三维子宫输卵管超声造影在诊断输卵管性不孕症中的临床应用

Clinical value of three-dimensional hysterosalpingo-contrast sonography in diagnosis of tubal infertility

目的探讨三维子宫输卵管超声造影(3DHy Co Sy)在诊断输卵管性不孕症中的临床应用价值。方法选择经腹腔镜检查证实为输卵管性不孕症患者164例共312条输卵管,采用3DHy Co Sy观察输卵管形态及走行,判断输卵管通畅性。结果 164例患者的312条输卵管中,3DHy Co Sy显示300条(96.2%)。其中输卵管通畅95条,输卵管通而不畅161条,输卵管阻塞44条(其中近端输卵管阻塞24条,远端输卵管阻塞20条),12条输卵管全程未显示。输卵管柔顺,表现为管径粗细均匀的共112例;扭曲81条;近端纤细103条,远端纤细9条,全程纤细12条;僵硬51条;盘曲14条;膨大33条。与通而不畅以及阻塞的输卵管相比,通畅的输卵管中柔顺、管径粗细均匀的比例较高(P均<0.001);通而不畅与阻塞的输卵管管径特征相近(P>0.017)。通畅的输卵管出现卵巢周围造影剂环状包绕的比例高于通而不畅或阻塞的输卵管(P均<0.001);输卵管通而不畅组卵巢周围仍有造影剂半环状或环状包绕,这一比例也高于输卵管阻塞组(P<0.001)。结论3DHy Co Sy能展现输卵管的立体空间走行,可作为评价不孕症患者输卵管通畅性的有效辅助手段。

Objective To assess clinical value of transvaginal three-dimensional hysterosalpingo-contrast sonography （3DHyCoSy） in the diagnosis of tubal infertility. Methods In total, 164 patients （312 fallopian tubes） diagnosed with tubal infertility by laparoscope were selected. The tubal morphology and walking pattern were observed by 3DHyCoSy to assess the tubal patency. Results Three hundred uterine tubes （96.2%） were clearly demonstrated by 3DHyCoSy, among which 95 tubes were unobstructed, 163 were partially occluded, 44 were occluded （proximal tubal occlusion in 24 and distal tubal occlusion in 20） and 12 were not shown throughout the examination. One hundred and twelve fallopian tubes were uniform in thickness, 81 were twisted, 103 with slender proximal segment, 9 with slender distal segment, 12 were completely slender, 51 were inflexible, 14 were twisted and 33 were dilated. Compared with the partially and completely occluded tubes, the proportion of flexible fallopian tubes in uniform thickness was significantly higher in the un-occluded tubes （both P 〈0.001 ） . The tubal thickness did not differ between the partially and completely occluded tubes （ P 〉0.017 ） . The percentage of the ring-shaped contrast agents surrounding the ovary in the unobstructed tube was significantly higher than those in the partially or completely occluded fallopian tubes （both P 〈0.001 ） . In the partially occluded tubes, there were still half-ring or ring-shaped contrast agents surrounding the ovary and the proportion was also significantly higher than that in the occluded fallopian tubes （ P 〈0.001 ） . Conclusions 3DHyCoSy can explicitly display the morphology and walking pattern of the uterine tube in three dimensions, which can effectively help to evaluate the tubal patency in patients with infertility.