四维超声输卵管造影在异位妊娠保守治疗后输卵管畅通性评价中的应用

Application of 4D ultrasound salpingography in the evaluation of tubal patency after conservative treatment of ectopic pregnancy

目的:探讨四维超声输卵管造影在异位妊娠保守治疗后输卵管畅通性评价中的应用价值。方法:选取医院妇产科门诊接诊的117例异位妊娠患者,其中35例行药物保守治疗,52例行腹腔镜下保守性手术,30例行开腹保守性手术,所有患者治疗后均行四维超声输卵管造影和腹腔镜下美兰通液检查,以美兰通液检查结果为金标准,分析四维超声对输卵管畅通性的诊断效能。结果:腹腔镜美兰通液对输卵管通畅检查完全畅通29例(占24.79%),通而不畅49例(占41.88%),阻塞39例(占33.33%);四维超声输卵管造影检查输卵管完全通畅24例(占20.51%),通而不畅42例(占35.90%),阻塞51例(占43.59%)。四维超声输卵管造影检查与腹腔镜美兰通液检查对输卵管畅通性的检查显示,完全畅通、通而不畅和阻塞结果比较,差异均无统计学意义。经Kappa分析显示,四维超声输卵管造影检查出输卵管完全畅通与腹腔镜美兰通液检符合率为75.86%(22/29),通而不畅者符合率为81.63%(40/49),输卵管阻塞者符合率为89.74%(35/39),两者一致性较高(Kappa=0.692,P<0.05)。以腹腔镜美兰通液检查结果为金标准,四维超声输卵管造影检查诊断输卵管阻塞的灵敏度、特异度、准确性、阳性预测值以及阴性预测值分别为89.74%(35/39)、79.49%(62/78)、82.91%(97/117)、68.63%(35/51)和93.94%(62/66)。3种不同治疗方法患者术后患侧输卵管的总畅通率评价结果比较,差异有统计学意义(x^(2)=8.418,P<0.05)。结论:四维超声输卵管造影对输卵管畅通性的评价准确性较高,异位妊娠行腹腔性保守性手术更有利于恢复输卵管功能。

Objective:To investigate the application value of four-dimensional(4D)ultrasound salpingography in the evaluation of tubal patency after conservative treatment of ectopic pregnancy.Methods:117 patients with ectopic pregnancy who admitted to obstetrics and gynecology outpatient department were selected,including 35 patients underwent conservative medication and 52 patients underwent conservative surgery under laparoscope,and 30 patients underwent laparotomy of conservative surgery.All patients underwent 4D ultrasound salpingography and Melan hydrotubation under laparoscope after treatment.The diagnostic efficacy of 4D ultrasound salpingography for tubal patency was analyzed through used the results of Melan hydrotubation as the gold standard.Results:29 cases(24.79%)were completely unblocked,and 49 cases(41.88%)were link but blocked and 39 cases(33.33%)were obstructed as the examination of tubal patency with laparoscopic Melan hydrotubation.4D ultrasound salpingography showed that above three kinds of states were 24 cases(20.51%),42 cases(35.90%)and 51 cases(43.59%),respectively.There was no statistically significant difference in above each examination of tubal patency between 4D ultrasound salpingography and the laparoscopic Melan hydrotubation.Kappa analysis showed that the coincidence rate between 4D ultrasound salpingography and the laparoscopic Melan hydrotubation was 75.86%(22/29)for completely unblocked,was 81.63%(40/49)for link but blocked and was 89.74%(35/39)for obstruction.The consistency between two methods was higher(Kappa=0.692,P<0.05).As the examination results of laparoscopic Melan hydrotubation,which were used as golden standard,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 4D ultrasound salpingography were 89.74%(35/39),79.49%(62/78),82.91%(97/117),68.63%(35/51)and 93.94%(62/66),respectively,in diagnosing fallopian tube obstruction.The difference of the evaluated results of total unblocked rate of affected side of fallopian tube of patients after surgery among 3 kinds of different therapeutic methods was significant(x^(2)=8.418,P<0.05).Conclusion:4D ultrasound salpingography has a high accuracy in evaluating tubal patency.Abdominal conservative surgery is more conducive to the recovery of the function of fallopian tube in ectopic pregnancy.It is an ideal choice for patients with demand of fertility.