不孕症四维子宫输卵管超声造影术分级与自然受孕率之间的关系

Relationship between the grading of four-dimensional hysterosalpingography and conception rate in infertile patients

目的 评估四维子宫输卵管超声造影(4D-HyCoSy)检查结果分型与术后1年自然受孕率之间的关系。方法本文选取我院接受4D-HyCoSy检查的患者731例,在排除男方不育因素、苗勒氏管畸形以及输卵管积水后,根据输卵管通畅程度将302例患者分为6组并对其自然受孕结果进行分析。结果 在4D-HyCoSy检查术后1年内,共计135例患者(37.09%)自然受孕,双侧输卵管通畅的VI型组自然受孕结果最高(66.67%),双侧输卵管阻塞的Ⅰ型组自然受孕概率最低(18.42%),一侧输卵管阻塞一侧输卵管通而不畅的Ⅱ型组自然受孕率为26.09%,其余三组自然受孕率接近,分别为Ⅲ型组(36.50%) IV型组(33.33%)以及V型组(33.33%)。多因素分析表明不孕类型对于自然受孕结果有着显著性的影响。结论 4D-HyCoSy是一种用于诊断输卵管通畅的安全有效的检查方法,可以作为临床不孕患者病因诊断的第一线检查推广使用。对于输卵管通畅度较差的Ⅰ型组及Ⅱ型组患者,应尽快采取更加积极的临床干预手段;而对于输卵管通畅度较好的患者,应结合其不孕类型根据实际情况给出相应的助孕建议。

Objective To assess the relationship between grading of four-dimensional hysterosalpingography( 4D-HyCoSy) results and natural conception rate one year after the procedure. Methods 731 patients who underwent 4D-HyCoSy at our hospital were included in this study,and after excluding male infertility factors,Mullerian duct malformations,and hydrosalpinx,302 patients were divided into 6 groups according to the degree of tubal patency and their natural conception outcomes were analyzed.Results Within one year after 4D-HyCoSy,a total of 135 patients( 37. 09%) conceived spontaneously,with the highest spontaneous conception rate( 66. 67%) in group VI with bilateral patency,the lowest spontaneous conception rate( 18. 42%) in groupⅠ with bilateral tubal obstruction,and 26. 09% in group Ⅱ with one tubal obstruction and one tubal opacity. The remaining three groups had similar natural conception rates,namely group Ⅲ( 36. 5%) group IV( 33. 33%) and group V( 33. 33%). Multifactorial analysis showed that the type of infertility had a significant effect on the outcome of spontaneous conception. Conclusion4D-HyCoSy is a safe and effective test for the diagnosis of tubal patency and can be promoted for use as a first-line test for the etiological diagnosis of infertility. For patients with poor tubal patency in type Ⅰ and type Ⅱ groups,more active clinical interventions should be taken as soon as possible;while for patients with good tubal patency,individualized interventions should be suggested according to their infertility types.