阴道超声、宫输卵管碘油造影及超声子宫水造影对不孕症患者中子宫腔粘连的诊断价值研究

The diagnostic value of different examination methods for intrauterine adhesion in infertility

目的:探讨阴道超声(TVS)、宫输卵管碘油造影(SHG)、超声子宫水造影(SIS)以及三种方法联合对不孕症患者中子宫腔粘连(IUA)的诊断价值。方法:以230例行宫腔镜检查或治疗的不孕症患者为研究对象,回顾性分析各种检查方法对IUA的诊断结果,评价各种检查方法的准确性、可靠性以及预测值。结果:230例病例中共确诊IUA患者112例,阳性率为48.7%。单一采用TVS、HSG或SIS检查,对IUA的诊断灵敏度均较低,其中以SIS最高,达到64.2%;三种方法特异度均高于灵敏度,其中以HSG最高达到90.4%;三种方法的漏诊率均明显高于误诊率,其中HSG漏诊率最高,达到60.0%。三种方法中SIS的正确诊断指数最高,达到47.5%。HSG阳性似然比最大(4.167),SIS阴性似然比最小(0.430)。将三种方法联合以后,诊断灵敏度提高到80.8%,漏诊率下降到19.2%,正确诊断指数达到65.4%,整体结果明显较单一诊断方法好。结论:存在宫腔异常的不孕症患者中宫腔粘连阳性率较高,单一阴道超声检查、子宫输卵管造影或超声子宫水造影检查的灵敏性较低,漏诊率较高,与金标准诊断的一致性较差,联合TVS/HSG/SIS三种方法用于宫腔粘连的诊断,准确性、可靠性及预测值均较好。

Objectives：To investigate the diagnostic value of transvaginal ultrasound （TVS）,hysterosal-pingography （HSG）,saline intrauterine sonohysterograph （SIS）and joint of three methods for intrauterine adhesion （IUA）of infertility patients.Methods：230 infertility patients inspected by hysteroscopy examination were selected as the research objects.The screening results of different methods for IUA were retrospectively analyzed,and the authenticity,reliability and prediction of different methods were evaluated.Results：112 patients among the 230 ca-ses of infertility were diagnosed as IUA,a positive rate of 48.7%.Using single TVS,HSG or SIS examination,the diagnostic sensitivity of IUA was low,in which SIS was the highest,up to 64.2%.The specificity of three methods was higher than that of sensitivity,of which HSG was the highest,reaching 90.4%;the missed diagnosis rate of three methods were higher than the misdiagnosis rate,and the missed diagnosis rate of HSG was the highest,reac-hing 60%.Correct diagnosis index of SIS was the highest in three methods,reaching 47.5%.The positive likeli-hood ratio of HSG was maximum （4.167）,and negative likelihood ratio of SIS was the minimum （0.430）.By combination of three methods,the sensitivity increased to 80.8%;missed diagnosis rate dropped to 19.2%;the correct diagnosis index reached to 65.4%;the overall results was better than single diagnosis method.Conclusion：There are high positive rate of intrauterine adhesion in uterine cavity abnormalities infertility patients,using single TVS,HSG or SIS for the diagnosis of IUA,the sensitivity is low with high rate of missed diagnosis,and consistency with the gold standard is poor.Combined use of TVS /HSG/SIS for the diagnosis of IUA,the authenticity,reliability and the prediction values are better.