超声造影与X线碘油造影评估输卵管畅通性的临床对比性研究

发布时间：2018-01-21 07:01

  本文关键词： 子宫输卵管超声造影 声诺维 碘油X线造影 四维超声造影 阴道超声 输卵管性不孕症　出处：《承德医学院》2017年硕士论文　论文类型：学位论文

【摘要】：不孕症是困扰每个区域乃至全球许多育龄女性的一个重要疾病问题,其患病率约占7%~10%。据统计:不孕症出现持续上涨的趋向。在众多不孕症患者中,输卵管病变是导致不孕的最重要病因之一,在国外:30%~35%与输卵管病因相关,在我国:50%与输卵管梗阻和通而不畅因素有关,各种病变因素(输卵管发育不全、盆腔炎后遗症、子宫内膜异位症、慢性输卵管炎等多种因素)以致输卵管功能性障碍或梗阻是输卵管性不孕症的主要影响因素。评价输卵管畅通性是诊治不孕症的一个关键环节,输卵管是否病变对不孕症病因的探讨具备关键性意义。精准评估输卵管的结构、功能也是医治输卵管性不孕症的首要环节,4D-子宫输卵管Sono Vue超声造影能同时准确诊断宫腔内状况、输卵管结构、畅通度、梗阻的位置,其无创、操作简单、成本低、数据存储持久。4D-HyCoSy准确评估输卵管畅通情况是医治不孕症的关键,同时也为临床医师医治提供了主要依据,成为了输卵管性不孕不可缺少的辅助性检查,对输卵管性不孕症患者的诊治有着重要临床价值。目的:本研究探讨4D-经阴道子宫输卵管Sono Vue超声造影(four-dimensional Hysterosalpingo contast sonography,4D-HyCoSy)、X线子宫输卵管碘化油造影术(Hysterosalpingography,HSG)分别与宫腹腔镜结果进行比较,分析二者诊断双侧输卵管畅通度的诊断价值(正确率)、敏感性、一致性、特异性。追踪随访6个月后自然受孕率,统计成功妊娠例数及各种情况,剖析4D子宫输卵管Sono Vue超声造影在诊断输卵管通畅度中的有效性,以探究4D-HyCoSy对输卵管畅通性的诊断意义及临床价值。方法:选用America生产的GE Voluson E8彩色多普勒诊断仪对58例不孕症女性患者进行4D-HyCoSy检查,选用SIMENS数字胃肠机ICON200对40例不孕女性患者进行HSG检查,同期记录受检者的检查结果以及记录双侧输卵管的畅通度及微泡盆腔内的扩散情况,以宫腹腔镜检查为金标准,统计分析其一致性、特异性及敏感性,追踪回访6个月后患者的受孕率,比较分析归纳4D-HyCoSy关于诊断输卵管畅通度的价值及重要的临床意义。结果:98例不孕女性患者,2例患者行单侧输卵管摘除术或者行单侧附件摘除术,58例患者(114条输卵管)行4D-HyCoSy:输卵管通畅17条,占14.9%(17/114),输卵管阻塞72条,占63.2%(72/114),输卵管通而不畅(狭窄)25条,占21.9%(25/114)。40例(80条输卵管)HSG中输卵管畅通25条,占31.25%(25/80),输卵管梗阻47条,占58.75%(47/80),输卵管通而不畅(狭窄)8条,占10%(10/80)。腹腔镜检查中输卵管通畅35条(其中HyCoSy组19条,HSG组16条),输卵管梗阻128条(其中HyCoSy组76条,HSG组52条),输卵管通而不畅(狭窄)33条(其中HyCoSy组21条,HSG组12条)。以宫腹腔镜检查为标准对照分析,HyCoSy组:敏感性(%)=97.8%;特异性(%)=84.2%;准确性(%)=92.2%。HSG组:敏感性(%)=88.5%;特异性(%)=81.3%;准确性(%)=83.8%,98例输卵管复通术后半年,HyCoSy组半年后的正常复孕率明显高于HSG组(P0.05),2种造影方法对输卵管诊断准确率的对比分析:4D-HyCoSy的准确率显著高于HSG(P0.05)。2组检查方式的特异性、一致性及敏感性对比:4D-HyCoSy对输卵管梗阻的诊断的一致性、特异性及敏感性都均高于HSG(P0.05)。结论:超声造影是评估输卵管畅通情况的新方法,其具有相对创伤小、安全、操作简便、准确、费用低廉、重复性好、资料保存持久并且可以长期使用等优点。与碘油X线相比,4D-HyCoSy诊断输卵管通畅性的诊断正确率,一致性、敏感性、特异性以及半年后正常妊娠的受孕率均明显高于HSG,并且还能实时观察微气泡在宫腔内的流动和扩散程度判断双侧输卵管畅通度,并同时知道卵巢、子宫和盆腔的种种情况,乃至检测宫腔形态、观察子宫肌层和卵巢的情况等方面具备特别高的灵敏度和特异度,最重要的是对轻度的腹膜粘连、输卵管的畅通度有一定的治疗功能,受孕时间也不受限制,受到大众的不断好评,是当前可作为检查输卵管畅通度或术后输卵管再通畅通度的首选的诊断价值最高的无创伤性医学影像学检查方法。
[Abstract]:Infertility is an important disease problem in each region and even the whole world many women of childbearing age, the prevalence rate of about 7%~10%. according to the statistics: the rising trend of infertility. In many patients with infertility, tubal disease is one of the most important causes of infertility in foreign countries: 30%~35% and tubal cause in our country. And the poor: factors associated with tubal obstruction and 50% lesions, various factors (tubal hypoplasia, sequelae of pelvic inflammatory disease, endometriosis, chronic salpingitis and other factors) so that the function of fallopian tube disorders or obstruction are the main influencing factors of tubal infertility. Evaluation of fallopian tube patency is a key link in the treatment of infertility, tubal whether on etiology of infertility lesions have key significance. Accurate assessment of tubal structure, function also treat tubal infertility The first step, the 4D- Sono Vue uterine tubal contrast-enhanced ultrasound can accurately diagnosis of uterine cavity, fallopian tube structure, smooth degree of obstruction, position, non-invasive, simple operation, low cost, data storage lasting.4D-HyCoSy accurate assessment of tubal patency is the key to cure infertility, but also provides the main on the basis of treatment for the clinician to become auxiliary examination of tubal infertility indispensable, has important clinical value in the diagnosis and treatment of patients with tubal infertility. Objective: This study investigated the Sono Vue transvaginal ultrasound contrast hysterosalpingography (4D- four-dimensional Hysterosalpingo contast sonography, 4D-HyCoSy), X-ray hysterosalpingography lipiodol angiography (Hysterosalpingography HSG), compared with the results of laparoscopy, the analysis of the two diagnostic value of diagnosis of bilateral tubal smooth degree (accuracy), sensitivity, a Consistency and specificity. The natural pregnancy rate after 6 months of follow-up, the statistical number of cases of successful pregnancy and various situations, the effectiveness analysis of tube patency in Sono Vue contrast-enhanced ultrasound in diagnosis of fallopian tubal uterine 4D, and the clinical diagnostic significance of 4D-HyCoSy on smooth tube price on the value of oviduct. Method: 4D-HyCoSy examination of 58 cases of female infertility patients with GE Voluson E8 color Doppler diagnostic instrument of America production, using SIMENS digital gastrointestinal machine ICON200 HSG was performed in 40 cases of female infertility patients during the same period, record examination results and record double oviduct smooth degree and micro bubble diffusion in the pelvic cavity, to the palace laparoscopy is the gold standard, analyze the consistency of statistics, specificity and sensitivity, the follow-up patients with pregnancy rate after 6 months, a comparative analysis of inductive 4D-HyCoSy on the diagnosis of tubal smooth degree and weight value 瑕佺殑涓村簥鎰忎箟.缁撴灉:98渚嬩笉瀛曞コ鎬ф偅鑰，

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