经阴道四维子宫输卵管超声造影评估不孕症患者输卵管通畅性的研究

Study on the application of transvaginal 4D-HyCoSy in the assessment of patency of fallopian tube of uterus of patients with infertility

目的:探讨经阴道四维子宫输卵管超声造影(4D-HyCoSy)在不孕症患者输卵管通畅性评估中的应用价值。方法:选取医院妇产科门诊接诊的135例(270条输卵管)不孕症患者,均行经阴道4D-HyCoSy检查,对患者输卵管的通畅性进行评估。以子宫输卵管造影(HSG)结果为“金标准”,评估4D-HyCoSy对输卵管通畅性的诊断准确性。结果:在135例患者的270条输卵管中,经4D-HyCoSy检查显示通畅154条(占57.04%),通而不畅68条(占25.19%),阻塞48条(占17.78%)。不同输卵管通畅程度患者的卵巢周围包绕情况、盆腔弥散情况比较,差异均有统计学意义(x^(2)=220.096,x^(2)=342.374;P<0.05)。4D-HyCoSy检查诊断输卵管通畅符合率、通而不畅符合率和阻塞符合率分别为85.71%、63.24%和91.67%,总符合率为81.11%。4D-HyCoSy对输卵管通畅性的诊断灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为77.19%、98.12%、91.67%、94.14%和93.7%。一致性Kappa检验显示,Kappa=0.774,P<0.05。结论:4D-HyCoSy能够直观、准确地反映输卵管畅通性,其诊断结果与HSG检查高度一致,且具有无创、安全的优点,是输卵管畅通性评估的理想手段。

Objective:To explore the application value of transvaginal four-dimensional hysterosalpingo-contrastsonography(4D-HyCoSy) in the assessment of patency of fallopian tube of uterus of patients with infertility.Methods:135 patients with infertility who admitted to department of gynecology and obstetrics of hospital were selected.All of them underwent transvaginal 4D-HyCoSy examination for fallopian tube of uterus.And then,the patency of fallopian tube of uterus of patients were further assessed.The results of hysterosalpingography(HSG) was used as “golden standard” to assess the diagnostic accuracy of that for the patency of fallopian tube of uterus.Results:In 270 fallopian tube of 135 patients,the results of 4D-HyCoSy indicated that 154 fallopian tubes were patency(57.04%),and 68fallopian tubes were unobstructed but not smooth,and 48 fallopian tubes were obstruction(17.78%).There were significant differences in the circumvolved situation around ovary and the dispersion situation of pelvic cavity among patients with different patency degrees of fallopian tube(x^(2)=220.096,x^(2)=342.374,P<0.05).The coincidence rates of 4D-HyCoSy examination were 85.71%,63.24% and 91.67% for patency,unobstructed but not smooth and obstruction,and the total coincidence rate of that was 81.11%.In addition,the diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 4D-HyCoSy were 77.19%,98.12%,91.67%,94.14% and 93.7% for patency of fallopian tube,respectively.And the results of coincidence Kappa test indicated that Kappa=0.774,P<0.05.Conclusion:4D-HyCoSy can directly and accurately reflect the patency of fallopian tube.And the diagnostic results of that are highly consistent with those of HSG examination,and it has the non-invasive and safe advantages.It is an ideal mean to assess the patency of fallopian tube.