不同子宫输卵管造影结果对选择宫腔镜-注水腹腔镜的意义

The Significance of Application of Hysteroscopy and Transvaginal Hydrolaparoscopy after Hysterosalpingography

目的探讨不同子宫输卵管造影(hysterosalpingography,HSG)结果后行宫腔镜联合经阴道注水腹腔镜(hysteroscopy and transvaginal hydrolaparoscopy,Hys-THL)检查的意义。方法回顾性研究2009年4月～2011年12月HSG提示不同程度输卵管和子宫异常而接受Hys-THL检查的364例不孕患者(共693条输卵管)的临床资料,比较2种检查方法的符合情况。结果以Hys-THL为金标准,HSG对子宫形态诊断的敏感性和特异性分别为100.0%(13/13),99.4%(349/351)。对输卵管通畅、间质部阻塞和积水诊断的敏感性分别为67.0%(390/582)、68.1%(49/72)和53.8%(21/39);特异性分别为72.0%(80/111)、69.4%(431/621)和98.2%(642/654)。结论对于HSG提示输卵管间质部阻塞的患者,IVF并非首选的助孕方式,Hys-THL可能为更好的选择。但对HSG提示有输卵管积水的患者,并不推荐进一步采取Hys-THL检查。

Objective To discuss the significance of the application of hysteroscopy and transvaginal hydrolaparoscopy （ Hys-THL） after hysterosalpingography （HSG） . Methods A retrospective study was carried out among 364 infertile patients with 693 fallopian tubes. All the 364 patients received HSG examination in our institute from April 2009 to December 2011 due to various abnormal uterus and fallopian tube indicated by HSG. Two examination methods were compared. Results With Hys-THL as the gold standard, the sensitivity and specificity of HSG in the diagnosis of uterine morphology were 100.0% （13/13）, and 99.4% （349/351） respectively. The sensitivity in the diagnosis of the patent fallopian tube, tube of interstitial obstruction and the hydrosalpin, were 67.0% （390/582）, 68. 1% （49/72） and 53.8% （21/39） respectively, and the specificity were 72.0% （80/111）, 69.4% （431/621） and 98.2% （642/654） respectivety. Conclusions Compared with IVF, hys-THL is abetter choice for the patients with tubal interstitial obstruction indicated by HSG. However, to the patients with hydrosalpinx, hys-THL is not recommended.