输卵管不孕患者经宫腔镜插管疏通治疗预后预测模型的探讨  

Study on predictive model in tubal infertility with different pregnancy outcome after tubal recanalization by hysteroscopy

作　　者：张健[1] 张丽君[1] 丁美芳[1] 侯利萍[1] 谢康云[1] 

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院,上海200030

出　　处：《中国内镜杂志》2007年第11期1142-1145,1149,共5页China Journal of Endoscopy

摘　　要：目的探讨输卵管性不孕患者经宫腔镜输卵管插管疏通治疗后发生不同妊娠结局的预测模型。方法采用非传统病例-对照研究的方法,调查194例输卵管性不孕患者(病例组83例和对照组111例)经宫腔镜输卵管插管疏通治疗后产生不同妊娠结局(仍未妊娠/异位妊娠和宫内妊娠)的影响因素:年龄、不孕年限、流产史、盆腔炎及盆腔手术史和疏通治疗前HSG的结果(包括输卵管的柔软度、通畅度、管腔黏膜显影情况、伞端及盆腔粘连情况)。采用单因素和Logistic多元回归分析筛选这些影响妊娠结局的因素,并行逐步判别分析,以进一步建立选择合适病例的预测模型。并以65例验证对象对此模型进行验证。结果单因素分析显示既往盆腔炎史、妇科手术史、HSG所示的输卵管柔软度、通畅度及管腔黏膜异常显影等5项指标为主要影响预后的因素;而多因素分析结果则以HSG所示的3项指标为主要影响因素。根据量化的各因素所建立的预测模型,经验证其敏感度86.2%,特异度80.6%,总判别准确率为84.8%。结论HSG所示的上述3项主要影响因素者,不宜选择输卵管疏通治疗。据此所建立的预测方法简单、实用,为指导临床医师选择合适病例和提高疗效提供一项较为客观、可靠的参考指标。[Objective] To establish a predictive model for tubal infertility for different pregnancy outcome after tubal recanalization by hysteroscopy. [Methods] 194 cases of tubal infertility were divided into two groups according to different pregnancy outcome after tubal recanalization： 83 served as case group and 111 as control group. They were studied using non-traditional case-control study to explore possible prognostic factors, such as age, years of infertility, abortion, pelvic inflammation diseases, pelvic surgical history and hysterosalpingography （HSG） before tubal recanalization （ including tubal pliability, patency, intratubal mucosa and adhesion in distal or pelvic）. Data was processed by single factor, Logistic multiple regression and discriminant analysis, and then model was estab- lished and verified by other 65 cases. [Results] On the screen, single factor analysis showed that pelvic inflammation diseases, gynoecological surgical history and abnormal HSG including tubal pliability, patency and mucosa were the risk prognostic factors. However, multiple regression analysis showed that only 3 abnormal HSG were the main factors. Predictive model was set up by using these 3 factors. According to the model, sensitivity, specificity and pre- dictive accuracy were identified as 86.2%, 80.6%, 84.8% respectively. [Conclusion] It is inappropriate to select tubal recanalization considering those severe defective tubes with 3 abnormal HSG. The model was simple and practical and could be a inpersonal and acceptable guideline for clinical gynoecologists applying.

关 键 词：输卵管性不孕 宫腔镜 疏通治疗 妊娠结局 判别分析 预测模型 子宫输卵管碘油造影 

分 类 号：R713.7[医药卫生—妇产科学]