两种子宫输卵管造影方法的比较及影像资料分析

发布时间：2018-05-13 09:36

  本文选题：子宫输卵管造影 + 高压注射器　； 参考：《河北医科大学》2014年硕士论文

【摘要】：目的：将改良的逐渐加压法子宫输卵管造影与传统的手推法子宫输卵管造影在输卵管阻塞性不孕症诊疗中的应用做对比研究,探讨高压注射器加压法的优越性和可行性,并对两种方法的影像学资料进行解剖学分析,使HSG这一检查更加安全、规范,为临床诊断和治疗提供新的科学依据。方法：1研究对象收集保定市第二中心医院2005年1月—2013年12月期间就诊的女性不孕症患者共200例,年龄20-44岁,平均29.3岁。采用回顾性研究将两组患者分为两组,100例患者利用高压注射器逐渐加压法子宫输卵管造影为研究组,100例常规手推法子宫输卵管造影为对照组。两组均排除了子宫先天发育异常及输卵管手术切除术的病例。所有患者均签署知情同意书。2研究设备及方法两组患者均在月经干净后3-7天内,由妇科医生操作经阴道向子宫内置入一个双腔气囊导管,然后来我科西门子R200数字胃肠机下行子宫输卵管造影。实验组利用Zentith-1710自动推注系统注射碘海醇,速率为0.2ml/s,压力为200PSI,若一侧或双侧不通,加压至300PSI进行加压造影,同时点片,并记录注射造影剂用量及X线曝光时间；注意患者的反应,预防输卵管破裂。对照组采用10ml注射器手推碘海醇进行子宫输卵管造影,遇阻力时可略加大注射压力,但以患者能忍受的压力范围之内,同时脚踩曝光按钮进行透视及摄片。两组在点片完毕用5m1注射器抽出球囊内气体,撤管,观察盆腔造影剂的弥散情况。3分析方法将输卵管的HSG表现分为正常和异常两组,正常者为完全通畅,异常包括完全梗阻、通而不畅和周围粘连。完全梗阻进一步区分出近段梗阻和远段梗阻。记录两组正常和异常输卵管的条数,比较两种方法各种情况之间的差异,并对两种方法中造影剂用量、X线曝光时间、造影剂逆流进行对比。根据影像资料,对通畅输卵管的近段和远段的长度及内径进行测量,与体调值对比,并且进行两组间比较。对实验组异常输卵管加压前后影像资料进行解剖学分析。所有结果采用SPSS软件建立数据库并进行统计分析,计量资料以均数±标准差(x±s)表示,两组对比采用t检查；计数资料用χ2检验,P0.05有统计学意义,表示二者差异显著。结果：两组不孕症患者的年龄、不孕史、妊娠次数等一般情况对比均无显著性差异,所以两组的造影结果具有可比性。(1)两组的诊疗效果对比：两组均为200条输卵管,实验组通畅条数为138条,对照组为116条,实验组明显高于对照组,有统计学意义。输卵管完全梗阻的实验组为43条,对照组为70条,完全梗阻率明显低于对照组。通而不畅实验组为9条,对照组为8条；周围粘连实验组为10条,对照组为6条,后两项均无明显差别。(2)两组用药剂量、不良反应及曝光时间对比：用药剂量实验组高于对照组；两组的不良反应无明显差别,两组均未引起严重不良反应。曝光时间实验组低于对照组,缩短了曝光时间,降低了患者X线辐射。(3)两组影像资料的解剖学分析：HSG正常表现为与子宫角相连的输卵管呈线状自内侧到外侧由细逐渐变粗,造影剂自输卵管伞部流出进入腹腔内,呈条片状或条纹状弥散涂抹于卵巢周围或周围肠管上,随着时间延长,逐渐变淡。完全梗阻的影像学表现为至少一侧输卵管完全不显影,或者部分显影,但远端未见弥散。完全梗阻进一步区分,将峡部及其以内的梗阻称为近段梗阻,壶腹部及其以远至伞端的梗阻为远段梗阻。通而不畅的影像学表现为至少有一侧输卵管的形态欠规则、毛糙、增粗或粗细不均,管壁欠光滑,仅有部分造影剂通过,.输卵管周围可伴／或不伴有粘连。周围粘连的影像学表现为伞端造影剂聚集成团,未弥散或弥散不良。实验组和对照组通畅输卵管近段长度分别43.83±7.53mm、41.60± 4.93mm;远段分别38.29±8.58mm、39.89±6.25mm;近段内径分别为0.63±0.10mm、0.66±0.12m;远段内径分别为3.99±0.88mm、3.90±0.71mm,两组各段长度及内径对比,无显著差异；但两组通畅输卵管近段长度均大于体调数值,内径值小于体调数值,通畅输卵管远段的测量值略低于体调数值,内径值差别不大。提示两种方法可拉伸输卵管近段的长度,但对输卵管的形态无明显改变。根据HSG可拉伸输卵管近段这一结果,可通过测量显影输卵管的长度,推测输卵管的梗阻位置。部分近段梗阻患者通过加压可促进峡部再通；而远段梗阻的病例,当压力升高时,由于不良反应明显加重,再通效果不明显。加压法可提高近段梗阻的再通率。通而不畅及周围粘连的加压后影像学改变不明显。结论：(1)逐渐加压法子宫输卵管造影在输卵管阻塞性不孕症诊疗价值优于常规法。该方法操作简单,降低了X线的辐射,可取得较满意的图像结果。(2)高压法HSG可以显著提高梗阻的复通率,并且对近段梗阻复通效果好于远段梗阻。(3)高压法HSG对输卵管壶腹部不完全梗阻和伞端粘连也有改善作用。
[Abstract]:Objective: To compare the application of the improved progressive pressure hysterosalpingography with the traditional hand push hysterosalpingography in the diagnosis and treatment of oviduct obstructive infertility, to explore the superiority and feasibility of the high-pressure syringe compression method, and to make an anatomic analysis of the imaging materials of the two methods, so that the examination of the HSG is more important. Add safety and specification to provide new scientific basis for clinical diagnosis and treatment. Methods: 1 subjects were collected from second central hospitals in Baoding city from January 2005 to December 2013, 200 cases of female infertility, aged 20-44 years old, with an average of 29.3 years. Two groups of patients were divided into two groups with retrospective study, and 100 patients were injected with high pressure injection. Hysterosalpingography was used as a study group, and 100 cases of routine hand push hysterosalpingography were used as the control group. The two groups were excluded from the congenital dysplasia of the uterus and the cases of oviduct resection. All patients signed the informed consent.2 research equipment and methods in two groups of patients within 3-7 days after menstruation. The doctor operates a double cavity balloon catheter into the uterus via the vagina and then comes to our department SIEMENS R200 digital gastrointestinal machine for hysterosalpingography. The experimental group uses a Zentith-1710 automatic injection system to injecting iodiol with a rate of 0.2ml/s and pressure of 200PSI. If one side or two side is not accessible, compression to 300PSI is performed at the same time. Point film, record the dosage of injection contrast agent and X-ray exposure time, pay attention to the response of the patient and prevent the rupture of the tubal. The control group adopts the 10ml syringe hand to push the hysterosalpingography with iodiol, and can slightly increase the injection pressure in the case of resistance, but it is within the range of pressure that the patient can endure, while the exposure button of the foot is taken for perspective and photography. In the two group, the gas was pumped out of the balloon with the 5m1 syringe at the end of the point slice, and the catheter was withdrawn and the dispersion of the pelvic contrast agent was observed. The.3 analysis of the fallopian tubes was divided into two groups of normal and abnormal groups. The normal subjects were completely unobstructed, including complete obstruction, unobstructed and peripheral adhesion. The proximal obstruction and distal segment were divided in the further area of complete obstruction. Obstruction. Record the number of two groups of normal and abnormal fallopian tubes, compare the differences between the two methods, and compare the dosage of contrast agent, X-ray exposure time, and contrast medium in the two methods. According to the image data, the length and diameter of the proximal and distal segments of the tubal are measured, and the value is compared with the body adjustment. Comparison between the two groups. Anatomic analysis of the imaging data before and after the abnormal fallopian tube compression in the experimental group. All the results were made up of SPSS software to establish a database and carried out statistical analysis. The measurement data were expressed in the mean number of standard deviations (x + s). The two groups were compared with the t examination; the count data were tested by chi 2, and P0.05 was statistically significant, indicating that the two differences showed significant difference. Results: there was no significant difference in age, infertility history and pregnancy times between the two groups of infertility, so the results of the two groups were comparable. (1) the comparison of the results of diagnosis and treatment in the two groups: two groups were 200 oviduct, the number of unobstructed strips in the experimental group was 138, the control group was 116, and the experimental group was significantly higher than the control group. There were obviously higher than the control group. Statistical significance. The total obstruction of oviduct was 43 in the experimental group and 70 in the control group. The total obstruction rate was significantly lower than that in the control group. The experimental group was 9, the control group was 8, the peripheral adhesion experimental group was 10, the control group was 6, and the two items were not significantly different. (2) the dosage of drug use, adverse reaction and exposure time comparison of the two groups were compared: (2) the contrast of the adverse reactions and exposure time: The drug dose in the experimental group was higher than that in the control group; there was no significant difference in the adverse reaction between the two groups. The two groups did not cause serious adverse reactions. The exposure time experimental group was lower than the control group. The exposure time was shortened and the X-ray radiation was reduced. (3) the anatomical analysis of the two groups of images: HSG is often shown as a linear self of the fallopian tubes connected with the horns of the uterus. The medial to lateral is gradually thickened, and the contrast agent outflows into the abdominal cavity from the parachute part of the fallopian tube and spreads on the ovary around the ovary or the surrounding intestines, and gradually dilute with time. The image of complete obstruction is at least on the side of the fallopian tube, or partial development, but the distal end is not diffuse. The obstruction of the isthmus and its internal obstruction is called the proximal obstruction. The ampullary and the obstruction from the distal to the parachute end is a distal obstruction. The unobstructed imaging shows that at least one side of the fallopian tube is under the irregular shape, coarse, coarse or coarse, and the tube wall is less smooth and only a part of the contrast agent passes, around the fallopian tube. The imaging findings of peripheral adhesions were cluster of parachute end contrast agents, which were not diffuse or diffuse. The length of the proximal segment of the fallopian tube in the experimental group and the control group was 43.83 + 7.53mm and 41.60 4.93mm, respectively, 38.29 + 8.58mm and 39.89 + 6.25mm in the distal segment, respectively 0.63 + 0.10mm and 0.66 0.12M, respectively. The length and diameter of the two groups were 3.99 + 0.88mm and 3.90 + 0.71mm, but there was no significant difference between the length and diameter of the two groups. However, the length of the tubal proximal segment in the two groups was larger than the body modulation value. The inner diameter was less than the body modulation value. The measured value of the unobstructed fallopian tube far segment was slightly lower than the volume modulation value. The length of the inner diameter was not significant. But the length of the proximal segment of the fallopian tube could be drawn by two methods, but the length of the proximal segment of the tubal was stretched. There is no obvious change in the shape of the fallopian tubes. According to the results of the HSG extensible tubal proximal segment, the position of the oviduct obstruction can be speculated by measuring the length of the oviduct. The patients with proximal obstruction can promote the repassage of the isthmus through pressure; and the cases of distal obstruction, when the pressure is increased, the adverse reaction is obviously aggravated and reacting. The pressure method can improve the recanalization rate of the proximal obstruction. It is not obvious that the imaging changes after the pressure and the pressure of the surrounding adhesion are not obvious. Conclusion: (1) the value of the hysterosalpingography in the diagnosis and treatment of oviduct obstructive infertility is better than that of the conventional method. The method is simple and the X-ray radiation can be reduced, and a satisfactory image can be obtained. Results. (2) high pressure method HSG can significantly improve the repassage rate of obstruction, and the effect of proximal obstruction is better than that of distal obstruction. (3) high pressure method HSG can improve the incomplete obstruction of the oviduct and the parachute end adhesion.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.6
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本文编号：1882615