数字减影血管造影与常规造影对输卵管阻塞性不孕症的临床应用价值比较

Comparison of conventional hysterosalpingography and digital subtraction angiography in fallopian tube obstruction infertility

目的 比较数字减影血管造影（DSA）与常规造影对输卵管阻塞性不孕症的临床应用价值。方法 选择2012年7月至2013年7月济南军区总医院收治的306例输卵管阻塞性不孕症患者,随机分为2组,每组各153例,分别行DSA与常规造影。比较2组患者输卵管插管、造影成功率、妊娠率。结果 2组患者输卵管插管、造影成功率均为100%,无一例发生严重并发症。DSA组患者复查输卵管再通成功率为85.6%（131/153）,高于常规造影组患者复查输卵管再通成功率81.0%（124/153）,但差异无统计学意义（χ^2=4.021,P=0.153）。DSA组患者2~6个月自然受孕率为37.5%（42/112）,高于常规造影组患者2~6个月自然受孕率23.2%（23/99）,且差异有统计学意义（χ^2=4.142,P=0.043）。未受孕患者经促排卵药物干预2~6个月自然受孕率DSA组为87.1%（61/70）,高于常规造影组的67.1%（51/76）,且差异有统计学意义（χ^2=6.879,P=0.018）。结论 利用DSA行子宫输卵管造影较常规造影治疗效果明显,不良反应少,并具有一定的临床价值。

Objective To explore the application of conventional hysterosalpingography and digital subtraction angiography （DSA） in fallopian tube obstruction infertility. Methods Three hundred and six patients with fallopian tube obstruction infertility in Ji＇nan Military Genera/ Hospital from July 2012 to July 2013 were enrolled in the study. All patients who recieved the same treatment were randomly divided into 2 groups, and DSA and conventional angiography were applied in different group respectively. According to comparative study and follow up review, the success rate of intubation and angiographic and pregnancy rate were evaluated. Results The success rate of fallopian intubation and angiography in the two groups was 100% , without any severe complications. The recanalization success rate was 85. 6% （ 131/153 ） and 81.0% （124/153） in DSA group and conventional angiography group, respectively, but the difference was not statistically significant （x^2 = 4. 021, P = 0. 153 ）. Natural pregnancy rate of DSA group in 2-6 months was 37.5% （42/112）and 23.2% （23/99）in conventional angiography group, and there was a significant difference （x^2 = 4. 142, P = 0. 043）. For those who did not conceive by natural within 6 months, natural pregnancy rate was observed with the intervention of ovulation drug as 87.1% （61/70） in DSA group and 67.1% （51/76） in conventional angiography group respectively in 2-6 months. The ratio of DSA group was significantly higher than that of conventional angiography group （x^2 =6. 879,P=0.018）. Conclusion There are obvious theraputic effects and fewer adverse reactions for hysterosalpingography with DSA and which proves some clinical values.