双氧水与声诺维三维输卵管超声造影对输卵管通畅度的诊断价值

Diagnostic value of fallopian tube obstruction using hydrogen peroxide solution and contrast-enhanced three-dimensional ultrasonography

目的比较双氧水与声诺维三维输卵管超声造影(3D-Hy Co Sy)对输卵管通畅度的诊断价值。方法回顾分析我院经阴道超声引导下行输卵管造影检查的24例不孕症患者(共47条输卵管)的影像资料,所有病例均行双氧水造影和3D-Hy Co Sy。3D-Hy Co Sy检查前行子宫输卵管碘油造影(HSG),以HSG检查结果作为评估输卵管通畅度的金标准,对比两种超声造影诊断输卵管通畅度的优缺点。结果 1与HSG诊断结果比较,3D-Hy Co Sy对输卵管通畅度的诊断符合率为80.9%,双氧水造影对输卵管通畅度的诊断符合率为59.6%,差异有统计学意义(P﹤0.05)。3D-Hy Co Sy的假阳性率为5.3%,低于双氧水造影(47.4%);3D-Hy Co Sy的假阴性率为14.3%,高于双氧水造影(3.6%)。23D-Hy Co Sy判断近端输卵管狭窄及梗阻部位结果与HSG高度一致(Kappa值分别为0.77、0.90),双氧水造影为基本一致(Kappa值分别为0.40、0.45)。3D-Hy Co Sy判断中远端输卵管狭窄及梗阻部位结果与HSG高度一致(Kappa值分别为0.70、0.80),双氧水造影与HSG一致性差(Kappa值分别为0.31、0.31)。结论双氧水造影与3D-Hy Co Sy检查安全无创、操作简便,但双氧水造影较3D-Hy Co Sy假阴性率低,3D-Hy Co Sy可更清晰地显示输卵管立体形态结构,准确评估输卵管的通畅度及确定梗阻部位;两者结合有望提高输卵管超声造影的诊断准确率。

Objective To compare the value of hydrogen peroxide solution and Sono Vue enhanced three-dimensional sonography（3D- Hy Co Sy） for the fallopian tube obstruction. Methods The image data of 24 infertility patients（totally 47 fallopian tubes）were retrospectively analyzed. All patients accepted transvaginal ultrasound examination. The hysterosalpingography（HSG）was used as the diagnosis standard. Results of using hydrogen peroxide solution and 3D-Hy Co Sy were compared.Results 1Compared to HSG,the coincidence rate in diagnosing fallopian tube obstruction by 3D-Hy Co Sy（80.9%）was significantly higher than that of hydrogen peroxide solution（59.6%,P﹤0.05）. The false-positive rate of 3D-Hy Co Sy（5.3%）was less than that of hydrogen peroxide（36.8%）. The false-negative rate of 3D-Hy Co Sy（14.3%）was higher than that of using hydrogen peroxide solution（3.6%）.2Results of using 3D-Hy Co Sy had a high consistency with HSG in determining proximal tubal stenosis and obstruction position（Kappa value were 0.70,0.80）, but the consistency between using the hydrogen peroxide solution and HSG was lower（Kappa value were 0.40,0.45）. 3D-Hy Co Sy and HSG results had a good agreement in determining distal tubal stenosis and obstruction position（Kappa value were 0.77,0.90）,while hydrogen peroxide was poor（Kappa value were 0.31,0.31）.Conclusion 3D-Hy Co Sy and hydrogen peroxide were safe and esay-operated. The 3D-Hy Co Sy could show the three-dimensional morphological structure of the fallopian tubes clearly,assess the tubal openness level eand determine the position of obstruction accurately. However,the false-negative rate of hydrogen peroxide was less than 3D-Hy Co Sy. If combine the two methods,It was expected to improve diagnosis precision of fallopian tube obstruction diagnosis.