“一站式”子宫输卵管超声造影在不孕症诊疗中的应用价值探讨

“One-stop” hysterosalpingography in diagnosis and treatment of infertility

关键词:  子宫输卵管造影  超声  不孕症  诊断效能

Key words:  hysterosalpingography  ultrasound  infertility  diognostic efficiency

摘要:

目的探讨“一站式”子宫输卵管超声造影（简称“一站式”造影）技术在女性生殖系统不孕症中的应用价值。方法回顾性分析2019年5月—2020年5月在上海健康医学院附属周浦医院行“一站式”造影诊疗的79例不孕症患者作为研究对象，入组患者均于1个月后行腹腔镜下美蓝通液术，将腹腔镜检查结果与“一站式”造影结果进行比较，以分析诊断效能。结果79例患者共156条输卵管，首次造影发现72条输卵管通畅，12条输卵管通而不畅，72条输卵管阻塞，对显影不良的输卵管行宫腔内0.9%NaCl溶液快速推注冲击后，共疏通输卵管52条，有效率61.9%（52/84）。冲击后显示80条输卵管通畅，48条输卵管通而不畅，28条输卵管阻塞。与腹腔镜下美蓝通液术比较，“一站式”造影诊断准确度95.5%，敏感度96.5%，特异度93.0%，阳性预测值87.5%，阴性预测值93%，两种检查方式一致性较高，差异有统计学意义（Kappa=0.926，P=0.03）。40例输卵管通畅的患者子宫肌层逆流发生率10%，28例输卵管通而不畅的患者子宫肌层逆流发生率78.5%，11例输卵管不通患者子宫肌层逆流发生率72.7%。“一站式”造影患者的不良反应为0级5例，Ⅰ级28例，Ⅱ级46例，无Ⅲ级或Ⅳ级发生，其中40例输卵管通畅的患者中12.5%发生0级不良反应，45.0%发生Ⅰ级不良反应，42.5%发生Ⅱ级不良反应；28例输卵管通而不畅的患者，21.4%发生Ⅰ级不良反应，78.5%发生Ⅱ级不良反应；11例输卵管通而不畅的患者，36.3%发生Ⅰ级不良反应，63.6%发生Ⅱ级不良反应。结论“一站式”造影诊疗技术能有效提高女性生殖系统不孕原因的诊断水平，值得临床进一步应用及推广。

Abstract:

ObjectiveTo explore the application value of “one-stop” hysterosalpingography in diagnosis and treatment of female infertility. MethodsSeventy-nine female patients with infertility admitted in Zhoupu Hospital from May 2019 to May 2020 were retrospective enrolled. All patients underwent one-stop hysterosalpingography, after one month patients also received laparoscopic chromopertubation with methylene blue. With the rerults of chromopertubation as gold standard the the diagnostic performance of “one-stop” hysterosalpingography was evaluated. ResultsIn 79 patients with 156 fallopian tubes, 72 fallopian tubes were unobstructed, 12 fallopian tubes were partially obstructed and 72 fallopian tubes were totally obstructed. After rapid impact of normal saline into the uterine cavity of 84 fallopian tubes, 52 fallopian tubes became opened with the effective rate of 62%. After impact, 80 fallopian tubes were unobstructed, 48 fallopian tubes were patially obstructed, and 28 fallopian tubes were obstructed. With laparoscopic chromopertubation as gold standard, the diagnostic accuracy of one-stop hysterosalpingography was 95.5%; and the sensitivity, specificity, positive predictive value and negative predictive value were 96.5%, 93%, 87.5% and 93%, respectively. Kappa test showed that the consistency of the two methods was high (Kappa=0.926, P=0.03). The incidence of myometrial reflux in patients with unobstructed (n=40), partially obstructed (n=28) and obstructed (n=11) fallopian tubes was 10%, 78.5% and 72.7%, respectively. The grade 0, grade Ⅰ and grade Ⅱ adverse reactions of “one-stop” hysterosalpingography occurred in 5, 28 and 46 cases, respectively; there were no grade Ⅲ or Ⅳ adverse reactions. Among 40 patients with unobstructed fallopian tubes, 12.5% had grade 0 adverse reactions, 45.0% had grade Ⅰ adverse reactions and 42.5% had grade Ⅱ adverse reactions; In 28 patients with partially obstructed fallopian tubes, 21.4% had grade Ⅰ adverse reactions and 78.5% had grade Ⅱ adverse reactions; in 11 patients with obstructed fallopian tubes, 36.3% had grade I adverse reactions and 63.6% had grade Ⅱ adverse reactions. ConclusionOne-stop hysterosalpinx contrast-enhanced ultrasonography can effectively improve the diagnostic level of female reproductive system infertility, which is worthy of further clinical application and promotion.