球囊导管加压注射法子宫输卵管造影对不孕症的应用价值

目的探讨利用球囊导管加压注射泛影葡胺行子宫输卵管造影的应用价值。方法对219例不孕症用76%泛影葡胺采用球囊导管加压注射法作子宫输卵管造影检查,并在透视下实时点片。结果普通注射时双侧输卵管显示185例(84.47%),单侧显示24例;加压注射后203例(92.69%)双侧输卵管显示,单侧显示14例,成功率100%。子宫畸形见于9例,输卵管异常131例,造影剂弥散与吸收异常104例。结论利用球囊导管加压注射水溶性造影剂,可以明显提高子宫输卵管造影质量及输卵管再通效果,有重要的临床价值。     

经阴道实时三维子宫输卵管超声造影成像技术评估单侧输卵管切除术史患者对侧输卵管通畅性

目的： 探讨经阴道实时三维子宫输卵管超声造影成像技术（real-time three-dimensional hysterosalpingo-contrast sonography,RT-3D-HyCoSy）对评估单侧输卵管切除术史患者对侧输卵管通畅性的应用价值。方法： 选取2018年3月—2021年12月于首都医科大学附属北京友谊医院妇科门诊就诊有单侧输卵管切除术史且有生育需求的育龄期患者66例,运用经阴道RT-3D-HyCoSy检查其对侧输卵管通畅性。根据造影结果输卵管是否通畅,分为通畅组、通而不畅组和阻塞组,比较3组患者疼痛评分。根据造影过程中是否发生造影剂逆流,分为有逆流组和无逆流组,比较2组患者的子宫内膜厚度和输卵管阻塞率。结果： 因1例患者子宫明显后屈,造影管卡在剖宫产术后的子宫前壁瘢痕处,置管未成功,故成功收集65例结果,超声造影显示输卵管35条（53.8%）通畅,15条（23.1%）通而不畅,15条（23.1%）阻塞。造影过程中13例（20%）发生子宫肌层造影剂逆流,52例（80%）未发生。输卵管通畅组、通而不畅组、阻塞组患者疼痛评分比较,差异有统计学意义（F=56.469,P<0.001）,阻塞组大于通而不畅组,通而不畅组大于通畅组（P<0.001）。有逆流组和无逆流组的子宫内膜厚度（t=0.163,P=0.872）和输卵管阻塞率（χ²=3.385,P=0.066）比较,差异均无统计学意义。结论： 经阴道RT-3D-HyCoSy能较好地评估单侧输卵管切除术史患者对侧输卵管的通畅性,患者耐受性较好,能为临床提供可视性强的图片信息,为生殖医学科医生预防此类患者再次发生异位妊娠及选择助孕方式提供了重要依据。     

Sonohysterosalpingographic screening for infertile patients.

OBJECTIVES: To compare the diagnostic accuracy of hysterosalpingography and sonohysterosalpingography in detecting tubal and uterine abnormalities. METHODS: In a prospective study for the evaluation of uterine and tubal pathologies, 186 patients with primary and secondary infertility rates (51.6% and 44%, respectively), as well as recurrent abortion rates (3.8%), underwent sonohysterosalpingography. The tubal pathologies, as well as intracavitary and/or structural uterine abnormalities, detected with this procedure were compared with preoperative hysterosalpingography and operative procedures. RESULTS: With surgical findings as the gold standard, sonohysterosalpingography had a sensitivity of 78.2%, a specificity of 93.1%, a positive predictive value of 82.7%, and a negative predictive value of 91%. For total tubal and uterine pathologies, the findings for the same parameters using HSG were 76.3%, 81.8%, 90.9%, and 59.2%, respectively. Sonohysterosalpingography was more accurate than hysterosalpingography for detecting intrauterine adhesions and various forms of uterine anomalies. CONCLUSIONS: Sonohysterosalpingography is a safe, easy, accurate, and promising procedure for the detection of female upper genital tract pathologies, especially because it can differentiate specific uterine anomalies.     

Application of Injection at Acupoint Zusanli （ST 36） in Hydrotubation

220例行输卵管通液术的患者被分为实验组(n=110)和对照组(n=110),实验组患者在进行输卵管通液术前用维生素K1足三里穴位注射,对照组术前不作其他处理.实验组不良反应例数明显少于对照组,且反应较轻.实验组输卵管通畅89例,占80.9%,对照组输卵管通畅63例,占57.3%.     

Role of Hysteroscopy Prior to Assisted Reproduction Techniques

Study ObjectiveTo determine whether diagnostic hysteroscopy before assisted reproduction techniques (ΑRT) in women without known disease of the uterine cavity is necessary.DesignProspective cohort clinical study.SettingReproductive medicine clinic.PatientsThe study group consisted of 217 infertile women attending the Reproductive Clinic for examination before undergoing ART, either in vitro fertilization or intracytoplasmic sperm injection.InterventionsPatients underwent transvaginal sonography (TVS) and hysterosalpingography (HSG) for initial evaluation. If there were no abnormal intrauterine findings, diagnostic hysteroscopy was additionally performed.Measurements and Main ResultsThe safety and diagnostic value of hysteroscopy before ART was examined. Diagnostic hysteroscopy was performed successfully, without complications, in all 217 women. Ninety-five (43.7%) had a history of ART failures (group 1), and 122 (56.3%) had undergone no previous ART attempts (group 2). In 148 women (68.2%), findings at hysteroscopy were normal, whereas in 69 (31.8%), hysteroscopy revealed intrauterine lesions (polyps, septa, submucosal leiomyomas, or synechiae) that led to operative hysteroscopy. The most common intrauterine abnormality was the presence of endometrial polyps in 26 patients (12%). The total percentage of abnormal intrauterine findings was higher in women with a history of repeated ART failures in comparison with those with no history of ART attempts. No statistically significant difference in the outcome of in vitro fertilization or intracytoplasmic sperm injection was observed between women with normal hysteroscopic findings and patients with hysteroscopically corrected endometrial disease.ConclusionSensitivity of diagnostic hysteroscopy is significantly higher than TVS and HSG in the diagnosis of intrauterine lesions. Diagnostic hysteroscopy should be performed before ART in all patients, including women with normal TVS and/or HSG findings, because a significant percentage of them have undiagnosed uterine disease that may impair the success of fertility treatment.     

联合应用子宫输卵管造影和B超监测卵泡治疗不孕症的疗效观察

目的 观察联合应用子宫输卵管造影和B超监测卵泡治疗不孕症的疗效.方法 将584例不孕症患者按照随机数字表法分为对照组(接受综合优化治疗)和研究组(接受综合优化治疗及优势输卵管侧助孕治疗),每组292例.所有患者均接受子宫输卵管造影,研究组接受B超监测卵泡以确定优势卵泡.结果 研究组宫内妊娠率高于对照组[40.07%(117/292)比19.86%(58/292)](P＜0.01),异位妊娠率低于对照组[29.79%(87/292)比51.37%(150/292)](P＜0.01).输卵管通而不畅者异位妊娠率[74.36%(58/78)]高于输卵管积水[38.96%(30/77)]、输卵管阻塞[38.24%(104/272)]、输卵管尚通[28.66%(45/157)](P＜0.01).结论 子宫输卵管造影可以了解不孕症患者输卵管情况,B超监测卵泡发育可以确定优势卵泡.两者结合指导性生活,可以提高妊娠率,值得临床推广.

Abstract：

Objective To observe the therapeutic effect on the infertilitas feminis combining hysterosalpingography (HSG) and B ultraphonic monitor for the follicle. Methods Five hundred and eighty-four patients with infertility were divided into two groups by random digits table: control group with 292 patients received the combined optimized treatment, and study group with 292 patients received the combined optimized treatment and optimizing fallopian tube to be pregnant. All patients received the HSG while the patients of the study group received the B ultraphonic monitor for the dominant follicle besides. Results The intrauterine gestation rate in the study group was higher than that in the control group [ 40.07% (117/292) vs. 19.86% (58/292)] (P ＜0.01),and the eccyesis rate was lower than that in the control group [29.79% (87/292) vs. 51.37%(l50/292)](P＜0.01). The eccyesis rate in fallopian tube incompletely unobstructed [74.36% (58/78)] was higher than that in hydrosalpinx [ 38.96% (30/77)] , salpingemphraxis [38.24% (104/272)] and fallopian tube unobstructed[28.66%(45/157)](P＜0.01). Conclusions HSG can detect and imply the situation of the fallopian tube of the infertilitas feminis women, and B ultraphonic can monitor the follicular development to catch the dominant follicle. Combining these two detection and guiding sexual life can raise the intrauterine gestation rate. It should be widely use in clinic.     

子宫内膜结核的子宫输卵管造影表现

目的探讨子宫内膜结核的子宫输卵管造影(HSG)表现。方法回顾性分析经宫-腹腔镜、刮除活检、组织学检查、细菌培养、聚合酶链式反应(PCR)及病理证实的18例子宫内膜结核患者,分析其HSG表现。结果 14例子宫内膜结核患者具有特异性改变,包括三叶草样、T型、假单角子宫、指套样等。4例为非特异性表现,包括子宫内膜炎、宫腔粘连变形以及对比剂渗入静脉及淋巴管。结论 HSG是诊断子宫内膜结核的一种重要检查方法,对于不明原因的不孕女性患者应尽早常规行HSG检查,可为临床不孕不育诊治提供重要依据。     

宫腔镜输卵管插管通液术在输卵管性不孕诊治中的应用

目的探讨宫腔镜下输卵管插管通液术对输卵管通畅度诊断的价值以及对输卵管通而不畅治疗的作用。方法 2009年1～12月120例不孕者（233条输卵管）经子宫输卵管造影术（hysterosalpingography,HSG）诊断为输卵管通而不畅214条,近端阻塞或未显影19条,宫腔镜输卵管插管通液来进一步诊断和治疗。结果 HSG诊断214条输卵管通而不畅,宫腔镜下输卵管插管通液诊断142条通而不畅,63条通畅,9条阻塞;HSG诊断19条输卵管近端阻塞或未显影,宫腔镜下输卵管插管通液诊断10条不通,5条通畅,4条通而不畅。146条（76例）输卵管通而不畅经通液治疗1～3次后,通畅110条（57例）,通而不畅36条（19例）,插管治疗治愈率75.3%（110/146）,病例治愈率75.0%（57/76）。对治疗后通畅的57例术后随访1年,术后1年内受孕率57.9%（33/57）,分娩率54.4%（31/57）;治疗后输卵管通而不畅的19例建议行宫、腹腔镜联合检查。结论宫腔镜下输卵管插管通液术对输卵管性不孕的诊断和通而不畅的治疗是安全、经济而有效的。     

超声子宫输卵管造影中近端输卵管“梗阻”的方法学研究

目的：探讨超声子宫输卵管造影中近端输卵管“梗阻”方法的可行性。方法选取2011年1月～2014年1月本院妇产科就诊的疑患不孕症患者175例,按完全随机分组方法将患者分成A、B、C、D共4个组。四组按不同方法进行造影。结果各组输卵管显示情况比较,近端梗阻率A组最高,为30.12%,B组为22.99%,C组为17.05%,D组最低为10.00%,四组比较差异有统计学意义（P＜0.05）。远端梗阻四组比较,差异无统计学意义（P＞0.05）。结论经阴道超声子宫输卵管造影对输卵管是否通畅判断准确,而且其有一定治疗作用。     

实时三维超声子宫输卵管造影评估不孕症患者输卵管显影时间

目的 分析不孕症患者实时三维超声子宫输卵管造影（RT-3D-HyCoSy）中输卵管显影时间,以评价输卵管通畅性。方法 回顾性分析同时接受RT-3D-HyCoSy和宫（腹）腔镜检查,并经宫（腹）腔镜检查证实的不孕症患者50例,计录输卵管显影时间,并进行统计学分析。结果 50例患者中双侧通畅27例（27/50,54.00%）;单侧通畅15例（15/50,30.00%）;双侧梗阻8例（8/50,16.00%）。通畅输卵管69条,梗阻输卵管31条。双侧通畅患者左、右侧、单侧通畅患者通畅侧输卵管显影时间差异无统计学意义（χ²=-5.12,P=0.08）;双侧梗阻患者左、右侧、单侧通畅患者梗阻侧输卵管显影时间差异无统计学意义（χ²=-2.81,P=0.25）。69条通畅输卵管显影时间为1.67~31.73 s（中位数6.68 s）,31条梗阻输卵管显影时间为0~25.05 s（中位数1.67 s）,梗阻输卵管显影时间小于通畅输卵管显影时间,差异有统计学意义（Z=6.029,P<0.01）。结论 RT-3D-HyCoSy可用以准确计量不孕症患者输卵管显影时间,为评估输卵管通畅性提供了新的参考依据。