宫腔镜代输卵管镜对输卵管远端黏膜评价的研究

Evaluation of Distal Mucosa of Fallopian Tube by the Hysteroscopy

目的:研究宫腔镜代输卵管镜对输卵管远端黏膜状况评价的应用价值,指导临床治疗方案的选择。方法:收集2015年1月—2018年2月首都医科大学附属复兴医院宫腔镜中心拟行输卵管切除术的174条输卵管,切除前行宫腔镜代输卵管镜评估输卵管黏膜状况。应用Puttemans分类方法,将gradeⅠ输卵管黏膜评为佳;gradeⅡ、Ⅲ输卵管黏膜评为欠佳;gradeⅣ、Ⅴ输卵管黏膜评为差。切除标本在光学显微镜下观察,以病理学为金标准,根据输卵管黏膜层炎细胞浸润情况以及黏膜病变程度,将输卵管分为正常输卵管,轻度、中度以及重度炎性改变,通过统计学分析宫腔镜代输卵管镜与病理学检测诊断远端输卵管黏膜病变的一致性。结果:宫腔镜诊断远端输卵管黏膜病变敏感度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率、总的符合率和Kappa值分别为98.2%、91.5%、84.6%、99.1%、8.5%、1.8%、93.7%、0.861。结论:宫腔镜代输卵管镜判断远端输卵管黏膜病变敏感度和特异度均较高,有较好的诊断价值,可以为临床选择提供依据。

Objective：To study the application of hysteroscopy in the evaluation of the distal mucosa of fallopian tube, and to analyze this feasibility hysteroscopy replacing falloposcopy in clinical practice. Methods：Clinical data of 174 fallopian tubes undergoing salpingectomy from January 2015 to February 2018 was collected.The mucosal status of fallopian tube was evaluated by the hysteroscopy replacing falloposcopy, before the salpingectomy. The pathological specimens of fallopian tube were then checked with microscope. According to the pathological standard, the fallopian tube was grouped as the normal group, the mild group, the moderate group and the severe group. The consistency between the pathological observation and the hysteroscopic evaluation was statistically analyzed. Results：The parameters of hysteroscopic evaluation on the mucosal lesions of distal tubal were included the sensitivity, specificity, positive predictive value, negative predictive value, false positive rate,false negative rate, total compliance rate, and the Kappa value being 98.2%, 91.5%, 84.6%, 99.1%, 8.5%, 1.8%,93.7% and 0.861. Conclusions：Hysteroscopy, with a good diagnostic value and instead of falloposcopy, may be selectively used to evaluate the mucosal lesions of distal tubal with high sensitivity and specificity.