经阴道子宫输卵管四维超声造影逆流征象及结果分析

Sign of contrast agent reflux during transvaginal four-dimensional hysterosalpingo-contrast sonography and results analysis

目的探讨经阴道子宫输卵管四维超声造影逆流征象及对受孕率的影响。方法选择不孕症患者152例,共计296条输卵管。采用经阴道子宫输卵管超声四维造影技术评估输卵管通畅性及观察子宫肌层逆流情况,12个月后对患者进行随访。结果 152例不孕患者中有62例患者出现逆流,逆流患者在超声造影中发现双侧通畅16例,双侧病变患者32例,单侧病变14例。双侧病变者中9例输卵管双侧阻塞,10例单侧不通合并另一侧通而不畅;13例双侧通而不畅;单侧病变者通而不畅10例,单侧阻塞4例。双侧输卵管不通者产生肌层逆流的风险是无双侧不通的9.636倍(P=0.022),而有人流史与自然流产、生产者和原发性不孕者发生肌层逆流的概率比较差异无统计学意义(P=0.163),随访135例患者中32例受孕,无肌层逆流较有肌层逆流患者更易受孕,其程度为后者的2.58倍,二者比较差异有统计学意义(P=0.038)。结论经阴道子宫输卵管四维超声造影能立体、直观、实时观察造影剂在宫腔、输卵管腔的流动及进入子宫肌层及周围血管的征象。逆流的发生为临床诊断子宫内膜病变提供了依据,具有重要临床价值。

Objective To explore the sign of contrast agent reflux during transvaginal four-dimensional hysterosalpingocontrast sonography（TVS 4D-HyCoSy） and its impact on pregnancy. Methods A total of 152 infertile women（296 fallopian tubes） were evaluated for tubal patency and the contrast agent reflux in myometrium with TVS 4D-HyCoSy. The patients were followed up after 12 months. Results In all 152 patients, reflux was observed in 62 patients. During TVS 4D-HyCoSy, 16 patients were with bilateral unobstruction; 32 patients were with bilateral lesions, including 9 cases of bilateral fallopian tubes obstruction, 10 cases of one side obstruction and the other side partly obstruction; 13 cases of bilateral partly obstruction; 14 patients were with unilateral lesions, including 10 cases of fallopian tube partly obstruction and 4 eases of unilateral fallopian tube obstruction. The risk of contrast agent reflux in bilateral tubal obstruction patients was 9.636 times to that in patients without bilateral tubal obstruction（P=0.022 ）. The probability of contrast agent reflux had no significant statistical difference among patients with a history of abortion and natural abortion, producers and idiopathic infertility （P=0.163）.The follow-up of 135 patients showed 32 people were pregnant, the conception rate of patients with no contrast agent reflux was 2.58 times to those with contrast agent reflux, there was statistical difference （P=0.038）. Conclusion TVS 4D-HyCoSy can observe the flow of contrast agent in uterine cavity and fallopian tube lumen and it can observe the sign of reflux in myometrium and surrounding vessels spatially, directly and real-timely. The reflux sign can provide important evidence for diagnosis of endometrial lesions and it has important clinical value.