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。

Transvaginal Real-Time Three-Dimensional Hysterosalpingo-Contrast Sonography in Assessing Contralateral Tubal Patency in Patients after Unilateral Salpingectomy

Objective: To evaluate the diagnostic value of transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (RT-3D-HyCoSy) in assessing the contralateral tubal patency in patients after unilateral salpingectomy. Methods: A total of 66 patients of childbearing age with a history of unilateral salpingectomy and fertility needs who were treated in the gynecological outpatient department of Beijing Friendship Hospital from March 2018 to December 2021 were enrolled, and the contralateral fallopian tubes were examined by transvaginal RT-3D-HyCoSy. According to the patency of the fallopian tubes, the patients were divided into the patency group, the partial patency group and the obstruction group, and the pain scores of the three groups were compared. According to whether the contrast agent reflux occurred during the hysterosalpingo-contrast sonography, the patients were divided into the reflux group and the non-reflux group, and the endometrial thickness and fallopian tube obstruction rate were compared between the two groups. Results: Because of the obvious retroflexion of the uterus in one case, the hysterosalpingographic tube was stuck in the scar of the anterior wall of the uterus after cesarean section, and the catheterization was not successful, so the results of 65 cases were collected successfully. Transvaginal RT-3D-HyCoSy showed that 35 (53.8%) fallopian tubes were patent, 15 (23.1%) were partially patent, and 15 (23.1%) were obstructed. Myometrial contrast agent reflux occurred in 13 cases (20%), but not in 52 cases (80%). There was a statistically difference in the mean pain scores between the patency group, the partial patency group and the obstruction group (F=56.469, P<0.001), and the mean pain score in the obstruction group was greater than that in the partial patency group while this score in the partial patency group was greater than that in the patency group (all P<0.001). There was no significant difference in the mean endometrial thickness (t=0.163, P=0.872) and the rate of tubal obstruction ( χ²=3.385, P=0.066) between the groups with and without reflux. Conclusions: Transvaginal RT-3D-HyCoSy can better evaluate the patency of the contralateral fallopian tube in patients after unilateral salpingectomy, and the patients tolerate it well. This auxiliary examination provides an important reference for such patients to prevent the occurrence of recurrent ectopic pregnancy, and for doctors to decide whether the assisted reproduction treatment is suitable.