子宫输卵管造影与宫腔镜插管通液检查生殖道异常情况的比较

Comparison of hysterosalpingography and catheterization and hydrotubation under hysteroscope in detection of genital tract abnormality

目的:比较子宫输卵管造影(HSG)与宫腔镜插管通液检查对生殖道异常情况检查的效果。方法:200例不孕症患者分为两组各100例,第一组行子宫输卵管碘剂造影,如果HSG提示输卵管、盆腔异常,予宫腹腔镜检查及手术;如果造影提示生殖道未见异常或仅宫腔异常,则行宫腔镜检查;如果HSG及宫腔镜检查无异常而6个月后仍未孕者,排除其他因素,行腹腔镜检查。第二组行宫腔镜检查,行宫腔镜下双侧输卵管插管通液,提示输卵管阻塞,予宫腹腔镜检查及手术,术中经宫颈插管通液,在腹腔镜下判断输卵管通畅情况来检验宫腔镜插管通液对诊断输卵管阻塞结果的准确性。结果:HSG对输卵管阻塞的诊断率高,宫腔镜下输卵管插管通液对输卵管阻塞的假阳性率较高。HSG可诊断部分盆腔粘连病例,而宫腔镜下输卵管插管通液不能诊断盆腔粘连。宫腔镜检查可诊断所有宫腔异常情况,HSG对宫腔粘连、子宫内膜息肉等宫腔内病变诊断率低。结论:应以HSG加宫腔镜检查作为不孕症患者生殖道异常情况的筛查手段。

Objective： To compare the effects of hysterosalpingography （HSG） and catheterization and hydrotubation under hyste- roscope in detection of genital tract abnormality. Methods： Two hundred infertile patients were divided into two groups, 100 patients in each group. The patients in the first group underwent HSG, if HSG showed tubal and pelvic cavity abnormality, hysteroscopy and operation were performed; if HSG showed no abnormality or only uterine cavity abnormality, hysteroscopy was performed; if HSG and hysteroscopy showed no abnormality but the patients were still unpregnancy after six months, laparoscopy was performed after excluding the other factors. The patients in the second group underwent bilateral catheterization and hydrotubation under hysteroscope, if tubal obstruction was found, hysteroscopy, laparoseopy, and operation were performed, hydrotubation via uterine cervix was performed during operation, tubal patency was judged under laparoscope to estimate the accuracy of catheterization and hydrotubation for diagnosis of tubal obstruction. Results： The diagnostic rate of HSG for tubal obstruction was high, the false positive rate of catheterization and hydrotubation under hysteroscope was relatively high. HSG could diagnose some cases with pelvic adhesion, but catheterization and hydrotubation under hysteroscope could not. Hysteroscopy was able to diagnose all kinds of uterine cavity abnormality, the diagnostic rates of HSG for uterine cavity adhesion and endometrial polyp were relatively low. Conclusion： HSG combined with catheterization and hydrotubation under hysteroscope can be used as screening methods for genital tract abnormality in infertile patients.