应用四维超声水晶透视成像技术评估宫外孕保守治疗后输卵管通畅性的价值研究

Evaluation of Tubal Patency After Conservative Treatment of Ectopic Pregnancy Using 4D Ultrasonography Crystal VUE

目的研究四维超声输卵管水晶透视成像(Crystal VUE)技术在评估宫外孕药物保守治疗后输卵管通畅性方面的价值。方法选取2016年6月至2020年9月间成功进行药物(甲氨蝶呤)保守治疗的132例宫外孕患者为研究对象,依据包块大小分为三组,以Crystal VUE技术为检测方法,分析输卵管通畅性特点,并与腹腔镜下美蓝通液术进行比较分析,深入研究输卵管管腔粗细及外观走行。结果132条输卵管中,Crystal VUE技术结果显示患侧输卵管通畅率57%(75/132),通而不畅率15%(20/132),阻塞率28%(37/132);腹腔镜下美蓝通液术示患侧输卵管通畅率62%(83/132),通而不畅率8%(10/132),阻塞率30%(39/132),两组通畅率和阻塞率比较差异无统计学意义(P>0.05),通而不畅率比较差异有统计学意义(P<0.05)。Crystal VUE技术诊断输卵管通畅性的准确度为75%(106/132),灵敏度为65%(32/49),特异度为83%(69/83),阳性预测值为86%(32/37),阴性预测值为93%(69/75);一致性分析Kappa值0.85,显示两组结果高度一致;宫外孕小包块组输卵管通畅率79%,通而不畅率9%,阻塞率12%;中包块组输卵管通畅率54%,通而不畅率18%,阻塞率28%;大包块组输卵管通畅率36%,通而不畅率18%,阻塞率45%,小包块组与大包块组输卵管通畅率及阻塞率差异均有统计学意义(P<0.05);132例宫外孕药物保守治疗后患者输卵管管腔粗细不均的有85例(64%),诊断通畅的输卵管粗细不均率45%,通而不畅的输卵管粗细不均率70%。输卵管走行僵直54例,输卵管积水15例,宫旁血管造影剂逆流32例。结论运用Crystal VUE技术能够清晰显示输卵管管腔边界,是临床可靠的评估输卵管通畅性及结构改变的有效手段。

Objective To evaluate the value of 4D ultrasonography Crystal Vue in the evaluation of tubal patency after ectopic pregnancy drug conservative treatment.Methods A total of 132 ectopic pregnancy patients who were successfully treated with methotrexate from June 2016 to September 2020 were selected as the research objects.They were divided into three groups according to the size of the lump.The characteristics of fallopian tube patency were analyzed by Crystal VUE technology as the detection method,and compared with laparoscopic methylothong fluid.Tubal lumen thickness and appearance of the line were deep studied.Results Among 132 fallopian tubes,Crystal VUE technology showed that the patency rate of falopian tube was 57%(75/132),the partially obstructed rate was 15%(20/132),and the completely obstructed rate was 28%(37/132).Laparoscopic methylene blue drainage showed that the patency rate of the fallopian tube was 62%(83/132),the partially obstructed rate was 8%(10/132),and the completely obstructed rate was 30%(39/132).There were no significant difference in patency rate and partially obstructed rate(P>0.05),but there was significant difference in partially obstructed rate between the two groups(P<0.05).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of Crystal VUE were 75%(106/132),65%(32/49),83%(69/83),86%(32/37)and 93%(69/75),respectively.Consistency analysis Kappa value was 0.85,indicating that the results of the two groups were highly consistent.In ectopic pregnancy group,the oviduct patency rate was 79%,the partially obstructed rate was 9%,and the completely obstructed rate was 12%.In the middle mass group,the patency rate of fallopian tubes was 54%,the partially obstructed rate was 18%,and the completely obstructed rate was 28%.The tubal patency rate was 36%,the partially obstructed rate was 18%,and the completely obstructed rate was 45%.There were statistical significance in the tubal patency rate and the tubal obstruction rate between the small mass group and the large mass group(P<0.05).Among 132 cases of ectopic pregnancy after conservative drug treatment,85(64%)cases had uneven thickness of fallopian tube lumen.Unobstructed fallopian tubes had an uneven thickness of 45%,and unobstructed fallopian tubes had an uneven thickness of 70%.There were 54 cases with rigid fallopian tubes,15 cases with hydrosalpinx,and 32 cases with contrast medium reflux in parametrial vessels.Conclusion Crystal VUE technology can clearly display the lumen boundary of the fallopian tube,which is a reliable and effective method for clinical evaluation of fallopian tube patency and structural changes.