经阴道子宫输卵管四维超声造影在评价输卵管通畅性中的应用价值

Clinical evaluation of tubal patency by transvaginal four-dimensional hysterosalpingo-contrast sonography

目的探讨经阴道四维超声造影(4D-HyCoSy)在输卵管通畅性评价中的应用价值。方法采用SonoVue造影剂对53例不孕患者行经阴道子宫输卵管四维超声造影检查,动态观察输卵管通畅性。结果 53例患者106条输卵管四维超声造影显示输卵管通畅47条,输卵管通而不畅36条,输卵管不通畅23条。超声造影表现:(1)输卵管通畅15例,输卵管走形柔顺,造影剂喷射状进入盆腔,并在盆腔内迅速弥散;(2)输卵管通而不畅12例,输卵管显影不连续,局部纤细或增粗,造影剂溢入盆腔,在盆腔内弥散不均匀;(3)输卵管不通畅6例,双侧输卵管不显影或仅某段显影。与腹腔镜检查结果对照,超声造影诊断输卵管通畅性的符合率为94%(17/18)。结论经阴道子宫输卵管四维超声造影可动态显示子宫、输卵管形态,诊断宫腔粘连及宫腔占位性病变,并评价输卵管的通畅情况。

Objective To explore the clinical value oftransvaginal four-dimensional hysterosalpingocontrast sonography （TVS 4D-HyCoSy）in evaluation of the patency of fallopian tubes. Methods Totally 53 patients underwent SonoVue TVS4D-HyCoSy to observe the tubal patency. Results Among the 106 tubes in 53 patients, TVS 4D-HyCoSy showed 47 unobstructed tubes, 23 obstructed tubes, and 36 partially passable tubes. In unobstructed cases, the fallopian tubes were smooth and regular in morphology, and contrast agents flowed into and dispersed over pelvic cavity rapidly and evenly. In the cases of partially passable tube, fallopian tubes were discontinuous and irregular in morphology, and contrast agents flowed into and dispersed over pelvic cavity slowly and unevenly. In obstructed cases, there were no or little contrast agents into the fallopian tubes. Compared with the results of laparoscopy, the diagnostic accuracy of TVS 4D-HyCoSy was 94.4%（17/18）. Conclusions TVS 4D-HyCoSy is a useful tool in demonstrating the morphological features of fallopian tube, diagnosing intrauterinc adhesion and lesion and assessing the tubal patency.