经阴道子宫输卵管超声造影卵巢周围增强特征与自然妊娠关系

The correlation between periovary enhancement characteristic of transvaginal fallopian ultrasound contrast of the patients and their natural pregnancy outcomes

目的:分析子宫输卵管超声造影卵巢周围增强特征与自然妊娠关系及评估输卵管伞端功能价值。方法:选取2018年1月-2019年12月本院妇科就诊的原发性或继发性不孕症患者136例,行经阴道子宫输卵管超声造影术(HyCoSy),观察输卵管末端造影剂在卵巢周围弥散特征,将弥散特征分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,测量伞卵间距。从第2个月始监测排卵,随访妊娠结局。结果:卵巢周围造影剂增强0级24例,伞卵间距7.07±0.76mm,其中自然妊娠成功2例(3.3%)失败22例(96.7%);I级33例,伞卵间距5.57±0.36mm,其中自然妊娠成功6例(18.2%)失败27例(81.8%);II级31例,伞卵间距3.98±0.18mm,其中自然妊娠成功13例(41.9%)失败18例(58.1%);Ⅲ级48例,伞卵间距3.07±0.13mm,其中自然妊娠成功31例(64.6%)失败17例(35.4%),随着增强级别升高患者伞卵间距降低(P=0.000),自然妊娠成功率升高(P=0.006)。结论:输卵管伞端功能及伞端与卵巢间相对位置,可影响子宫输卵管超声造影剂在卵巢周围的增强特征,伞端黏连越严重、伞端与卵巢的相对距离越远,子宫输卵管超声造影剂在卵巢周围的增强越少,自然妊娠成功率越低。

Objective: To explore the correlation between periovary enhancement characteristic of transvaginal fallopian ultrasound contrast of the patients and their natural pregnancy outcomes, and to study its value for evaluating the function of fimbriated extremity of fallopian. Methods: 136 patients with primary or secondary infertility were selected and were given transvaginal hysterosalpinx ultrasonography(HyCoSy) from January 2018 to December 2019. The dispersion characteristics of contrast agents at the end of the fallopian around the ovary of the patients were observed, and the dispersion characteristics were divided into Ⅰ, Ⅱ, Ⅲ and Ⅳ levels. Then the space between fimbriated extremity of fallopian and ovary was measured. Ovulation monitoring of the patients was conducted and their pregnancy outcomes were followed up from the 2 nd month after HyCoSy. Results: There were 24 cases with grade 0 periovarian contrast enhancement, and the distance between fimbriated extremity of fallopian and ovary was 7.07±0.76 mm, among them, 2 patients(3.3%) were succeeded natural pregnancy and 22 patients(96.7%) were failed natural pregnancy. There were 33 patients with grade I enhanced by periovarian contrast agent, and the distance between fimbriated extremity of fallopian and ovary was 5.57±0.36 mm, among them, 6 patients(18.2%) were succeeded natural pregnancy and 27 patients(81.8%) were failed natural pregnancy. There were 31 patients with grade Ⅱ enhanced by periovarian contrast agent, and the space between the fimbriated extremity of fallopian and ovary was 3.98±0.18 mm, among them, 13 patients(41.9%) were succeeded natural pregnancy and 18 patients(58.1%) were failed natural pregnancy. There were 48 patients with grade Ⅲ enhanced by contrast agent around the ovary,and the space between the fimbriated extremity of fallopian and ovary was 3.07±0.13 mm,among them,31(64.6%)were succeeded natural pregnancy and 17(35.4%)were failed natural pregnancy.The space between the fimbriated extremity of fallopian and ovary had shortened as the increase of grade of the enhanced by contrast agent around the ovary(P=0.000),but the success rate of natural pregnancy had increased(P=0.006).Conclusion:The function of fimbriated extremity of the fallopian and the space between the fimbriated extremity of the fallopian and the ovary maybe influence the enhancement characteristics of the fallopian ultrasound contrast agent around the ovary.The more severe the fimbriated extremity of fallopian is attached,the farther the relative space between the fimbriated extremity of fallopian and the ovary,the less the enhancement of the fallopian ultrasound contrast agent around the ovary,and the lower the success rate of natural pregnancy.