经阴道四维超声造影评价输卵管妊娠保守治疗后输卵管通畅性的临床价值

发布时间：2018-03-24 17:44

本文选题：经阴道四维超声造影　切入点：输卵管妊娠　出处：《大连医科大学》2017年硕士论文

【摘要】：目的:育龄期女性的输卵管是早期受精和胚胎发育的场所,它的结构以及功能的异常改变常常会导致不孕或输卵管妊娠的发生。利用经阴道四维超声输卵管造影(Four-dimensional Hysterosalpingo-contrast sonography,4D-HyCoSy)来评价输卵管妊娠患者经药物保守治疗后以及经保守性手术治疗后双侧输卵管的通畅状态,探讨经阴道4D-HyCoSy在药物保守治疗后及保守性手术治疗后输卵管妊娠患者中应用的临床价值,为这部分患者再次妊娠选择合适的时间和方式或早期进行临床干预提供依据。方法:选择2015年1月~2016年9月在滨州医学院附属医院妇产科门诊以及生殖医学科门诊就诊的120例经药物保守治疗以及经保守性手术治疗后的输卵管妊娠患者。将120例患者分为三组:A组为保守性药物治疗的患者(40例);B组为腹腔镜下保守性手术治疗的患者(40例);C组为开腹保守性手术治疗的患者(40例),所有患者均行经阴道4D-HyCoSy,观察双侧输卵管通畅状况,来客观评价输卵管妊娠患者保守治疗后双侧输卵管通畅情况。随机选择其中40例与腹腔镜下美兰通液(金标准)结果对照,比较两种方法的一致性。结果:1、经阴道4D-HyCoSy与腹腔镜下美兰通液检查评价输卵管通畅性的结果一致性较高。Kappa值为0.732(P0.001),经阴道4D-HyCoSy诊断的敏感性为88.9%(24/27)、特异性为92.5%(49/53)、阳性预测值为85.7%(24/28)、阴性预测值为94.2%(49/52)、准确率为91.3%(73/80)。2、腹腔镜治疗组患侧患侧输卵管通畅率(32.5%)明显高于药物治疗组(7.5%)、开腹治疗组(10.0%);腹腔镜治疗组患侧输卵管通而不畅率及阻塞率(37.5%、30.0%)明显低于药物治疗组(47.5%、45.0%)、开腹治疗组(45.0%、45.0%);三个不同治疗组间差异均具有统计学意义(P0.05)。结论:1、经阴道4D-HyCoSy对输卵管通畅性的评估结果与腹腔镜下美兰通液检查的一致性较高(Kappa值为0.732)。2、腹腔镜保守性手术治疗更有助于输卵管功能的保留和恢复,可在有生育要求的患者中推广应用。3、经阴道4D-HyCoSy安全可靠,操作简单,可以实时观看输卵管内造影剂的走向,可对输卵管通而不畅的患者起到一定的治疗作用,值得临床推广使用。
[Abstract]:Objective: the fallopian tubes of women of childbearing age are the place for early fertilization and embryonic development. Abnormal changes in structure and function often lead to infertility or tubal pregnancy. Four-dimensional Hysterosalpingo-contrast sonography4D-HyCoSysystem was used to evaluate the patients with tubal pregnancy after drug conservative treatment and conservative treatment. The patency of bilateral fallopian tubes after sexual surgery, To explore the clinical value of transvaginal 4D-HyCoSy in patients with tubal pregnancy after conservative drug therapy and conservative surgical treatment. Methods: from January 2015 to September 2016, we selected the Department of Obstetrics and Gynecology and the Department of Reproductive Medicine in the affiliated Hospital of Binzhou Medical College. 120 cases of tubal pregnancy were treated with conservative drug therapy and conservative surgery. 120 cases were divided into three groups: group A: 40 cases treated with conservative drugs, group B: conservative surgery under laparoscope. 40 patients in group C were treated with laparotomy and conservative surgery. All the patients were treated with 4D-HyCoSys via vagina to observe the patency of bilateral fallopian tubes. Objective to evaluate the patency of bilateral fallopian tubes in patients with tubal pregnancy after conservative treatment. Results the consistency of the two methods was higher than that of vaginal 4D-HyCoSy and laparoscopic methylene blue liquid test. Kappa value was 0.732kappa, the sensitivity of transvaginal 4D-HyCoSy diagnosis was 88.9 / 27, the specificity was 92.5 / 49 / 53, and the positive prediction was positive. The value was 85.7 / 28, and the negative predictive value was 94.20.49 / 52g, and the accuracy was 91.373 / 80 / 2. The patency rate of the affected side of the affected side in the laparoscopic treatment group was significantly higher than that in the drug treatment group (7.5V) and the laparotomy treatment group (10.0); the rate of tubal patency and obstruction in the laparoscopic treatment group was 37.5% and 30.0% (P < 0.05). The difference between the three different treatment groups was statistically significant (P 0.05). Conclusion: 1. The results of transvaginal 4D-HyCoSy in evaluating the patency of fallopian tubes are higher than those in laparoscopy. [WT5HZ] the results of the evaluation of the patency of fallopian tubes by transvaginal 4D-HyCoSy are consistent with those of laparoscopy. The value of Kappa was 0.732n.2.Laparoscopic conservative surgery was more helpful for the preservation and recovery of fallopian tube function. It can be popularized and applied in patients with fertility requirement. The transvaginal 4D-HyCoSy is safe and reliable, easy to operate, and can watch the direction of the contrast agent in the fallopian tube in real time. It can play a certain therapeutic role in the patients with tubal patency. It is worth popularizing in clinic.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.22;R445.1

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