实时三维宫腔输卵管造影下输卵管通畅度与显影压力的关系研究

Relationship between tubal patency and tubal pressure under real-time three-dimensional hysterosalpingography

目的探讨采用实时三维宫腔输卵管造影观测输卵管通畅度与输卵管显影压力的关系。方法选取2018年1至12月在杭州市中医院拟诊为输卵管性不孕症的患者180例,均行经阴道实时三维宫腔输卵管造影术(3D-HyCoSy)检查,分析输卵管通畅度与输卵管显影压力的关系。结果180例患者中,9例患者为单侧输卵管切除术后,共获取有实时三维显影资料的输卵管351条。其中输卵管通畅185条,输卵管通而不畅155条,输卵管阻塞11条。与双输卵管通畅患者相比,存在输卵管病变的患者宫腔最大压力与单支输卵管显影压力均升高(均P<0.05)。单支输卵管显影压力对输卵管通畅与通而不畅的诊断价值ROC曲线分析显示,AUC为0.814,最佳诊断界值为14.5 kPa,灵敏度为0.800,特异度为0.753(P<0.05)。结论采用3D-HyCoSy可辅助诊断输卵管通畅度,输卵管显影压力可鉴别诊断输卵管通畅与通而不畅,最佳诊断界值为14.5 kPa。

Objective To investigate the relationship between tubal patency and tubal pressure during real-time three-dimensional hysterosalpingography.Methods A total of 180 patients who were diagnosed with tubal infertility in Hangzhou Municipal TCM Hospital from January to December 2018 were enrolled in the study.All patients underwent transvaginal real-time three-dimensional hysterosalpingography(3D-HyCoSy)examination,and the relationship between the tubal patency and tubal pressure was analyzed.Results Among 180 patients,9 had unilateral salpingectomy.3D-HyCoSy showed that in 351 fallopian tubes examined,185 were patency,155 were partially patency and 11 were full obstructed.Compared to patients with double fallopian tubes patency,the maximum pressure in the uterine cavity and the pressure of a single fallopian tube were increased in patients with fallopian tube disease(both P<0.05).The ROC curve analysis of the diagnostic value of single fallopian tube pressure on patency and partially patency of the fallopian tube showed that the AUC was 0.814,the best diagnostic threshold was 14.5 kPa,the sensitivity was 0.800,and the specificity was 0.753(P<0.05).Conclusion 3D-HyCoSy can assist in the diagnosis of fallopian tube patency,and fallopian tube imaging pressure can differentiate between patency and partially patency.