子宫输卵管造影与腹腔镜检查对输卵管通而不畅诊断的对比研究

发布时间：2018-06-07 01:30

  本文选题：子宫输卵管造影 + 腹腔镜检查　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:分析子宫输卵管造影对比腹腔镜在诊断输卵管通而不畅中的准确率,以及两者的对比差异,了解子宫输卵管造影对诊断输卵管通而不畅的价值及对临床选择合适的腹腔镜手术时机提供建议与依据。方法:收集浙江大学附属妇产科医院门诊与住院资料,选取2014.1.1至2016.12.31在我院门诊行子宫输卵管造影诊断为输卵管通而不畅,同时在我院住院部行腹腔镜检查的患者;对比子宫输卵管造影结果与腹腔镜检查结果,收集患者年龄、检查间隔时间、生育史、盆腹腔手术史、对侧输卵管通畅程度及是否存在盆腔其他异常;分析各条件下腹腔镜下检查结果的区别。结果:录入患者199位,共397条输卵管,其中290条HSG诊断为通而不畅。HSG诊断为通而不畅的输卵管腹腔镜检查提示167条为通畅,17条通而欠畅,52条通而不畅,10条通而极不畅,22条近端堵塞,8条远端堵塞,14条积水,符合率为17.9%;患者年龄与输卵管通畅程度分析时,选取35岁为节点分为两组,高龄组与低领组,高龄组(n=34)术中输卵管堵塞占26.5%,术中输卵管状态评分5.06±7.71,低龄组(n=256),术中输卵管堵塞占13.7%,术中输卵管状态评分3.46±6.21。低龄组输卵管通畅程度及状态评分显著优于高龄组,具有统计学差异(P0.05)。以患者的不孕类型分组,分为原发不孕组(n=173)与继发不孕组(n=153),术中原发不孕组输卵管状态评分为2.58±5.19,术中堵塞输卵管占11.6%;继发不孕组输卵管通畅程度评分为5.22±7.63,术中输卵管堵塞占20.5%,继发不孕组输卵管通畅程度及输卵管状态评分显著低于原发不孕组,具有统计学差异(P0.05)。根据患者生育史分为平产组(n=29)与剖宫产组(n=16)进行对比分析,两组之间术中卵管状态及通畅程度均无显著性差异(P0.05)。腹腔镜检查与HSG检查相隔时间≤12个月(n=267条),术中输卵管状态评分为3.85±6.28,间隔时间12个月(n=23条),术中输卵管状态评分为4.87±7.84.间隔时间小于12个月组患者术中输卵管状态评分优于大于12个月组患者,但两者无明显统计学差异(P0.05)。近期组术中输卵管堵塞率为14.1%低于远期组(30.4%),两者具有统计学差异(P0.05)根据患者手术史分为无手术史组(n=188),宫腔手术史(n=74)、腹腔手术史组(n=21),提示,腹腔手术史组对比无手术史组在术中输卵管状态及输卵管通畅程度上均无统计学差异。宫腔手术史组术中输卵管状态评分(5.50±7.65)高于无手术组术中输卵管状态程度评分(2.74±5.38),具有统计学意义(P0.05);宫腔手术组堵塞输卵管占20.3%明显高于无手术组(6.9%)具有统计学意义(P0.05)。根据对侧输卵管情况分为优组(通畅/通而欠畅)与差组(堵塞/积水),优组(n=55)术中输卵管状态评分为2.69±4.99,术中堵塞输卵管占5.7%;差组(n=51)术中卵管状态评分为8.37±8.34,术中输卵管堵塞占27.5%,优组输卵管状态评分及输卵管通畅程度显著优于差组,两组间有明显显著学差异(P0.05)。腹腔镜检查患者中其中术前诊断合并子宫肌瘤有13条,合并腺肌病1条,合并畸胎瘤2条,合并内异26条,合并积水20条。其中合并子宫肌瘤、内异囊肿的患者与无其他盆腔异常的患者术中检查输卵管通畅程度均无明显统计学差异(P0.05)。术前无明显盆腔异常的患者术中输卵管状态评分为2.80±5.56,堵塞占11.7%;合并积水组术中输卵管状态评分为12.15±6.64,堵塞占35%。合并积水的患者术中输卵管堵塞率及输卵管状态评分均明显高于无手术组患者,具有统计学差异(P0.05)。选择检查间≤12个月,年龄35岁,排除合并异位囊肿、积水必要行腹腔镜检查的患者,排除对侧输卵管为堵塞或积水,排除宫腔手术史,共77个患者,127条HSG诊断为通而不畅的输卵管,术中腹腔镜诊断结果通畅86条,通而欠畅6条,通而不畅26条,通而极不畅2条,近端堵塞5条,远端堵塞3条。其中可以通过腹腔镜下手术处理(术中输卵管评分8分的)共4人,的仅占5.2%。结论:子宫输卵管造影对于诊断输卵管通而不畅的符合率较低。合并有高龄、宫腔手术史、对侧输卵管条件差、积水、HSG检查间隔时间12个月的患者更建议行腹腔镜检查明确输卵管状态。未合并以上因素的患者术中输卵管通畅率较高。
[Abstract]:Objective: to analyze the accuracy of hysterosalpingography compared with laparoscopy in the diagnosis of tubal obstruction, and the difference between them, and to understand the value of hysterosalpingography in the diagnosis of tubal obstruction and to provide advice and basis for the selection of appropriate laparoscopic operation time. Methods: to collect the affiliated obstetrics and Gynecology of Zhejiang University. The data of hospital outpatient and hospitalization were selected from 2014.1.1 to 2016.12.31 in the outpatient department of our hospital with hysterosalpingography, which was diagnosed as fallopian tube and unobstructed, and in the hospital of our hospital, the patients were examined by laparoscopy, and compared with the results of hysterosalpingography and laparoscopy, the age of the patients, the interval time, the history of birth, and the pelvic and abdominal surgery were collected. History, the degree of patency of the lateral fallopian tube and the presence of other pelvic abnormalities; analysis of the differences in the results of laparoscopy under various conditions. Results: 199 patients were enrolled and 397 oviducts were recorded, of which 290 HSG were diagnosed as unobstructed.HSG diagnosis of tubal laparoscopy, and 167 were unobstructed, 17 unobstructed and 52. And not smooth, 10 passage and very poor, 22 proximal blockage, 8 distal blockage, 14 hydrops, the rate of 17.9%. When the age and tubal patency analysis, selected two groups of 35 years old, the age group and the low collar group, the elderly group (n=34) oviduct blockage accounted for 26.5%, the intraoperative oviduct status score 5.06 + 7.71, low age group (n=256), The oviduct blockage in the operation accounted for 13.7%. The oviduct status score in the 3.46 + 6.21. group was significantly better than that in the elderly group (P0.05). The patients' infertility group was divided into primary infertility group (n=173) and secondary infertility group (n=153), and the oviduct status score of the Zhongyuan infertility group was 2.58. The oviduct blockage in the operation was 11.6%, and the level of tubal patency was 5.22 + 7.63 in secondary infertility group and 20.5% of oviduct obstruction in the operation. The level of tubal patency and tubal status in secondary infertility group was significantly lower than that of the primary infertility group (P0.05). According to the history of childbirth, the patients were divided into the flat production group (n=29) and caesarean section (n =16) contrast analysis, there was no significant difference in the state and patency of the oviduct between the two groups (P0.05). The interval between the laparoscopy and the HSG examination was less than 12 months (n=267), the oviduct status score was 3.85 + 6.28, the interval time was 12 months (n=23), and the oviduct status score in the operation was 4.87 + 7.84. interval less than 12 months. The oviduct status score of the patients was better than those in the 12 months group, but there was no significant difference between the two groups (P0.05). The rate of tubal blockage in the recent group was 14.1% lower than that in the long-term group (30.4%), and the difference was statistically significant (P0.05) according to the patient's operation history (n=188), the history of uterine cavity surgery (n=74), and the history of abdominal surgery (n=21). It was suggested that there was no statistical difference in the oviduct status and the patency of the oviduct in the group without operation history. The oviduct status score in the uterine cavity surgery group was 5.50 + 7.65 higher than that in the non operative group (2.74 + 5.38), with statistical significance (P0.05); the uterine cavity operation group blocked the fallopian tubes. 20.3% was significantly higher than that in the non operative group (6.9%) (P0.05). The oviduct status in the superior group (n=55) was 2.69 + 4.99, the oviduct was 5.7% in the operation, and the oviduct status in the operation group (n=51) was 8.37 + 8.34 during the operation and the oviduct in the operation. The blockage accounted for 27.5%. The oviduct status score and the degree of tubal patency were significantly better than those in the poor group. There were significant differences between the two groups (P0.05). Among the laparoscopic patients, 13 were diagnosed with uterine myoma, 1 with adenomyosis, 2 with teratoma, 26 with endometriosis, and 20 in the combined hydromyoma. There was no significant difference in the degree of tubal patency in patients with abnormal cysts and other pelvic abnormalities (P0.05). The oviduct status score of the patients without obvious pelvic abnormalities before operation was 2.80 + 5.56, and the blockage accounted for 11.7%, and the oviduct status score in the combined hydropic group was 12.15 + 6.64, and the blockage accounted for the patients with 35%. combined with water accumulation. The oviduct blockage rate and the oviduct status score of the patients were significantly higher than those in the non operation group (P0.05). The selection examination room was less than 12 months, the age 35 years old, excluding ectopic cysts, the necessary laparoscopic examination, the exclusion of the lateral oviduct obstruction or water, the exclusion of the history of uterine cavity surgery, a total of 77 patients, 127 HSG was diagnosed as unobstructed fallopian tube, and the results of laparoscopy were unobstructed in 86 cases, through and unobstructed 6, through and unobstructed 26, through and unobstructed 2, 5 in the proximal end and 3 in the distal end. Among them, 4 people could be treated by laparoscopy (intraoperative oviduct score 8), only 5.2%. conclusion: hysterosalpingography for diagnosis The conforming rate of unobstructed fallopian tubes was low. The patients who had the history of uterine cavity surgery, poor lateral fallopian tube conditions, water accumulation, and HSG examination interval of 12 months were more recommended for the diagnosis of fallopian tube status.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.6
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本文编号：1989077