子宫输卵管超声造影对输卵管通畅性的诊断研究  

Comparative study of dynamic real-time 3D hysterosalpingo-contrast sonograghy in the diagnosis of tubal patency

作　　者：陈梅[1] 张盛敏[1] 薛念余[1] 许幼峰[1] 郭旻华[1] 舒静[2] 张宜生[2] 

机构地区：[1]宁波市第一医院超声科,315010 [2]宁波市第一医院妇产科,315010

出　　处：《中华医学超声杂志（电子版）》2016年第7期531-537,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨子宫输卵管超声造影对输卵管性不孕症患者诊断的临床价值。方法选取2013年5月至2014年7月在宁波市第一医院生殖中心就诊的165例女性不孕症患者共312条输卵管（18例因宫外孕切除患侧输卵管）,采用经阴道实时动态三维子宫输卵管超声造影（TVS DRT-3D-HyCoSy）,观察输卵管超声造影表现,并于造影后30~40 d行腹腔镜输卵管通液术,术后对TVS DRT-3D-HyCoSy与腹腔镜检查结果进行比较,采用四格表资料评价诊断性试验的真实性,采用Kappa检验分析2种诊断方法的一致性。结果 165例312条输卵管经TVS DRT-3D-HyCoSy显示44例（26.7%,44/165）86条输卵管通畅,超声造影表现为双侧输卵管光滑、走行柔顺,双侧输卵管内造影剂同时喷射入盆腔,盆腔弥散均匀;121例（73.3%,121/165）226条输卵管阻塞,超声造影表现为双侧输卵管不显影、节段性显影或显影不同步,局部纤细或增粗,极少量或无造影剂溢入盆腔,盆腔无弥散或不均匀弥散。腹腔镜输卵管通液术中推注亚甲蓝注射液观察37例（22.4%,37/165）73条输卵管通畅,术中表现为大量亚甲蓝溢出;128例（78.6%,128/165）239条输卵管阻塞,术中表现为输卵管伞端无或少量亚甲蓝溢出。与腹腔镜输卵管通液术比较,超声造影诊断输卵管通畅的敏感度、特异度分别为89.12%（213/239）、82.19%（60/73）,2种检查方法诊断输卵管阻塞具有较高一致性（Kappa=0.76）。结论 TVS DRT-3D-HyCoSy对输卵管性不孕症患者的诊断准确性较高,有一定的临床价值。Objective To explore the clinical value of hysterosalpingo-contrast sonography（TVS DRT-3D-HyCoSy） in the diagnosis of tubal infertility. Methods 312 fallopian tubes from 165 cases（18 were subject to salpingectomy for ectopic pregnancy） diagnosed as infertility in the Department of Ultrasonography in Ningbo First Hospital from May 2013 to July 2014 was evaluated using the TVS DRT-3D-HyCoSy. Laparoscopic hydrotubation were performed at 30-40 days after angiography, and the result were compared with that of the transvaginal hysterosalpingo-contrast sonography. Methodologically, fourfold table and Kappa test were adopted to assess the authenticity of diagnostic experimentation and the consistency between two diagnostic tools respectively. Results TVS DRT-3D-HyCoSy has revealed that of 312 fallopian tubes from 165 cases（18 cases with ectopic pregnancy resection of the fallopian tubes for ectopic pregnancy）, 86 fallopian tubes from 44 cases（26.7%, 44/165） were unobstructed and 226 fallopian tubes from 121 cases（73.3%, 121/165） were obstructed. For unobstructed cases, the fallopian tubes were marked by smoothness and pliancy, and contrast agents, when injected into the pelvic cavity through both fallopian tubes, showed even dispersion; for obstructed cases, however, ultrasonic contrast of fallopian tubes was marked by discontinuity and irregularity in development, and few or no contrast agents, when injected through both fallopian tubes, were found to overflow in the pelvic cavity which showed no or uneven dispersion. 73 fallopian tubes from 37 cases（22.4%, 37/165） were found to be unobstructed and 239 fallopian tubes from 128 cases（78.6%, 128/165） were found to be obstructed by virtue of laparoscopic hydrotubation using methylthioninium chloride injection. When subject to laparoscopic hydrotubation, unobstructed cases showed a large amount of injection overflow whereas unobstructed cases showed little or no injection overflow. Compared with laparoscopic hydrotubation, the sensitivity and spe

关 键 词：超声检查 造影剂 子宫 输卵管疾病 不育 女(雌)性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.6[医药卫生—诊断学]