经阴道四维子宫输卵管超声造影临床耐受性及相关因素分析

Transvaginal Four-Dimensional Hysterosalpingo-Contrast-Sonography:Tolerability,Side Effects and Complications

目的:通过评估经阴道四维子宫输卵管超声造影(TVS 4D-HyCoSy)患者疼痛程度、持续时间及其他不良反应、并发症发生情况,探讨患者对TVS 4D-HyCoSy的耐受程度以及影响造影过程中下腹疼痛的因素。方法:2013年12月至2015年10月北京大学第一医院共379例患者入院行TVS 4D-HyCoSy,应用疼痛数字评价量表(NRS)对造影过程中、术后0.5小时、术后2小时及术后24小时分别进行疼痛评分,并对影响造影疼痛的因素进行单因素及多因素分析。结果:TVS 4D-HyCoSy检查过程中,57.78%(219/379)的患者自觉下腹痛,平均疼痛评分4.54±2.34分,其中29.29%(111/379)轻度疼痛,19.26%(73/379)中度疼痛,仅9.23%(35/379)重度疼痛。术后0.5小时、术后2小时及术后24小时平均疼痛评分分别为4.38±2.06分、2.64±1.28分和1.75±0.50分。8.44%的患者造影过程中出现迷走神经反应。Stacey不良反应分级中1级、2级、3级和4级发生率分别为29.29%(111/379)、14.25%(54/379)、10.29%(39/379)和3.96%(15/379)。TVS 4D-HyCoSy术后未见发热、盆腔炎和腹膜炎等远期并发症发生。输卵管双侧阻塞及宫腔置管疼痛是影响造影过程中下腹疼痛程度的独立危险因素。结论:TVS 4D-HyCoSy造影过程中腹痛轻微,不良反应发生率低,患者具有良好的耐受性,是一项安全、有效地评估输卵管通畅性的检查方法。

Objective:To evaluate the tolerability,side effects,and complications of transvaginal four dimensional hysterosalpingo-contrast-sonography(TVS 4 D-HyCoSy) using SonoVue and to analyze the factors influencing the degree of pain perception during this procedure.Methods:Between December 2013 and October 2015,379 women who had underwent TVS 4 D-HyCoSy were interviewed at 0.5 h,2 h,and 24 h after TVS 4 D-HyCoSy about the level of pain,an 11-point(0-10) numerical rating scale was used to evaluated their responses.Side effects and late complications were also recorded and assessed by the Stacey score.Results:57.78%(219/379) of patients had lower abdominal pain and the average pain score was 4.54±2.34,of which 29.29%(111/379) were mild pain,19.26%(73/379) were moderate pain,only 9.23%(35/379) were severe pain.The mean pain scores at 0.5 h,2 h,and 24 h after surgery were 4.38 ± 2.06,2.64 ± 1.28,and 1.75 ± 0.50,respectively.A vagus nerve response occurred during angiography in 8.44% of patients.The incidence rates of grade 1,grade 2,grade 3 and grade 4 in Stacey′s adverse reaction grade were 29.29%(111/379),14.25%(54/379),10.29%(39/379) and 3.96%(15/379),respectively.No long-term complications such as fever,pelvic inflammatory disease and peritonitis occurred after TVS 4 D-HyCoSy.Bilateral obstruction of the fallopian tube and pain in the uterine cavity were independent risk factors for the degree of pain in the lower abdomen during angiography.Conclusions:TVS 4 D-HyCoSy is a simple,safe and well-tolerated examination for assessing tubal patency and could be a first-line procedure for tubal patency investigation in infertile women.