经阴道实时三维子宫输卵管造影在诊断输卵管性不孕症中应用价值

Clinical Value of Transvaginal Real-time Three-dimensional Hysterosalpingocontrast Sonography in the Diagnosis of Tubal Infertility

目的探讨经阴道实时三维子宫输卵管造影(RT 3D-HyCoSy)在诊断输卵管性不孕症中的应用价值。方法选取2016年1月至2017年6月在我院就诊的210例女性不孕症患者,分别行RT 3D-HyCoSy检查和腹腔镜检查,观察两种检查差异。结果 210例患者共计405条输卵管接受检查; RT 3D-HyCoSy与腹腔镜诊断输卵管结果 Kappa值=0. 408(P<0. 05); RT 3D-HyCoSy诊断输卵管通畅性的灵敏度、特异度、阳性预测值、阴性预测值和Youden指数分别为64. 68%、85. 29%、81. 25%、71. 02%和0. 500; RT 3D-HyCoSy诊断盆腔粘连的灵敏度、特异度、阳性预测值、阴性预测值和Youden指数分别为96. 00%、65. 71%、93. 33%、76. 67%和0. 617;在无粘连组和轻度粘连组中,RT 3D-HyCoSy诊断与腹腔镜诊断输卵管结果一致性Kappa值分别为0. 416和0. 524(P<0. 05);在中度粘连组和重度粘连组中,RT 3D-HyCoSy诊断与腹腔镜诊断输卵管结果一致性Kappa值分别为0. 314和0. 202(P<0. 05)。结论 RT 3D-HyCoSy在诊断输卵管性不孕症中有一定的价值,但盆腔粘连程度可影响RT 3D-HyCoSy诊断情况。

Objective To explore the clinical value of three-dimensional transvaginal real-time hysterosalpingocontrast sonography（ RT 3 d-HyCoSy） in the diagnosis of tubal infertility. Methods 210 infertility female patients,from January 2016 to June 2017,were treated by RT 3 d-HyCoSy Examination and laparoscopic examination,and the differences were observed. Results The total 405 fallopian tubes in 210 patients were examined.The results kappa value of RT 3 d-HyCoSy and laparoscopic diagnosis was 0. 408（ P〈0.05）. The sensitivity,specificity,positive predictive value,negative predictive value and Youden index,of tubal patency by RT 3 d-HyCoSy,were 64. 68%,85. 29%,81. 25%,71. 02% and 0. 500 respectively. The sensitivity,specificity,positive predictive value,negative predictive value and Youden index of RT 3 d-hycosy in pelvic adhesion diagnosis were 96%,65. 71%,93. 33%,76. 67% and 0. 617 respectively.In no adhesion group and mild adhesion group,the consistency kappa values of RT 3 d-hycosy diagnosis and laparoscopic diagnosis of fallopian tube were 0. 416 and 0. 524（ P〈0.05） respectively.In the moderate adhesions group and the severe adhesions group,the consistency kappa values of RT 3 d-hycosy diagnosis and laparoscopic diagnosis of fallopian tube were 0. 314 and 0. 202（ P〈0.05） respectively.Conclusion RT 3 d-HyCoSy has a certain value in diagnosing tubal infertility,but the degree of pelvic adhesion can affect the diagnosis of RT 3 d-HyCoSy