选择性输卵管造影术用于输卵管近端梗阻的临床价值

Clinical value of selective salpingography for proximal tubal obstruction

目的探讨选择性输卵管造影术(selective salpingography,SSG)用于输卵管近端梗阻(proximal tubal obstruction,PTO)的临床价值。方法回顾性分析河北生殖妇产医院自2021年9月至2022年10月期间257例因子宫输卵管造影术(hysterosalpingography,HSG)诊断PTO而行SSG检查的结果。其中发生近端梗阻的输卵管共计373条,双侧同时发生PTO 232条,单侧发生PTO 141条,均于我院行SSG进一步检查。观察SSG术后输卵管是否恢复通畅,以及恢复通畅后输卵管形态学表现,并对SSG术后的表现归类比较。根据HSG所在不同医疗中心的分为本院组和外院组,根据病变累计范围分为单侧组和双侧组,比较观察不同组别PTO行SSG后表现的差异。结果根据是否与术前HSG诊断一致、是否恢复通畅以及恢复通畅后输卵管形态学情况,把PTO患者的SSG术后表现分为3大类和A、B、C、D、E、F等6个亚型,3大类表现包括梗阻型、通畅型和不全梗阻型,A、B、C为梗阻型,D、E为通畅型,F为不全梗阻型。梗阻型占比25.20%,通畅型占比64.61%,不全梗阻型占比10.19%。双侧病变的SSG术后呈梗阻型表现的占比高于单侧,差异有统计学意义(P<0.05)。不同医疗中心患者的SSG术后结局有差异,其恢复通畅的概率不同,差异有统计学意义(P<0.05)。结论SSG具备输卵管疏通和HSG质量控制的双重作用,其最重要的临床意义是明确输卵管梗阻的定位及定性诊断。

Objective To investigate the clinical value of selective salpingography(SSG)in proximal tubal obstruction(PTO).Methods A retrospective analysis was performed for the results of SSG examination in 257 cases of PTO diagnosed by hysterosalpingography(HSG)at Hebei Maternity Hospital from September 2021 to October 2022.Among them,there were a total of 373 fallopian tubes with proximal obstruction,232 with bilateral PTO and 141 with unilateral PTO.All of them underwent further examined by SSG in our hospital.Whether the fallopian tubes were restored to patency after SSG and the morphological manifestations of the fallopian tubes after the restoration of patency were observed,and the manifestations after SSG were classified and compared.The patients were divided into the local hospital group and the erternal hospital group according to the different medical centers where HSG examinations were performed,and were divided into the unilateral group and the bilateral group according to the cumulative extent of lesions.The differences in the outcomes of PTO after SSG in different groups were observed and compared.Results According to whether it was consistent with the preoperative diagnosis of HSG,whether patency was restored,and the morphology of the fallopian tubes after restoration of patency,the postoperative SSG manifestations of PTO patients were divided into three categories and six subtypes of A,B,C,D,E,and F.The three main categories of manifestations included obstructive,patency and incomplete obstruction,A,B,and C are obstructive types,D and E are patency types,and F are incomplete obstructive type.The obstruction type accounted for 25.20%,the patency type accounted for 64.61%,and the incomplete obstruction type accounted for 10.19%.The proportion of bilateral lesions with obstructive manifestations after SSG was higher than that of unilateral lesions,and the difference was statistically significant(P<0.05).The postoperative outcomes of SSG varied between different medical scenters,and the probability of postoperative recovery was different,with statistically significant difference(P<0.05).Conclusion The SSG has the dual role of tubal unclogging and HSG quality control,and its most important clinical significance is to clarify the localization and qualitative diagnosis of tubal obstruction.