子宫输卵管碘油造影术临床应用价值

Clinical Value of Hysterosalpingography before Laparoscopic Surgery for Tubal Factor Infertility

目的探讨盆腔因素导致的女性不孕症患者腹腔镜术前应用子宫输卵管碘油造影术(HSG)的临床应用价值,提高对女性输卵管因素不孕的诊断水平。方法对2005年10月—2009年10月在北京天坛医院妇产科就诊的202例因不孕症患者行HSG,并在其后半年内对行腹腔镜输卵管粘连分离术和(或)造口术患者进行术后盆腔探查,将之与术前造影结果进行对比分析。结果宫腔异常者6例,符合率100%。双侧输卵管阻塞20例,术中符合15例,符合率75%。21例(10.4%)腹腔镜发现盆腔粘连明显,而HSG未能提示。结论 HSG对输卵管形态异常及宫腔情况诊断较可靠,但对盆腔粘连的评价可靠性较低。可以作为女性不孕症输卵管因素的一线诊断方法 。

Objective To evaluate the clinical value of preoperative hysterosalpingography （HSG） in the management of tubal factor infertility （TFI）.Methods We retrospectively analyzed the clinical data of 202 TFI patients who had undergone HSG before laparoscopic surgery in our department from December 2005 to October 2009.The results of pre-operative imaging and post-operative pelvic exploration were compared.Results Agreement between HSG and laparoscopy was found in six patients with abnormalities of uterine cavity.Twenty patients had bilateral blocked tubes,but only 15 cases （75%） were confirmed by laparoscopy.HSG showed 288 twisted tubes and/or tubae laciniae adhesions,among which 225 tubes were confirmed by intra-operative observations.HSG showed 48 tubes with cornual occlusion,among which 25 occusions were confirmed by laparoscopy.Finally,21 patients （10.4%） had pelvic adherence,which was not detected by HSG.Conclusion HSG is useful for the diagnosis of the abnormal shape of the fallopian tube and intrauterine conditions,but is less reliable for pelvic adherence.Therefore,it can be used as a first-line tool for TFI.