经阴道四维子宫输卵管超声造影逆流影响因素分析

Analysis of the reasons of contrast agent venues intravasation during transvaginal four-dimensional hysterosalpingo-contrast sonography

目的:探讨经阴道四维子宫输卵管超声造影中发生子宫肌层及宫旁静脉丛逆流的影响因素,以减少和避免逆流发生,提高诊断准确性。方法:分析2016年6月至2017年6月广州医科大学附属第三医院306例不孕症患者进行四维子宫输卵管超声造影检查时45例发生逆流患者的声像图特征,分析子宫内膜厚度、月经干净天数、有无宫腔操作史、输卵管通畅性等与逆流发生的相关性。结果:四维子宫输卵管超声造影逆流发生率14.71%。卡方检验显示子宫内膜厚度、月经干净天数对逆流的发生有显著影响(P=0.031、P<0.001),有无宫腔操作史、输卵管是否通畅对逆流的发生无显著影响(P=0.610、0.137)。Logistic回归分析显示逆流发生率与子宫内膜厚度(回归系数为-1.171,P<0.001)、月经干净天数(回归系数为0.439,P=0.015)相关。结论:造影前经阴道超声测量子宫内膜厚度及根据月经周期选择合适的检查时间,可有效降低逆流发生率,减轻不良反应,提高子宫输卵管超声造影检查的准确性。

Objective To explore the influencing factors of uterine myometrial and parauterine venous plexus reflux during transvaginal four-dimensional contrast-enhanced hysterosalpingography,which will help reduce and avoid the occurrence of reflux and improve the accuracy of diagnosis.Methods A total of 306 infertile patients who underwent transvaginal four-dimensional contrast-enhanced hysterosalpingograph from June 2016 to June 2017 in the Third Affiliated Hospital of Guangzhou Medical University were retrospectively enrolled.The ultrasonographic characteristics were reviewed and the correlations between reflux and endometrial thickness,days after menstruation,intrauterine operation history and patency of fallopian tube were analyzed.Results The incidence of countercurrent during four-dimensional contrast-enhanced hysterosalpingography was 14.71%.The chi-square test showed that the endometrial thickness and the days after menstruation had statistically significant effects on the incidence of reflux(P=0.031 and<0.001,respectively).There were no statistically significant effects of intrauterine operation history and patency of the fallopian tube on the incidence of reflux(P=0.610,0.137).Logistic regression analysis showed that the incidence of reflux was associated with endometrial thickness(B=-1.171,P<0.001)and the days after menstruation(B=0.439,P=0.015).Conclusions Transvaginal ultrasound measurement of endometrial thickness before angiography and selection of appropriate examination time according to the menstrual cycle can effectively reduce the incidence of reflux,and adverse reactions,and improve the accuracy of four-dimensional contrast-enhanced hysterosalpingography.