非全身麻醉镇静下经子宫输卵管超声造影评估输卵管通畅性

Evaluation of Fallopian Tube Patency Using Transvaginal Ultrasound Hysterosalpingography Under Non-general Anesthesia Sedation

目的:探讨在非全身麻醉镇静下经阴道四维子宫输卵管造影技术(TVS 4D-HyCoSy)诊断子宫输卵管通畅性的应用价值。方法:选取十堰市人民医院于2022年1月-2023年11月,疑似输卵管源性不孕症患者共196例,376条输卵管,随机分为三组,分别采用常规方法行子宫输卵管超声造影(传统组)71例,139条输卵管,超声造影前静脉注射丙泊酚+舒芬太尼(全麻组)58例,110条输卵管,超声造影前静脉注射右美托咪定+舒芬太尼(镇静组)67例,127条输卵管,且以腹腔镜下美蓝通液检查术(laparoscopy chromoupertubation using methylene blue,LC)结果作为金标准比较三组超声造影结果诊断准确率、疼痛程度及安全性(不良反应)。结果:传统组、全麻组、镇静组结果与LC检查的一致率分别为84.9%、91.8%、92.9%,三组比较无明显差异(P>0.05);但镇静组和全麻组在假性输卵管阻塞检出率(2.4%、2.7%)方面明显低于传统组(10.4%),差异有统计学意义(P<0.05),且镇静组在近端梗阻率明显低于传统组、全麻组,差异有统计学意义(P<0.05)。镇静组、全麻组VAS评分显著低于传统组(P<0.05);镇静组的不良反应发生率明显低于全麻组、传统组低(P<0.05)。结论:非全身麻醉镇静下经TVS 4D-HyCoSy能安全、准确地判断输卵管通畅性,值得临床推广应用。

Objective To evaluate the value of transvaginal four-dimensional hysterosalpingography(TVS 4D-HyCoSy)in diagnosing fallopian tube patency under non-general anesthesia sedation.Methods A total of 196 suspected tubal infertility patients with 376 fallopian tubes treated in Shiyan Renmin Hospital from January 2022 to November 2023 were randomly di⁃vided into three groups.Specifically,71 cases with 139 fallopian tubes underwent conventional hysterotubal contrast ultra⁃sound(traditional group);58 cases with 110 fallopian tubes were administered intravenous propofol+sufentanil injection before contrast-enhanced ultrasonography(general anesthesia group);67 cases with 127 fallopian tubes received general anesthesia(sedation group).Laparoscopy chromopertubation using methylene blue(LC)results served as the standard for comparing diagnostic accuracy,the degree of pain,and safety(adverse reactions)among the three groups.Results The consistency rate of LC in the traditional,general anesthesia,and sedation groups was 84.9%,91.8%,and 92.9%,respec⁃tively(P>0.05).However,the detection rates of false-positive fallopian tube obstruction in the sedation group(2.4%)and general anesthesia group(2.7%)were decreased compared with that in the traditional group(10.4%)(P<0.05).The rate of proximal obstruction in the sedation group was lower than that in both traditional and general anesthesia groups(P<0.05).Additionally,the VAS scores for pain in the sedation and general anesthesia groups were lower than that in the tradi⁃tional group(P<0.05).The incidence of adverse reactions in the sedation group was lower than in the general anesthesia and traditional groups(P<0.05).Conclusion TVS 4D-HyCoSy conducted under non-general anesthesia sedation safely and accurately determines the fallopian tube patency,which is worthy of clinical application.