输卵管性不孕的影像学分级在腔镜治疗中的意义  

Diagnosis Value of the Grading of Salpingography in the Treatment of laparoscopy

作　　者：张雄军[1] 陈晋[1] 张文悫[1] 邓志春[1] 柏魏[1] 

机构地区：[1]大理学院玉溪附属医院,云南玉溪653100

出　　处：《大理学院学报（综合版）》2010年第2期56-60,共5页Journal of Dali University

基　　金：玉溪市卫生局2009年立项课题

摘　　要：目的:依据输卵管造影表现建立影像学分级,并与腹腔镜下输卵管状态评级的诊断进行一致性对照研究。方法:回顾性分析2005年1月至2008年12月间,109例经子宫输卵管碘油造影后行腹腔镜检查的病例,依据输卵管造影的形态、积水程度、碘油留在输卵管内及进入盆腔后的弥散情况将输卵管造影的影像分为5级(级别越高,病变程度越重),并与腹腔镜下输卵管评级进行一致性检验。结果:211条输卵管的影像学分级与腹腔镜下输卵管状态评级具有较好的一致性(左侧Kappa=0.923,右侧Kappa=0.884,P<0.05)。10例经子宫输卵管造影分级诊断为输卵管近端阻塞的病例,经腹腔镜下评级为低级别。结论:输卵管影像学分级能很好地判断输卵管的病变程度,特别是对于近端阻塞者。对输卵管性不孕的患者,应进行输卵管影像学分级,指导选择治疗方法。Objective： To investigate the consistency of diagnosis for the grading of fallopian tube by imageology and laparoscopy. Methods： 109 infertile cases that underwent the Hysterosalpingography （HSG） and laparoscopy orderly from January 2005 to June 2008 were analyzed retrospectively. Their tubes were classified into five grades with imageology according to the shapes of salpingian obstruction, the stagnation of lipiodo in salpingian , the information of diffusion by lipiodol entering into pelvic cavity through salpingian, and the degree of the oviduct was classified into four grades with laparoscopy also, according to the degree of the oviduct patency, the macroscopic aspect of endosalpinx, the thickness of the tubal wall, the nature and extent of adhesions and other complications. The higher the grade was, the worse the lesion of salpingian was. The correlation of two types of grading with imageology and laparoscopy was analyzed. Results： Of the 211 cases diagnosed as occlusion tubes by HSG, 85 were classified into the low grade and 126 cases were into high grade. All of them were confirmed by laparoscopy, and of the low grade of laparoscopy were 95, while of the high grade were 116. There was almost coincidence of diagnosis for the grading of fallopian by imageology and laparoscopy （the left Kappa = 0.923, the right Kappa = 0.884, P〈0.05）. 10 of 211 cases were diagnosed as proximate occlusion by HSG, but these cases were diagnosed proximate normal. Conclusion： The grading of fallopian tube by HSG can be used as the first step to diagnose the tube occlusion precisely, especially to diagnose the proximate occlusion and inner wall of tubal lesion ,and can help doctors to offer the right treatment for infertility.

关 键 词：放射摄影术 腹腔镜 输卵管 不孕症 

分 类 号：R713.7[医药卫生—妇产科学]