经阴道实时三维子宫输卵管超声造影并药物注入治疗输卵管阻塞观察

Study of treating salpingemphraxis by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography and drug injection

目的评价经阴道实时三维子宫输卵管超声造影(TVS RT-3D-HyCoSy)检查对输卵管通畅性诊断的准确性,探讨TVS RT-3D-HyCoSy联合药物对输卵管狭窄的治疗效果。方法选择不孕症女性行经阴道实时三维子宫输卵管超声造影检查,再行宫腹腔镜(HSC-LSC)美蓝造影,确诊输卵管狭窄患者后,将102条输卵管不通畅者随机分成A,B两组。A组(62条):造影结束后将生理盐水溶解配置的混合药液10ml经双腔球囊导管加压由宫腔注入输卵管内,每周1次,3次为1疗程,共4疗程。B组(40条):造影结束后,口服药物,4周为1疗程,共4疗程。所有入选者于下一月经周期同一时间再次行RT-3D-HyCoSy,评估疗效及复通率。结果 ①RT-3D-HyCoSy评估输卵管通畅、通而不畅及阻塞的准确率分别为94.54%,92.11%,96.30%,诊断总准确率94.17%,误诊率为5.83%,与HSC-LSC美蓝造影比较,差异无统计学意义(χ^(2)=0.6828,P=9.5343)。②输卵管通而不畅者,行混合药液注射治疗与全身药物治疗后,两组比较,差异有统计学意义(χ^(2)=3.306,P<0.069)。结论 RT-3D-HyCoSy能真实反映输卵管的空间走行、形态结构、清晰显示盆腔及卵巢周围造影剂弥散情况,能有效评价输卵管通畅性;经阴道超声引导综合药物输卵管内注射是治疗输卵管炎症、炎性粘连、狭窄及不通畅的一种安全有效的治疗方法。

Objective To evaluate the accuracy of transvaginal real-time there-dimensional hysterosalpingo-contrast sonography(TVS RT-3 D-HyCoSy) in the diagnosis of tubal patency, and investigate the effect of TVS RT-3 D-HyCoSy combined with drugs in the treatment of oviduct stenosis.Methods Infertile women were selected for TVS RT-3 D-HyCoSy, followed by hysteroscope-laparoscope(HSC-LSC) Megalulography.After the diagnosis of tubal stenosis, 102 patients with obstructed tubal were randomly divided into group A and group B.Group A(n=62):after the hysterosalpingography, 10 ml mixed medicinal solution was injected into the fallopian tube from the uterine cavity once a week, and three weeks as a course of treatment for four cycles.Group B(n=40):after the hysterosalpingography, medication was taken through the oral route, and four weeks as a course of treatment for four cycles.All subjects received RT-3 D-HyCoSy again at the corresponding time of the next menstrual cycle to evaluate the efficacy and recanalization rate.Results①The accuracy of TVS RT-3 D-HyCoSy in the evaluation of tubal patency, partially unobstructed and obstruction were 94.54%,92.11%,96.30%.The total diagnostic accuracy was 94.17%,and the misdiagnosis rate was 5.83%.There was no statistically significant difference between TVS RT-3 D-HyCoSy and HSC-LSC Metanography(χ^(2)=0.6828,P=9.5343).②If the oviduct was partially unobstructed, the difference was statistically significant between mixed medicinal solution injection therapy and systemic drug therapy(χ^(2)=3.306,P<0.069).Conclusion TVS RT-3 D-HyCoSy can truly reflect the distribution and morphology of the fallopian tube and diffusion of contrast medium in pelvic cavity and peri-ovarian, and can be a simple and effective method to evaluate the patency of the fallopian tube.Injecting drugs into the fallopian tube guided by transvaginal ultrasound is a safe and effective treatment method for the treatment of salpingitis, inflammatory adhesion, stenosis and obstruction.