经阴道4D-HyCoSy在输卵管不孕诊断中的应用

doi:10.7517/issn.1674-0475.211215

摘要/Abstract

摘要： 本文探讨经阴道四维超声子宫输卵管造影(4D-HyCoSy)在输卵管不孕患者诊断中的应用价值。选取疑似输卵管不孕患者75例(150条输卵管)作为研究对象,均行经阴道4D-HyCoSy检查。以腹腔镜美蓝通液术检查结果作为金标准,经阴道4D-HyCoSy诊断输卵管阻塞86条、诊断输卵管未发生阻塞64条、误诊输卵管阻塞23条;Kappa分析显示,4D-HyCoSy检查与腹腔镜美蓝通液术检查一致性较好(Kappa值分别为0.528、0.709,P＜0.05);阴道4D-HyCoSy检查左侧、右侧输卵管不孕的ROC曲线下面积(AUC)值分别为0.770和0.859,95% CI为0.661～0.880和0.769～0.949,P＜0.001,cut-off值为≤1,诊断敏感度分别为65.85%和77.50%,特异度分别为88.24%和94.29%。经阴道4D-HyCoSy诊断输卵管不孕与"金标准"(腹腔镜美蓝通液术检查)一致性较高,可为输卵管不孕的临床诊断和治疗提供新方向。

关键词: 四维超声子宫输卵管造影, 造影剂, 输卵管不孕, 妊娠成功率, 输卵管阻塞

Abstract: This article discussed the application value of transvaginal four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) in patients with tubal infertility. 75 patients with suspected tubal infertility (150 fallopian tubes) were selected as the research subjects, and all underwent transvaginal 4D-HyCoSy examination. Taking the results of laparoscopic methylene blue as the gold standard, transvaginal 4D-HyCoSy diagnosed 86 fallopian tube obstruction, 64 fallopian tube obstruction was diagnosed, and 23 fallopian tube obstruction was misdiagnosed. Kappa analysis showed that 4D-HyCoSy examination has a good consistency with laparoscopic methylene blue pass examination (Kappa values were 0.528 and 0.709, respectively, P<0.05). The area under the ROC curve of vaginal 4D-HyCoSy examination of left and right fallopian tubes for infertility were 0.770 and 0.859, respectively, with 95%CI of 0.661-0.880 and 0.769-0.949, P<0.001, cut-off value ≤1, and the diagnostic sensitivity was 65.85% and 77.50%, the specificity was 88.24% and 94.29%, respectively. Transvaginal 4D-HyCoSy diagnosis of tubal infertility has a high consistency with the "gold standard" (laparoscopic malignant fluid examination), which could provide a new direction for the clinical diagnosis and treatment of tubal infertility.

Key words: four-dimensional hysterosalpingo-contrast sonography, contrast agent, tubal infertility, pregnancy success rate, tubal obstruction

刘玉君, 谭庆英, 李汝斐, 巫晶晶, 潘慧妍. 经阴道4D-HyCoSy在输卵管不孕诊断中的应用[J]. 影像科学与光化学, 2022, 40(3): 565-569.

LIU Yujun, TAN Qingying, LI Rufei, WU Jingjing, PAN Huiyan. Application of Transvaginal 4D-HyCoSy in the Diagnosis of Tubal Infertility[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(3): 565-569.

参考文献

[1] 王添平, 张国福. 输卵管阻塞性不孕的介入治疗[J]. 中国实用妇科与产科杂志, 2019,35(1):83-86.
[2] 张小田, 周凤英. 实时谐波超声造影术联合经阴道四维子宫输卵管造影术在输卵管造影中的应用[J]. 中国医疗设备, 2019,34(9):85-89.
[3] Wang W Q, Zhou Q L, Gong Y F, et al. Assessment of fallopian tube fimbria patency with 4-dimensional hysterosalpingo-contrast sonography in infertile women[J]. Journal of Ultrasound in Medicine, 2017,36(10):2061-2069.
[4] 刘佳, 俞磊. 经阴道子宫输卵管四维超声造影评价输卵管通畅性的价值[J]. 海南医学, 2017,28(24):4043-4046.
[5] 陈子江, 刘嘉茵, 黄荷凤, 等. 不孕症诊断指南[J]. 中华妇产科杂志, 2019,54(8):505-511.
[6] Sun Y, Zhang J, Bai W P. Higher prevalence of endometrial polyps in patients with fallopian tube obstruction:A case-control study[J]. Journal of Minimally Invasive Gynecology, 2019,26(5):935-940.
[7] 白玮, 吕爱霞, 马林秀, 等. 输卵管阻塞性不孕症介入再通术后通畅率影响因素的Logistic回归分析[J]. 中国妇幼保健, 2017,32(3):557-559.
[8] 杨潇曼. 基于系统综述的评估不孕女性子宫和卵巢最佳方法的专家共识[J]. 国际生殖健康/计划生育杂志, 2018,37(6):497.
[9] 杨继, 同俊义, 张英伟, 等. 三维超声造影与子宫输卵管造影诊断输卵管性不孕的临床价值比较[J]. 广西医科大学学报, 2017,34(7):980-983.
[10] Ludwin I, Ludwin A, Wiechec M, et al. Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye[J]. Human Reproduction, 2017,32(4):758-769.
[11] 周青, 熊雯, 陈琴, 等. TVS 4D-HyCoSy评估不孕症患者输卵管通畅度的临床应用分析[J]. 实用医院临床杂志, 2017,14(6):55-57.
[12] 石富文, 杨敏, 顾小宁, 等. 经阴道四维超声子宫输卵管造影评估不孕症患者输卵管通畅性[J]. 中国医学影像技术, 2019,35(5):730-734.
[13] 刘满荣, 黄健源, 丁可, 等. 子宫输卵管四维超声造影在不孕症诊断中的临床应用[J]. 海南医学, 2018,29(14):2001-2004.
[14] 杨珉珉, 刘敏, 陈艳, 等. 经阴道四维子宫输卵管超声造影评价输卵管通畅性诊断效能的观察及误诊分析[J]. 诊断学理论与实践, 2018,17(2):202-206.
[15] 武忆东. TVS 4D-HyCoSy对不孕症患者输卵管通畅的临床价值[J]. 深圳中西医结合杂志, 2018,28(1):176-177.
[16] 苏红, 吕开红, 杨勇. 超声造影诊断输卵管源性不育症的临床应用价值[J]. 临床超声医学杂志, 2017,19(10):679-681.
[17] Exacoustos C, Pizzo A, Lazzeri L, et al. Three-dimensional hysterosalpingo contrast sonography with gel foam:Methodology and feasibility to obtain 3-dimensional volumes of tubal shape[J]. Journal of Minimally Invasive Gynecology, 2017,24(5):827-832.
[18] 田红菊, 高春燕, 颜苹, 等. 经阴道子宫输卵管四维超声造影中造影剂逆流的影响因素[J]. 中国介入影像与治疗学, 2019,16(10):612-615.
[19] 张俊仁, 何飞, 王雷, 等. 子宫输卵管造影动态影像学异常路径显影分析[J]. 中国药物与临床, 2019,19(9):1446-1447.
[20] 郑兴邦, 关菁. 子宫输卵管造影的图像解读[J]. 中国实用妇科与产科杂志, 2019,35(1):77-80.
[21] 梁丽, 张建蕾, 景磊, 等. 四维超声造影与盐水灌注超声造影评价不孕症输卵管通畅性的对比研究[J]. 贵州医药, 2018,42(7):874-875.
[22] 马园园, 孙延霞. 盆腔子宫内膜异位症误诊为卵巢囊肿蒂扭转病例报告[J]. 临床误诊误治, 2018,31(12):24-26.
[23] 陆英慧, 李琴, 汪玲, 等. 不孕症应用经阴道子宫输卵管四维超声造影检查70例效果观察[J]. 安徽医药, 2020,24(3):453-455, 637.
[24] 张婧, 董冲亚, 香钰婷, 等. 经阴道四维子宫输卵管超声造影临床耐受性及相关因素分析[J]. 实用妇产科杂志, 2019,35(3):199-203.
[25] Chunyan G, Bin P, Ping Y, et al. Assessment of the influence on spontaneous pregnancy of hysterosalpingo-contrast sonography[J]. BioMed Research International, 2018,2018(1):4901281.
[26] He Y N, Ma X H, Xu J J, et al. Comparison of assessment methods for fallopian tubal patency and peritubal adhesion between transvaginal 4-dimensional hysterosalpingo-contrast sonography and laparoscopic chromopertubation[J]. Journal of Ultrasound in Medicine, 2017,36(3):547-556.
[27] 肖艳, 袁丽, 丁波, 等. 四维子宫输卵管超声造影诊断不孕的价值研究[J]. 中国性科学, 2018,27(2):118-120.