经阴道4D-HyCoSy在输卵管不孕诊断中的应用

Application of Transvaginal 4D-HyCoSy in the Diagnosis of Tubal Infertility

本文探讨经阴道四维超声子宫输卵管造影(4D-HyCoSy)在输卵管不孕患者诊断中的应用价值。选取疑似输卵管不孕患者75例(150条输卵管)作为研究对象,均行经阴道4D-HyCoSy检查。以腹腔镜美蓝通液术检查结果作为金标准,经阴道4D-HyCoSy诊断输卵管阻塞86条、诊断输卵管未发生阻塞64条、误诊输卵管阻塞23条;Kappa分析显示,4D-HyCoSy检查与腹腔镜美蓝通液术检查一致性较好(Kappa值分别为0.528、0.709,P<0.05);阴道4D-HyCoSy检查左侧、右侧输卵管不孕的ROC曲线下面积(AUC)值分别为0.770和0.859,95%CI为0.661~0.880和0.769~0.949,P<0.001,cut-off值为≤1,诊断敏感度分别为65.85%和77.50%,特异度分别为88.24%和94.29%。经阴道4D-HyCoSy诊断输卵管不孕与“金标准”(腹腔镜美蓝通液术检查)一致性较高,可为输卵管不孕的临床诊断和治疗提供新方向。

This article discussed the application value of transvaginal four-dimensional hysterosalpingo-contrast sonography(4D-HyCoSy)in patients with tubal infertility.75 patients with suspected tubal infertility(150 fallopian tubes)were selected as the research subjects,and all underwent transvaginal 4D-HyCoSy examination.Taking the results of laparoscopic methylene blue as the gold standard,transvaginal 4D-HyCoSy diagnosed 86 fallopian tube obstruction,64 fallopian tube obstruction was diagnosed,and 23 fallopian tube obstruction was misdiagnosed.Kappa analysis showed that 4D-HyCoSy examination has a good consistency with laparoscopic methylene blue pass examination(Kappa values were 0.528 and 0.709,respectively,P<0.05).The area under the ROC curve of vaginal 4D-HyCoSy examination of left and right fallopian tubes for infertility were 0.770 and 0.859,respectively,with 95%CI of 0.661-0.880 and 0.769-0.949,P<0.001,cut-off value≤1,and the diagnostic sensitivity was 65.85%and 77.50%,the specificity was 88.24%and 94.29%,respectively.Transvaginal 4D-HyCoSy diagnosis of tubal infertility has a high consistency with the“gold standard”(laparoscopic malignant fluid examination),which could provide a new direction for the clinical diagnosis and treatment of tubal infertility.