1369例不孕患者水溶性造影剂DSA下动态子宫输卵管造影分析

Analysis of Hysterosalpingography in 1369 Infertility Patients with Water Soluble Contrast Medium under Digital Subtraction Angiography

目的探讨原发性不孕（PI）与继发性不孕（sI）患者子宫输卵管造影（HSG）的特点及导致输卵管不通畅的危险因素。方法回顾性分析1369例不孕患者的水溶性造影剂DSA下HSG造影资料，根据不孕的原因为PI及sI两组，对两组一般情况及造影结果进行比较；再以双侧输卵管通畅与否为因变量，以年龄、生育史、是否有宫外孕史、盆腔手术史、输卵管结核病史、流产史、原发或继发性不孕、合并其它疾病与否、子宫形态异常与否为自变量，进行多因素二分类1ogiStic回归分析，探讨输卵管不通畅的危险因素。结幂PI组年龄比sI组小[（27．27±3．82）岁VS（29．97±4．80）岁]，双侧输卵管通畅率较sI组高（45．50％vS34．74％），两组比较有统计学差异（P〈0．05）；LogiStic回归分析显示年龄、宫外孕史、流产史及子宫形态异常是输卵不通畅的危险因素（OR值=0．903、O．198、1．542、0．120；95％的可信区间：0．903～0．958、0．120—0．352、1．002～2．375、0．036～0．399）。结论PI和sI在年龄及输卵管通畅率方面存在差异，大龄、宫外孕史、流产史及子宫形态异常是输卵不通畅的危险因素。

To analysis the hysterosalpingography（HSG） features of primary infertile（PI） and secondary infertile（SI） patients and related risk factors of Fallopian tubal blockage and incomplete patency. Digital subtraction angiography（DSA） imaging data of HSG with water soluble contrast medium in 1369 infertile patients were retrospectively analyzed. Patients were divided into two groups according to etiopathogenisis of infertility, including PI group and SI group. The general states and appearance of HSG were compared between the two groups. And then, with bilateral tubal patency or not as a dependent, and with age,childbearing history or not, ectopic pregnancy（EP） history or not, pelvic surgery history or not, tubal tuberculosis history or not, abortion history or not, PI or SI, complicating of other disease or not, paramorphia of uterus or not as covariates, multivariate binary logistic regression analysis was used to estimate the risk factors of tubal blockage or incomplete patency. in PI group was significantly smaller than in SI group[（27.27± 3.82） y vs（29.97±4.80）y, P〈0.05], and bilateral tubal patency rate in PI group was significantly higher than in SI group（45.50% vs 34.74%, P〈0.05）. Logistic regression analysis showed that age, EP history, abortion history and paramorphia of uterus were risk factors of tubal blockage or incomplete patency （OR=0.903, 0.198, 1.542, 0.120; 95% CI： 0.903-0.958, 0.120-0.352, 1.002-2.375, 0.036-0.399）. There are differences in age and tubal patency rate between PI and SI patients. Elder age, EP history, abortion history and paramorphia of uterus are risk factors of tubal blockage or incomplete patency.