RT-3D-HyCoSy对子宫发育异常不孕症患者输卵管通畅性的评估价值

Evaluation value of tubal patency for infertility patients with uterine dysplasia by RT-3D-HyCoSy

目的探讨经阴道实时三维子宫输卵管超声造影(RT-3D-HyCoSy)在不同类型子宫发育异常不孕症中的诊断效果及对患者输卵管通畅性及受孕情况的评估价值。方法选择不孕症患者145例,年龄21~36岁,平均年龄29.21岁;原发性不孕85例,继发性不孕60例。均接受RT-3D-HyCoSy检查、X射线子宫输卵管碘油造影,以腹腔镜检查为金标准。评估RT-3D-HyCoSy检查子宫畸形类型,以及输卵管通畅性的诊断符合率,观察治疗后的受孕情况。结果145例患者中,纵隔子宫52例(35.86%),单角子宫48例(33.10%),双子宫24例(16.55%),弓形子宫12例(8.28%)。RT-3DHyCoSy、X射线子宫输卵管碘油造影诊断输卵管通畅性异常的灵敏度分别为90.91%、77.27%,特异度分别为93.24%、84.46%,准确度分别为92.14%、81.07%。超声引导输卵管造影诊断输卵管阻塞(88.46%vs 73.08%)、输卵管通而不畅(92.50%vs 80.00%)、输卵管通畅(93.24%vs 84.46%)符合率均高于X射线子宫输卵管碘油造影诊断符合率(P<0.05)。RT-3D-HyCoSy检查显示10条输卵管无法评估,输卵管阻塞多发生于峡部,而输卵管通而不畅多发生于间质部。治疗后随访1年,3个月内不孕症患者受孕70例,受孕率为48.28%,1年内受孕118例,受孕率为81.38%。结论RT-3D-HyCoSy可准确诊断子宫发育异常的类型,且对输卵管通畅性具有较高的诊断符合率,可为临床提高受孕率提供指导,值得临床推广。

Objective To investigate the diagnostic effect of RT-3D-HyCoSy in different types of infertility with uterine dysplasia,and value of it in evaluating tubal patency and pregnancy.Methods A total of 145 patients with infertility were enrolled,aged 21-36 years old with mean age of 29.21 years old;85 cases were primary infertility and 60 were secondary infertility.All patients performed RT-3D-HyCoSy examination and X-ray hysterosalpingography,and laparoscopy was used as the gold standard.The diagnostic coincidence rate of RT-3D-HyCoSy for uterine malformation types and tubal patency was evaluated,and pregnancy status after treatment was observed.Results Among 145 patients,there were 52 cases of mediastinal uterus(35.86%),48 of unicornuate uterus(33.10%),24 of double uterus(16.55%)and 12 of arch uterus(8.28%).The sensitivity,specificity and accuracy of RT-3D-HyCoSy and X-ray hysterosalpingography in diagnosis of abnormal tubal patency were 90.91%and 77.27%,93.24%and 84.46%,92.14%and 81.07%,respectively.The coincidence rates of ultrasound-guided salpingography in the diagnosis of tubal obstruction(88.46%us 73.08%),tubal patency(92.50%us 80.00%)and tubal patency(93.24%us 84.46%)were higher than those of X-ray hysterosalpingography(P<0.05).The results in RT-3D-HyCoSy exami nation showed that 10 fallopian tubes could not be evaluated,the tubal obstruction mostly occurred in isthmus,and tubal obstruction mostly occurred in interstitial.In 1-year follow-up post treatment,70 infertile patients were pregnant within 3-month,with pregnancy rate of 48.28%,and 118 infertile patients were pregnant within 1-year with pregnancy rate of 81.38%.Conclusion It is demonstrated that RT-3D-HyCoSy could accurately diagnose the types of abnormal uterine development,and has high diagnostic coincidence rate for tubal patency,which could provide guidance for clinical improvement of pregnancy rate,and it is worthy of clinical promotion.