造影能看到官腔及输卵管腔内的形态,对生殖道结核有特异的诊断价值;腹腔镜能看到盆腔与输卵管外形,对外在型子宫内膜异位症的诊断准确率高。分析了3种方法与妊娠的关系,其共同特点是操作后半年内妊娠率较高(44.9%～62.0%)。讨论了在不育检查中如何选择输卵管检查法,以提高各种方法的诊断价值与妊娠率。

Evaluation of tubal patency is one of the important items in the investigation of female infertility. The methods we used are: hydrotubation (HT) , injection of saline solution; hysterosal -pingography (HSG), injection of iodized oil; and laparoscopy (LS), injection of methylene blue solution during laparoscopy. A total of 1 145 times were performed, HT 679, HSG 329 and LS 137. Contraindications were ruled out before each procedure. Patients were all followed at least up to 1 year after the procedure. The reliability of these methods were compared. 165 cases had HSG after HT. Results coincide, patent and nonpatent, in 137 but not in 28. The reliability rate for HT is 83%;50 cases had HSG and LS. 41 coincide but in 9 HSG accurate in 5 and LS in 4. So the reliability for HSG is 92% while that of LS is 90%.HT is simple and could be performed in any gynecologic clinic. It only shows that the tubes are patent or not, and a nonreliability of 17%. The reliability of HSG and LS are high. HSG besides showing tubal patency also shows the uterine cavity and tubal lining which helps in the pathological diagnosis such as tuberculosis. It also leaves a permanent record for further references. Laparoscopy gives a clear view of adhesions around the uterus and tubes, and particularly useful in the diagnosis of endometriosis. However, limitations will be encountered when adhesions are extensive preventing clear observation. The advantages and disadvantages of these methods were discussed. Their usefulness depends on the art of selection.The pregnancy rate after HT, HSG and LS are 24. 5% , 26. 0% and 34. 7% respectively. One phenomenon in common is that pregnancy rate within 6 months after the procedure are 44. 9%, 62. 0% and 50. 0% respectively. Emphasis made on planned investigation and full use of this optimum time after the procedure to increase the result of pregnancy.