经阴道子宫输卵管四维造影对输卵管中近端梗阻假阳性检测准确性的影响

False-postive factors of proxmal tubal obstrctions in transvaginal four-dimensional hysterosalpingo-contrast sonography

目的探讨经阴道子宫输卵管四维造影对输卵管中近端假阳性检测准确性的影响。方法选择2015年9月-2016年9月期间我院生殖中心的不孕受检者子宫输卵管2D/3D/4D实时造影的患者共263例527条输卵管,依据造影方法分成A、B、C、D、E组,观察并根据情况予以不同处理措施,分析各因素对输卵管近端梗阻的影响。结果 A组63例123条输卵管无特殊操作出现近端梗阻表现52条,假阳性率为39.02%;B组52例导管位于一侧宫角有23条同侧宫角及输卵管不显影,调整后10条仍不显影,假阳性率为55.55%;C组球囊过大或过小的46例90条输卵管中有46条双侧输卵管近端不显影,调整后23条不显影,假阳性率为50.00%;D组子宫过度前屈或卵巢贴近子宫的44例85条输卵管中31条输卵管不显影,通过改变体位后14条输卵管不显影,假阳性率为55.29%;E组111条输卵管中有66条输卵管近端不显影,经语言安慰患者使其放松、经导管注入温盐水加混合液,及10min后重复造影等方法,仍有15条不显影,假阳性率为76.58%,B、C、D、E组输卵管最终显影率、假阳性准确率均高于A组,差异具有统计学意义（P均〈0.05）。结论在造影过程中可以仔细观察,及时调整,提高输卵管近端显示率,有利于提高诊断的准确性。

Objective To explore false-postive factors of proxmal tubal obstrctions in Transvaginal fourdimensional hysterosalpingo-contrast sonography, so to improve the accuracy of the proximal tubal obstruction. Methods 263 patients with fallopian tube including 506 tubals were selected from September 2015 to September 2015 in our reproductive center client uterine tubal infertility during 2D / 3D / 4D real-time imaging. According to the imaging method, they were devided into groups A, B, C,D and E. According to the situation, different measures were observed and given, the effect of various factors on the proximal tubal obstruction was analyzed. Results In group A, 52 of 123 oviducts proximal tubes were not developed without any handle, false postive proportion was 39.02%. In Group B, 23 of 52 oviducts unilateral proximal tubes were not developed, and it was 10 of 52 after relocating cathete tips, false postive proportion was 55.55%. In group C, 46 of 90 oviducts proximal tubes were not developed, and it was 23 of 90 after adjustment, alse postive proportion was 50.00%. In group D, 31 of 85 oviducts proximal tubes were not developed, and it was 14 of 85 by changing the patients position, false postive proportion was 55.29%. In group E, 66 of 111 oviducts proximal tubes were not developed, and it was 15 of 111 by relaxing the patients, injecting with warm saline mixture, and（or） repeating Transvaginal four-dimensional hysterosalpingo-contrast sonography in 10 minutes, false postive proportion was 76.58%. The eventually developing rate of fallopian tubes, false positive rates of groups B, C, D and E were higher than that of group A, there were statistically significant difference（P 〈 0.05）. Conclusion Many factors lead to false-positive proximal tube obstruction, and it is possible to be corrected timely in the ransvaginal four-dimensional hysterosalpingo-contrast sonography. So that the false positive rate can be lowered, and the accuracy of diagnosis can be improved.