子宫输卵管超声造影在输卵管阻塞诊断中的应用价值

Application value of hysterosalpingo-contrast-sonography in diagnosis of fallopian tubel obstruction

目的探讨子宫输卵管超声造影(HyCoSy)在输卵管阻塞诊断中的应用价值。方法选择38例经子宫输卵管造影(HSG)诊断为一侧或双侧输卵管完全或不完全阻塞的输卵管性不孕症患者(67条输卵管),于月经干净后3￣7d行HyCoSy,并与HSG诊断结果对照分析。然后根据患者耐受程度维持一定压力,在造影条件下动态观察输卵管显示情况,疏通阻塞输卵管,术后进行随访。结果 38例患者中,HyCoSy诊断完全阻塞41条,欠通畅18条。与HSG比较,两种方法在判断输卵管通畅性方面高度一致,Kappa值为0.83,HyCoSy诊断输卵管通畅的敏感性、特异性、阳性预测值及阴性预测值分别为88.88%、100%、100%及98.31%。38例患者中,17例双侧输卵管不通患者有7例怀孕,占41.2%,一侧或双侧欠通畅21例患者有11例怀孕,占52.4%,9例宫外孕术后患者正常妊娠5例,占总妊娠率的17.2%。结论 HyCoSy安全、无创、操作简便,且疗效佳,对于输卵管性不孕症患者能起到诊断和治疗的双重作用,可临床推广应用。

Objective To explore the applicaiton value of hysterosalpingo-contrast-sonography（HyCoSy）in diagnosis of fallopian tubel obstruction. Methods Thirty-eight patients with tubal infertility sufferred from completely or incompletely unilateral or bilateral tubal obstruction were enrolled in this study（67 fallopian tubes）. HyCoSy was performed at 3 - 7 d after menstrual clean, the results were compared with those of hysterosalpingography （HSG）. By considering the patients＇ stress tolerance, visualization of the oviduct was dynamically observed and the obstructed oviducts were cleared out, the patients were followed up after operation. Results In 38 cases, there were 41 fallopian tubes completely obstructed, 18 fallopian tubes were incompletely obstructed. Compared with HSG, the fallopian tube patency of two methods had high consistence, the Kappa value was 0.83. The sensitivity,specificity, positive predictive value and negative predictive value of HyCoSy in diagnosis of fallopian tubel obstruction were 88.88%, 100%, 100% and 98.31%. In 17 patients with bilateral blocked oviducts, 7 patients were pregnant （accounting for 41.2% ）, 11 patients were pregnant among 21 patients with bilateral or unilateral incompletely obstruction （accounting for 52.4% ） , 5 patients were pregnant among 9 patients after ectopic pregnancy operation, and the total pregnancy rate was 17.2%o Conclusion HyCoSy is a safe, non-invasive and easy method with good curative effect, and it plays an important role in diagnosis and treatment for patients snfferring from tubal infertility.