116例继发性不孕症子宫输卵管碘油造影的X线分析

X-ray analysis of hysterosalpingography in 116 patients with secondary infertility

目的探讨继发性不孕症的子宫输卵管碘油造影的X线表现。方法回顾性分析116例经临床诊断为继发性不孕症患者的子宫输卵管碘油造影的X线资料,包括术中的动态观察摄片及24h后的盆腔弥散片;并对部分相关数据进行统计学分析。结果子宫表现为正常的100例,宫腔粘连12例,双角子宫及鞍状子宫各2例。双侧共232条输卵管。表现为正常的右侧39条,左侧42条;完全阻塞,包括伴积水和不伴积水的右侧36条,左侧39条;不全阻塞,即通而不畅、伴积水的右侧18条,左侧16条;因管腔炎性狭窄而致完全闭塞的右侧12条,左侧6条;因管腔炎性狭窄而致不全闭塞的右侧9条,左侧12条;输卵管周围粘连的右侧2条,左侧2条,其中1条同时合并伞部不全阻塞。静脉或间质淋巴逆流18例。双侧输卵管的各个阻塞部位计数资料对比分析,其差异无统计学意义(χ2=2.00,P>0.05)。结论继发性不孕症的子宫输卵管碘油造影主要表现为输卵管的阻塞或不全阻塞,阻塞部位多发生于伞部、壶腹部,常伴有不同程度的积水;其次为管腔炎性病变狭窄而致闭塞或不全闭塞。子宫因素多为宫腔粘连所致。

Objective To study the X-ray findings of hysterosalpingography（HSG） in patients with secondary infertility.Methods One hundred and sixteen patients who were diagnosed with secondary infertility and underwent HSG using iodine oil contrast were collected.Their radiological findings were retrospectively reviewed,including sequential spot films and films taken 24 h after HSG to examine contrast diffusion in the pelvis.Statistical analysis was performed.Results Abnormal uteri were found in 16 patients,including endometrial adhesions（12 cases）,double horns uterus（2 cases） and saddle form uterus（2 cases）.232 fallopian tubes were examined.Complete tubal blockage with or without hydrosalpinx was seen in the right fallopian tubes（n=36）,in the left fallopian tubes（n=39）;Incomplete tubal blockage with hydrosalpinx was seen in the right（n=18） and the left（n=16）;Complete occlusion with salpingitis stenosis was seen in the right（n=12） and the left（n=6）;Incomplete occlusion with salpingitis stenosis was seen in the right（n=9） and the left（n=12）.Peritubal adhesions were found in the right（n=2） and the left（n=2） with 1 tube having fimbria incomplete blockage.Venous or lymphatic backflow was found in 18 cases.There was no statistically significant difference in the incidences of blockage in the different sites of bilateral fallopian tubes（χ2=2.00,P〉0.05）.Conclusion The cause found on HSG in women with secondary infertility is commonly complete or incomplete tubal blockage,mainly in the fimbria and ampulla with varying degrees of hydrosalpinx,then is complete or incomplete occlusion with salpingitis stenosis.Uterine factors are mainly caused by endometrial adhesion.