宫腹腔镜联合评估两种输卵管造影的诊断价值

Comparison of the Value of Three-dimensional Hysterosalpingo-contrastsonography and Hysterosalpingography in the Diagnosis of Tubal Infertility

目的 比较子宫输卵管三维超声造影(3D-H yCoSy)和X线下子宫输卵管造影(HSG)方法 对输卵管不孕的诊断价值。方法 回顾性分析我院2015年1月至2016年12月输卵管不孕患者278例,所有患者均接受3D-HyCoSy、HSG检查,并于检查后6月内行宫腹腔镜联合手术,以宫腹腔镜下美兰通液检查结果 作为金标准,探讨两种方法 对输卵管性不孕症的诊断价值。结果 Kappa一致性分析结果 显示3D-H yCoSy与宫腹腔镜检查结果 一致性较好,HSG与宫腹腔镜检查结果 一致性中等;HSG与3D-Hy CoSy诊断通畅的输卵管敏感性、特异性、准确率均无差异;诊断通而不畅、远端梗阻的输卵管,3D-HyCoSy敏感性、准确率显著高于HSG;诊断近端梗阻输卵管,3D-HyCoSy特异性、准确率显著高于HSG。但HSG、3 D-HyCoSy对于诊断通而不畅的输卵管敏感性较低,对于诊断近端梗阻的阳性预测值亦较低。结论 HSG及3D-HyCoSy可作为输卵管不孕的筛查方法 ,且3D-HyCoSy更具优势,但对于输卵管性不孕症的诊断仍存在一定局限性;宫腹腔镜联合手术能明确不孕原因同时进行治疗,值得临床诊疗中推广与应用。

Objective To compare the value of three-dimensional hysterosalpingo-contrastsonography and hysterosalpingography in the diagnosis of tubal infertility.Methods In this retrospective study,a total of 278 cases of tubal infertility who received three-dimensional hysterosalpingocontrastsonography,hysterosalpingography examination,and followed by hysteroscopy combined with laparoscopy treatment within 6 months from January 2015 to December 2016 has been analyzed.The results of laparoscopic Methylene Blue hydrotubation were taken as the gold standard in the comparison of the diagnostic value of two methods.Results Kappa analysis results showed that 3D-HyCoSy was in good coherence while HSG was in moderate coherence with hysteroscopy combined with laparoscopy in diagnosis of tubal infertility.HSG and 3D-HyCoSy had no siginificant differences for diagnosing patency in sensitivity,specificity,accuracy and positive predictive value.3D-HyCoSy had better sensitivity and accuracy than HSG in diagosing accesible but not smooth and distal obstructive oviduct.3D-HyCoSy had better specificity and accuracy than HSG in diagosing proxmal tubal obstruction.However,HSG and 3D-HyCoSy had low sensitivity in diagosing accesible but not smooth oviduct,and low positive predictive value in in diagosing proxmal tubal obstruction.Conclusion HSG and 3D-HyCoSy could be used as screening methods in the diagnosis of tubal infertility,and 3D-HyCoSy had better clinical value.However both methods had limitations in the diagnosis of tubal infertility.Hysteroscopy combined with laparoscopy could clarify the cause of infertility and treat it,and worth being widely promoted in clinical application.