子宫输卵管造影与宫腹腔镜联合探查诊断输卵管性不孕的一致性分析

Analysis of the diagnostic consistency of hysterosalpinography and laparoscopy combined with hysteroscopy in tubal infertility

目的分析子宫输卵管造影(hysterosalpingography,HSG)和宫腹腔镜联合探查诊断输卵管性不孕的一致性。方法收集225例因HSG结果异常行宫腹腔镜联合探查术的不孕症患者,由妇产科医师重新读片诊断,诊断结果分为通畅、近端阻塞、远端积水、通而不畅或粘连,分析具有一定临床经验的妇产科医师与影像科医师解读造影片诊断的符合率以及HSG不同诊断结果与宫腹腔镜联合探查所见的一致性。结果 450条输卵管中,妇产科医师诊断通而不畅或粘连的有126条(28.00%),与影像科医师诊断通而不畅或粘连的86条(19.11%)相比,差异有统计学意义(P<0.05)。HSG和宫腹腔镜联合探查在诊断输卵管通畅性方面的一致性较好,Kappa值为0.531(P<0.05)。HSG诊断输卵管通畅性敏感度为91.15%,特异度为69.64%,Youden指数为0.608;诊断输卵管近端梗阻的敏感度为77.92%,特异度为93.30%,Youden指数为0.712;诊断输卵管远端积水的敏感度为74.49%,特异度为91.48%,Youden指数为0.660;诊断输卵管通而不畅或粘连敏感度为25.49%,特异度为81.70%,Youden指数为0.072。结论 HSG适合作为输卵管性不孕女性诊断的初筛方法,具有较高的准确性,但对盆腔粘连性病变的诊断率较低并影响检查结果,临床上应对HSG结果提示异常的不孕症患者及时进行宫腹腔镜联合探查,以便更加全面地诊断及治疗。

Objective To analyze the diagnostic consistency of hysterosalpinography and laparoscopy combined with hysteroscopy in tubal infertility. Methods 225 female infertility patients with abnormal uterine oviduct radiography who further received laparoscopy combined with hysteroscopy exploration were selected. Their film diagnosis were re - read by the doctors in Department of Obstetrics and Gynecology. Their diagnostic results were smooth, proximal obstruction, distal hydrocephalus, and smooth but not fluent or adhesions ; then coincidence rate of diagnosis for radiography films were analyzed by the doctors with certain clinical experience in Department of Obstetrics and Gynecology and Imaging Department. Diagnostic consistency was analyzed be- tween the different diagnostic results of hysterosalpinography and laparoscopy combined with hysteroscopy. Results There were 126 fallopian tubes （28.00%） in 450 with smooth and not fluent or adhesion under the diagnosis of doctors in Department of Ob- stetrics and Gynecology. There were 86 fallopian tubes （ 19.11% ） in 450 under the diagnosis of doctors in Imaging Department. There were significant differences （P 〈 0. 05 ）. HSG and laparoscopy combined with hysteroscopy exploration had a good consistency in the diagnosis of tubal patency, and the Kappa value was 0. 531 （P 〈 0.05 ）. The HSG diagnosis sensitivity of fallopian tube patency was 91.15% , the specificity was 69. 64%, and Youden index was 0. 608. The sensitivity of proximal obstruction was 77. 92%, the specificity was 93.30%, and the Youden index was 0. 712; the sensitivity of distal hydrops was 91.48% , the specificity was 25.49%, and the Youden index was 0. 660; the diagnosis sensitivity of smooth but not fluent or adhesion was 81.70%, the specificity was 0. 072, and the Youden index was 74. 49%. Conclusion HSG is suitable to be the preliminary screening of the diagnosis of tubal infertility. It has a high accuracy, but has a low diagnostic rate in pelvic adhesions and affects the results. The infertility patients with abnormal HSG results should be treated with laparoscopy combined with hysteroscopy exploration in a timely manner, so that a more comprehensive diagnosis and treatment should be used.