子宫输卵管碘油造影和腹腔镜检查对盆腔粘连不孕诊治价值的探讨

The value of hysterosalpingography and laparoscopy in the diagnosis and treatment of infertile women with pelvic adhesions

目的比较子宫输卵管碘油造影(HSG)和腹腔镜检查对不同程度盆腔粘连不孕患者的临床诊治价值。方法选择2004年1月至2006年6月在北京协和医院接受HSG和腹腔镜通液检查的不孕症198例,其中162例腹腔镜下诊断合并不同程度的盆腔粘连,36例无盆腔粘连。根据盆腔粘连评分将盆腔粘连患者分为3组:轻度粘连组51例,输卵管99条;中度粘连组47例,输卵管90条;重度粘连组64例,输卵管123条。无粘连组36例,输卵管72条。共检查输卵管384条。结果HSG与腹腔镜均诊断输卵管通畅的阳性符合率(敏感度)79·0%,两者诊断不通的阴性符合率(特异度)61·6%。随着盆腔粘连严重程度的加剧,HSG的敏感度递减(95·5%,86·3%,73·5%,51·5%),特异度递增(18·2%,34·3%,68·1%,81·5%)。各组HSG的敏感度比较差异均无统计学意义(P>0·05),特异度比较差异均有统计学意义(P<0·05)。HSG对于输卵管形态异常,伞端粘连、积水等病变与腹腔镜下的检查结果均有70%以上的符合率。结论HSG对于不同程度盆腔粘连的不孕患者检查的敏感度与特异度有所不同,盆腔粘连越重,敏感度越低,特异度越高;腹腔镜在确诊输卵管疾病的同时,能够发现与改善或去除盆腔粘连等可能导致不孕的因素;如果合并有明确的盆腔粘连病史者,不管HSG结果如何,应积极进行腹腔镜检查。

Objective To explore the clinical diagnostic value on hysterosalpingography （HSG） and laparoscopy associated with pelvic adhesions in infertility women. Methods From Jan. 2004 to Jun. 2006, one-hundred and ninety-eight infertile patients in Peking Union Medical College Hospital were recruited and they all received both HSG and laparoscopy examination before. One-hundred and sixty-two patients who had pelvic adhesion detected by laparoscopy were divided into three groups according to the severity of pelvic adhesions as follows： mild adhesions （51 cases and 99 fallopian tubes were examined）, moderate adhesions （47 cases and 90 fallopian tubes were examined）, severe adhesions （64 cases and 123 fallopian tubes were examined）. There were 36 infertile patients without pelvic adhesions and 72 fallopian tubes were examined in them. Three hundred and eighty-four fallopian tubes were examined totally. Results The sensitivity of HSG and laparoscopy in the diagnosis of unobstructed tubes was 79.0%, and the specificity was 61.6%. The sensitivity of HSG was decreased （95.5%, 86.3%, 73.5%, 51.5%, P 〉0.05） and the specificity was increased （18.2%, 34. 3%, 68. 1%, 81.5%, P 〈 0. 05 ） as the severity of pelvic adhesions aggravated. The rates in diagnosis of tubal conformation abnormity or umbrella adhesion and hydropyosalpinx by HSG and laparoscopy were all above 70%. Conclusion The sensitivity reduces and specificity increases as the severity of pelvic adhesions aggravated in the diagnosis of tubal abnomality by HSG in infertility women. The pelvic adhesions and other infertile factors related to the fallopian tubal can be detected and wiped off under laparoscopy. If the infertile women had history of pelvic adhesions, the laparoscopy should be suggested in spite of the results of HSG.