四维超声造影评价输卵管通畅性的方法差异性研究

Difference analysis of four-dimensional contrast-enhanced Ultrasound in evaluation of fallopian tube patency

目的 观察不同温度(常温、40℃稍高温)0.9%氯化钠注射推注的四维超声造影在评价输卵管通畅性中的差异,分析其临床价值。方法 以2019年1~10月期间因不孕而于本院行输卵管通畅性检查的638例育龄妇女为研究对象,所有不孕育龄妇女均先行二维超声、四维超声输卵管检查及X线碘油输卵管造影,其中2019年1~5月期间以常温0.9%氯化钠注射注入的超声检查,2019年6~10月期间以40℃的稍高温0.9%氯化钠注射注入的超声检查。以X线碘油输卵管造影检查为金标准,分析常温、40℃稍高温0.9%氯化钠注射推注的四维超声造影的输卵管通畅性检出结果,并采用SPSS软件绘制常温、40℃稍高温0.9%氯化钠注射推注的四维超声造影ROC曲线图。结果 与常温0.9%氯化钠注射推注四维超声造影比较,稍高温(40℃)0.9%氯化钠注射推注四维超声造影的输卵管远端情况显示更清晰,对输卵管“串珠状”阻塞现象亦能清晰显示。常温0.9%氯化钠注射推注四维超声造影检查出157条输卵管阻塞,与X线碘油输卵管造影检查相比,诊断符合率为85.3%(157/184)。稍高温(40℃)0.9%氯化钠注射推注四维超声造影检查出189条输卵管阻塞,与X线碘油输卵管造影检查相比,诊断符合率为98.95%(157/184)。稍高温(40℃)0.9%氯化钠注射推注四维超声的诊断敏感性、特异性、准确率(94.8%、91.3%、93.2%)均高于常温0.9%氯化钠注射推注四维超声诊断(81.7%、82.9%、84.5%)(P<0.05)。结论 四维超声造影可作为评价输卵管通畅性的优选方法,具有较高的诊断敏感性、特异性和准确性,且操作过程中适当加温0.9%氯化钠注射可进一步提升诊断敏感性、特异性和准确性。

Objective To observe the difference of four-dimensional contrast-enhanced ultrasonography(CEUS in evaluating tubal patency at different temperatures(normal temperature, slightly high temperature at 40 ℃) and to analyze its clinical value. Methods A total of 638 women of childbearing age who underwent tubal patency examination due to infertility in our hospital from January to October 2019 were studied. All women of childbearing age underwent two-dimensional ultrasonography, four-dimensional ultrasonography and X-ray iodized oil salpingography. Among them, normal saline was injected during January to May 2019 and slightly high temperature saline was injected during dune to October 2019 by Ultrasound examination. With X-ray iodized oil salpingography as the gold standard, the detection results of tubal patency by four-dimensional contrast-enhanced ultrasonography with normal saline injection at room temperature and 40 ℃ and slightly high temperature were analyzed. The ROC curves of four-dimensional contrast-enhanced ultrasonography with normal saline injection at normal temperature and 40 ℃were plotted by SPSS software. Results Compared with normal temperature saline injection, slightly high temperature saline injection of four-dimensional contrast-enhanced ultrasonography showed a clearer picture of the distal end of the fallopian tube and the phenomenon of "beaded" obstruction of the fallopian tube. Four-dimensional contrast-enhanced ultrasonography with normal saline injection at room temperature revealed 157 tubal obstructions. Compared with Xray iodized oil salpingography, the diagnostic accuracy was 85.3%(157/184). Four-dimensional contrast-enhanced ultrasonography with saline injection at a slightly high temperature(40 ℃) revealed 189 tubal obstructions. Compared with X-ray iodized oil salpingography, the diagnostic coincidence rate was 99.0%(157/184). The diagnostic sensitivity,specificity and accuracy of four-dimensional ultrasound(94.8%, 91.3% and 93.2%) with slightly high temperature saline injection were higher than those with normal temperature saline injection(81.7%, 82.9%, 84.5%)( P <0.05).Conclusion Four-dimensional contrast-enhanced ultrasound can be used as an optimal method to evaluate the patency of fallopian tube. It has high diagnostic sensitivity, specificity and accuracy. The sensitivity, specificity and accuracy of diagnosis can be further improved by warming normal saline properly during operation.