子宫输卵管碘油造影在诊断输卵管性不孕中的研究

Value of Hysterosalpingography in Diagnosis of Fallopian Tube Pathology among Infertile Women

【目的】通过与腹腔镜直视下输卵管通液术比较,分析子宫输卵管碘油造影对引起女性不孕症的输卵管病变的筛查与诊断价值。【方法】以2005年1月至2009年11月因存在输卵管阻塞或粘连因素,在中山大学孙逸仙纪念医院妇产科住院进行腹腔镜检查的288例女性不孕症患者作为研究对象,以腹腔镜直视下输卵管通液术为明确输卵管是否畅通的"金标准",与术前子宫输卵管碘油造影的结果进行比较,判断后者诊断输卵管病变的敏感度和特异度。【结果】子宫输卵管碘油造影对输卵管通畅度诊断的总体敏感度为94.69%,特异度为41.96%;对输卵管近端阻塞诊断的敏感度和特异度分别为92.60%,74.71%;对输卵管积水诊断的敏感度和特异度分别为82.18%,91.98%;对输卵管伞部粘连诊断的敏感度和特异度分别为23.07%,75.54%;诊断双侧输卵管阻塞的敏感度为60.66%,特异度为82.83%。【结论】子宫输卵管碘油造影能够较准确地判断输卵管形态及腔内的通畅情况,有较高的敏感度;对输卵管近端阻塞及输卵管积水有较高的诊断价值,但对输卵管伞端粘连的诊断价值较小。子宫输卵管碘油造影可作为筛查女性不孕患者输卵管通畅性的首选方法,为腹腔镜检查和手术的必要性提供较可靠的依据。

【Objective】To evaluate the diagnostic accuracy of hysterosalpingography（HSG） in the diagnosis of fallopian tube pathology among infertile women.【Methods】A total of 288 infertile women were examined by HSG before they underwent laparoscopy.Tube pathology detected at HSG was compared with pathology detected at laparoscopy.Sensitivity,specificity,and Youden index of HSG in the diagnosis of tube pathology were calculated,regarding laparoscopy as the reference standard.【Results】The sensitivity of 94.69% and specificity of 41.96% for HSG while evaluating general tubal patency was determined.The sensitivity and specificity of HSG in diagnosis of proximal tubal occlusion were 92.60% and 74.71%.The sensitivity and specificity of HSG in diagnosis of hydrosalpinx were 82.18% and 91.98%.As a test of peritubal adhesions,hysterosalpingography had sensitivity of 23.07% and specificity of 75.54%,respectively.When definition of tubal occlusion was limited to two-sided,the sensitivity and specificity were 60.66% and 82.83%,respectively.【Conclusion】 The diagnostic value of hysterosalpingography in the diagnosis of peritubal adhesions is poor.Hysterosalpingography is more accurate in the diagnosis of tubal occlusion and hydrosalpinx.