二维基波超声造影联合盆腔水造影对输卵管伞端形态和功能的研究

Study on fimbrial part′s morphology and function of fallopian tubes by using two-dimensional fundamental sonosalpingography combined with saline infusion pelvic sonosalpingography

目的探讨子宫输卵管二维基波超声造影(简称"二维基波造影")联合盆腔水造影对输卵管伞端形态和功能的评估价值。方法选择2018年5月至2019年12月浙江省人民医院不孕症女性患者246例,首先接受子宫输卵管动态三维谐波超声造影(简称"动态三维谐波造影"),排除双侧输卵管不通的16例后,230例行二维基波造影联合盆腔水造影,其中21例在检查后6个月内接受腹腔镜直视下输卵管通染术(laparoscopy and dye test,LDT)并以此作为金标准。结果①排除不通的输卵管,二维基波造影联合盆腔水造影、动态三维谐波造影对其余伞端的总显示率分别为77.4%、24.0%,差异有统计学意义(P<0.001)。②根据二维基波造影联合盆腔水造影的超声表现,将伞端分类为正常、疑似异常、异常。当输卵管处于通畅时,正常伞端占86.4%,疑似异常伞端占13.6%;当输卵管处于通而不畅时,异常伞端占81.2%,疑似异常伞端占18.8%。正常、异常伞端根据输卵管通畅性不同,出现的比例差异有统计学意义(P<0.001)。③将伞端进一步分类为正常(正常伞端)和非正常(疑似异常和异常伞端),与LDT比较,准确性、敏感性、特异性、阳性预测值、阴性预测值、约登指数分别为92.0%、100%、88.2%、80.0%、100%、0.88,与LDT结果高度一致(Kappa=0.828)。④上述230例在检查过程中、结束后30 min内发生的不良反应均为自限性,无1例发生严重并发症。结论二维基波造影联合盆腔水造影能无创、直观、准确地评估输卵管伞端形态和功能,可以为临床选择治疗策略、判断手术预后提供客观的影像学依据。

Objective To evaluate the performance of two-dimensional fundamental sonosalpingography combined with saline infusion pelvic sonosalpingography(abbreviated as"2DFS+SIPS"in this article)for assessing fimbrial part′s morphology and function of fallopian tubes.Methods A total of 246 infertile women were collected from Zhejiang Provincial People′s Hospital from May 2018 to December 2019.They underwent dynamic three-dimensional harmonic sonosalpingography(abbreviated as"4DHS"in this article)first.Cases which were diagnosed as bilaterally tubal obstruction would be excluded.2DFS+SIPS was performed in 230 patients.Among them,21 underwent laparoscopy and dye test(LDT)within 6 months and the results were regarded as golden standard.Results①Tubes which were diagnosed as complete obstruction would be excluded.The total display rate of remaining fimbrial parts by using 2DFS+SIPS and 4DHS were 77.4%and 24.0%respectively,which had statistically difference(P<0.001).②According to 2DFS+SIPS,fimbrial parts were classified into 3 types:normal,suspected abnormal and abnormal.Normal fimbrial parts accounted for 86.4%while suspected abnormal ones accounted for 13.6%under the condition of patency;abnormal fimbrial parts accounted for 81.2%while suspected abnormal ones accounted for 18.8%under the condition of partial obstruction.The difference in the proportion of normal and abnormal fimbrial parts according to different tubal patency was statistically significant(P<0.001).③Fimbrial parts were classified into normal(normal fimbrial parts)and abnormal(suspected abnormal and abnormal fimbrial parts)further according to 2DFS+SIPS,the results were compared with LDT.Accuracy,sensitivity,specificity,positive predictive value,negative predictive value and Youden′s index were 92.0%,100%,88.2%,80.0%,100%,0.88,respectively.The consistency analysis showed the results of 2DFS+SIPS and LDT were highly consistent(Kappa=0.828).④All the side effects occured during the procedure or within 30 minutes after the procedure were self-limited.No serious complications were observed.Conclusions 2DFS+SIPS is a preferred method for assessment of fimbrial part′s morphology and function,with its advantages of non-invasiveness,intuition,and accuracy.This combination could provide objective imaging basis for choosing clinical treatment strategies and predicting prognosis.