研究经阴道实时三维子宫输卵管超声造影中造影剂逆流影响因素  

Study on influencing factors of reflux of contrast medium in transvaginal real-time three-dimensional hysterosalpingo-contrast sonography

作　　者：王琴[1] 王金萍[1] 李燕[1] 陈晓艺[1] WANG Qin;WANG Jin-ping;LI Yan;CHEN Xiao-yi(Department of Ultrasound Medicine,the First Afiliated Hospital of Anhui University of Chinese Medicine,Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院超声医学科,安徽合肥230031

出　　处：《中国临床医学影像杂志》2023年第1期51-55,60,共6页Journal of China Clinic Medical Imaging

基　　金：安徽省2018年度重点研究与开发计划项目(1804h08020248);安徽中医药大学科研项目(2019fyyb11)。

摘　　要：目的:分析经阴道实时三维子宫输卵管超声造影(Transvaginal real-time three-dimensional hysterosalpingo-contrast sonography,TVS RT-3D-HyCoSy)中影响造影剂逆流的危险因素以减少此类现象发生。方法:随机选取2021年1月—2022年5月在我院行3D-HyCoSy检查的179例不孕症患者,分为逆流组72例、非逆流组107例。采用多因素Logistic回归分析出影响逆流发生的重要因素。结果:单因素分析显示不孕类型(χ^(2)=17.203,P<0.001)、宫腔操作史(χ^(2)=6.451,P=0.011)、子宫内膜厚度(χ^(2)=30.719,P<0.001),推注压力(χ^(2)=22.224,P<0.001)、置管类型(χ^(2)=39.883,P<0.001)、输卵管通畅性情况(P=0.009)与逆流发生差异存在统计学意义。多因素分析显示不孕类型(P=0.018,OR=3.427,95%CI 1.237~9.499)、内膜厚度(P<0.001,OR=6.010,95%CI2.611~13.829)、推注压力(P=0.005,OR=4.186,95%CI 1.534~11.42)、置管类型(P=0.010,OR=3.101,95%CI 1.309~7.346)、双侧输卵管通畅情况(P=0.030)是预测TVS RT-3D-HyCoSy评价不孕症检查过程中发生逆流的重要影响因素,其中双侧输卵管阻塞患者发生造影剂逆流的风险概率是双侧输卵管通畅患者的10.460倍(95%CI 2.472~44.259)。结论:TVS RT-3D-HyCoSy造影时患者不孕类型及输卵管通畅性无法被干预,但是可以通过选择患者合适的造影时间、合适的造影管及降低推注压力来减少逆流发生的易感因素,从而减少逆流的发生,准确快速评估输卵管状况。Objective:To analyze the risk factors that affect reflux of contrast medium in transvaginal real-time three-dimensional hysterosalpingo-contrast sonography(TVS RT-3D-HyCoSy)to reduce the occurrence of this phenomenon.Methods:A total of 179 infertile patients who underwent RT-3D-HyCoSy examination in our hospital from January 2021 to May 2022were randomly selected,and were divided into reflux group(72 cases)and non reflux group(107 cases).Multivariate Logistic regression was used to analyze the important factors affecting the occurrence of reflux.Results:Univariate analysis showed that there were significant differences between infertility type(χ~2=17.203,P<0.001),history of intrauterine operation(χ~2=6.451,P=0.011),endometrial thickness(χ~2=30.719,P<0.001),bolus injection pressure(χ~2=22.224,P<0.001),catheter type(χ~2=39.883,P<0.001),tubal patency(P=0.009)and reflux.Multivariate analysis showed infertility type(P=0.018,OR=3.427,95%CI 1.237~9.499),endometrial thickness(P<0.001,OR=6.010,95%CI 2.611~13.829),bolus injection pressure(P=0.005,OR=4.186,95%CI1.534~11.42),catheter type(P=0.010,OR=3.101,95%CI 1.309~7.346),bilateral tubal patency(P=0.030)were important factors for predicting the occurrence of reflux during the evaluation of infertility examination by TVS RT-3D-HyCoSy,and the risk probability of contrast agent reflux in patients with bilateral fallopian tube obstruction was 10.460 times(95%CI 2.472~44.259)higher than that in patients with bilateral tubal patency.Conclusion:During TVS RT-3D-HyCoSy,the patient’s infertility type and tubal patency cannot be intervened.However,the susceptibility to reflux can be reduced by selecting the appropriate imaging time,appropriate imaging tube and reducing the bolus pressure for the patient,so as to reduce the occurrence of reflux and accurately,and rapidly evaluate the fallopian tube status.

关 键 词：不育 女性 造影剂 超声检查 多普勒 彩色 

分 类 号：R711.6[医药卫生—妇产科学] R445.1[医药卫生—临床医学]