^99Tcm O4^-显像与X线造影检查不孕症患者输卵管病变的对比分析

Examination of the oviducts of patients with infertility using 99Tcm O4- imaging and X-ray hysterosal- pingography

目的对比x线子宫输卵管造影与^99Tcm O4^-输卵管显像对不孕症患者输卵管病变的诊断价值。方法选择2008年1月至2009年6月间，至少一侧输卵管通畅或通而不畅的不孕症患者150例（通畅输卵管85条，通而不畅输卵管197条，单侧不通输卵管18条），分别行x线子宫输卵管造影及^99Tcm O4^-输卵管显像。x线造影判别输卵管形态分类为正常、迂曲、僵直、扩张或积水^99Tcm O4^-显像诊断输卵管功能类型分别为正常、轻度、中度、重度损伤、无功能和输卵管阻塞。对检查结果进行对比分析，2种方法对输卵管异常检出率比较采用，检验。结果共282条通畅或通而不畅输卵管。^99Tcm O4^-显像对这些输卵管的异常检出率（81．6％，230／282）明显高于x线造影组（69．9％，197／282）X^2=14．14，P〈0．05。2种方法结合，可明显提高输卵管异常检出率（89．4％，252／282）。在^99Tcm O4^-显像示功能损伤输卵管中，输卵管迂曲的发生率明显高于功能正常者（15．3％，8／52），且随功能损伤程度的加重（轻度、中度、重度、无功能）而逐渐增高（30．8％，32／104；31．4％，16／51；37．1％，13／35；42．5％，17／40）；功能损伤输卵管的扩张发生率（16．3％，17／104；11．8％，6／51；17．1％，6／35；20．0％，8／40）也明显高于功能正常者（9．6％，5／52）。输卵管僵直的发生率在轻、中及重度受损输卵管中分别为27．9％（29／104）、29．4％（15／51）、28．6％（10／35），而在输卵管无功能时则较低，为15．O％（6／40）。结论x线子宫输卵管造影检查对输卵管形态的判断有优势，而^99Tcm O4^-输卵管显像能较好地判断输卵管功能损伤的程度。两者结合有助于全面正确了解输卵管情况。

Objective To compare the value of X-ray hysterosalpingography and 99Tcm pertechne- tate oviduct imaging in identifying the tubal cause of infertility. Methods One hundred and fifty patients with infertility having unilateral or bilateral patent tubes were examined by both 99Tcm O4- imaging and X-ray hysterosalpingography in our hospital from January 2008 to June 2009. The result of the oviduct examination by X-ray hysterosalpingography was classified as normal, tortuous, stiff, dilated or hydrops. The result by 99Tcm O4- imaging was classified as having normal, mild, moderate or severe damage, nonfunctioning and tubal obstruction. The results of the two imaging modalities were compared by X2 test. Results The detec- tion rate of tubal abnormalities by radionuclide imaging （81.6%, 230/282） was higher than that by X-ray （69.9% , 197/282 ; X2 = 14. 14, P 〈 0.05 ） and significantly higher （ 89.4% , 252/282） when combining X-ray and 99TcmO4- imaging. The incidence rate of tortuous tubes with positive 99TcmO4- imaging was signifi- cantly higher than that with normal 99Tcm O4- imaging （ 15.3%, 8/52）. And the incidence rate increased with the severity of damage revealed by 99Tcm O4- imaging （30.8%, 32/104; 31.4%, 16/51; 37.1%, 13/35 ; 42.5%, 17/40）. The incidence rate of dilated tubes with different severity of damage revealed by 99Tcm O4- imaging （16.3%, 17/104; 11.8%, 6/51; 17. 1%, 6/35; 20.0%, 8/40） was significantly higher than that with normal 99TcmO4- imaging （9.6% , 5/52）. The incidence rates of stiff tubes in the mildly, moderately and severely damaged and nonfunetioning oviducts were 27.9% （29/104）, 29.4% （15/ 51 ）, 28. 6% （10/35） and 15.0% （6/40）, respectively. Conclusions Radionuclide imaging of the ovi- duct can determine the extent of tubal dysfunction; while, X-ray hysterosalpingography is better for the de- tection of morphological abnormalities of the uterus and oviducts. Therefore, combined imaging can maxi- mize the likelihood of identifying the tubal cause of infertility.