经阴道子宫输卵管超声造影在不孕症诊断中的应用

目的:探讨经阴道子宫输卵管超声造影对不孕症的诊断和治疗方法。方法:对159例不孕症患者进行B超下双氧水造影加药物治疗。结果:159例中,140例明确诊断,诊断符合率88.1%,109例达到治疗目的,有效率为68.6%。结论:经阴道子宫输卵管超声造影具有无创、简便、高效等优点,对不孕症的诊断有较高的价值,并有良好的治疗效果。     

经阴道B超诊断输卵管积液的价值

目的评价经阴道超声检查诊断输卵管积液的临床价值。方法不孕症患者经阴道超声检查，并对检查结果进行比较．经子宫输卵管造影术或腹腔镜手术证实的输卵管积液患者434例，共550个病灶，术前分别以双盲法进行。结果经阴道超声检查正确诊断434例，检出病灶550个，误诊3个，诊断准确率为99．7％。结论经阴道超声检查对输卵管积液诊断的诊断准确率高（99．7％），有较高的临床实用价值。     

经阴道输卵管超声诊断输卵管通畅性应用

目的:研究经阴道输卵管声学造影(TSSG)在诊断输卵管通畅性中的临床应用.方法:对586例不孕症患者,在阴道B超下进行了输卵管的经阴道输卵管声学造影检查.结果:经阴道输卵管声学检查操作简便、费用低、创伤小、诊断率高且有一定的治疗作用.结论:经阴道输卵管声学造影是诊断输卵管通畅性的安全可靠的方法.     

阴道B超下输卵管盆腔显影技术在不孕症检查中的应用

目的评价阴道B超输卵管盆腔显影术在不孕症临床诊治中的价值。方法在阴道超声的引导下,经阴道穹隆穿刺向盆腔注入1000ml~1500ml生理盐水后,再经宫腔注入“造影剂”,同时用阴道超声探头作盆腔扫描。结果不仅能观察到输卵管是否通畅,而且能观察到输卵管伞端形态和活动度以及盆腔是否有粘连带等。输卵管伞端显影率与对照组的差异具有非常显著性意义(P<0.01)。结论阴道B超输卵管盆腔显影技术在不孕症的诊断中,有着很高的临床应用价值。     

阴道超声下宫腔输卵管通液123例分析

目的:探讨阴道超声下宫腔输卵管通液对不孕症患者的应用价值。方法:分析123例不孕症患者行阴道超声下宫腔输卵管通液检查的结果。结果:不孕症患者中有41例存在宫腔异常(33.3%),有74例双侧或单侧输卵管不通畅或欠通畅(60.2%),有5例盆腔粘连。治疗后随访6~24个月,妊娠率达41.9%。结论:阴道超声下宫腔输卵管通液有助于宫腔病变的鉴别诊断,对输卵管性不孕有较好的诊断及治疗意义。     

经阴道B超诊断输卵管结核的价值

近年来,各种原因引起的不孕症的发病率呈逐年上升趋势,其中输卵管结核是导致原发性不孕的一个重要原因。本文采用经阴道B超诊断由于输卵管结核导致的原发性不孕症12例,其中7例进行X线摄片、彩色超声、CT、腹腔镜等检查,所有病例均经诊断性治疗或病理检查证实为输卵管结核。现报道如下。     

腹部B超与阴道B超诊断异位妊娠的临床效果

目的比较腹部B超与阴道B超诊断异位妊娠的临床效果。方法选取2018年1月至2019年6月天津市河西医院收治的经手术病理检查确诊的异位妊娠患者70例作为研究对象,所有患者均行腹部B超及阴道B超检查,比较两种检查方式诊断异位妊娠的准确率及盆腔积液、附件包块、假孕囊、胚芽检出率。结果阴道B超诊断准确率显著高于腹部B超,差异有统计学意义(P<0.05);阴道B超盆腔积液、附件包块、假孕囊以及胚芽检出率高于腹部B超,差异有统计学意义(P<0.05)。结论阴道B超诊断异位妊娠准确率高于腹部B超,且阴道B超盆腔积液、附件包块、假孕囊以及胚芽检出率更高。     

双氧水子宫输卵管声学造影术的临床应用

目的 探讨双氧水子宫输卵管声学造影术的临床应用价值。方法 对66例不孕症患者进行B超监测下双氧水子宫输卵管声学造影术，用以检查输卵管通畅程度。结果 根据宫腔内推注生理盐水及双氧水时的阻力大小、B超显像宫腔有无分离、液体及微气泡从输卵管伞端的溢出情况、子宫直肠陷窝有无积液来判定输卵管通畅与否，66例中双侧输卵管通畅者36例，一侧输卵管不通畅者14例，双侧输卵管均不通畅者16例。结论 双氧水子宫输卵管声学造影术是临床检查输卵管通畅情况的一种新的、准确可靠的诊断方法，具有很好的临床应用价值。     

B超结合宫腔镜在输卵管性不孕症诊治中的应用

目的：探讨B超结合宫腔镜行输卵管插管在诊治输卵管性不孕症中的价值。方法：对照组60例不孕妇女进行常规输卵管通液,观察组60例进行B超结合宫腔镜输卵管插管术。结果：对照组治疗后,输卵管通畅率23．3％,观察组治疗后．输卵管通畅率63．3％,两组比较有显著差异。结论：B超结合宫腔镜输卵管插管是诊治输卵管性不孕症患者理想的方法。     

经阴道B超诊断异位妊娠的价值探讨

目的:探讨经阴道B超诊断异位妊娠的效果和价值。方法:选取我院在2016年1月-2017年1月间接收的异位妊娠患者62例,对其分别进行腹部B超及阴道B超诊断,对比两种诊断方法的符合率及声像图阳性率。结果:经腹部B超诊断符合率为64.52%,经阴道B超诊断符合率为96.77%,二者差异有统计学意义(P0.05);经阴道B超检查假孕囊、盆腔积液、胚芽、心管搏动、附件包块的检出率均高于经腹部B超检查,二者差异有统计学意义(P0.05)。结论:对异位妊娠采用经阴道B超诊断,诊断符合率较高,可以为患者的后期治疗提供依据,值得推广应用。     

子宫输卵管声学造影在不孕症中的应用

目的:旨在探讨子宫输卵管声学造影对不孕症患者输卵管通畅性及宫腔疾病的诊断价值。方法:对医院近6 a来85例不孕症患者进行子宫输卵管声学造影,评价输卵管通畅性及宫腔情况,并与腹腔镜或手术、宫腔镜对照。结果:输卵管声学造影显示双侧输卵管阻塞及宫腔病变与腹腔镜或手术、宫腔镜符合率为100%,双侧输卵管欠通畅及一侧欠通畅一侧阻塞的符合率分别为83.3%和92.6%。结论:子宫输卵管声学造影具有无创性、风险小、适用范围广等优点,可作为不孕症评价盆腔的首选方法。     

超声影像学诊断输卵管通畅性的临床应用进展

因不孕症就诊的女性中,有25%～35%存在输卵管病变。对输卵管通畅的检查和评估是不孕症治疗的常规方法。评估输卵管通畅性的方法包括：X线子宫输卵管造影（HSG）、腹腔镜下美蓝通液术（LC）、经阴道超声（TVS）、盐水灌注超声造影（SIS）和子宫输卵管四维超声造影（4D-HyCoSy）。HSG目前应用广泛,结果较可靠,但其假阳性率较高,且存在射线暴露和碘过敏的风险。LC是诊断的“金标准”,但为有创操作,费用高,临床应用受到限制。TVS和SIS的诊断价值有限,临床上较少应用。4D-HyCoSy诊断准确,操作便捷、无创,又可避免碘过敏、射线暴露、肺栓塞等风险,与传统方法相比,具有较显著的优越性。     

子宫输卵管超声造影术对于临床诊断输卵管堵塞所致不孕症的研究进展

不孕症(infertility)是育龄妇女的常见疾病之一,我国育龄妇女不孕症发病率为7%～10%。输卵管疾病导致的不孕症占女性不孕症的30%～50%。因此,评估输卵管通畅性对不孕症的病因诊断十分重要。子宫输卵管超声造影术(HyCoSy)是在超声监测下,实时观察造影剂通过宫腔、输卵管的情况及进入盆腔后的分布情况,对输卵管通畅性进行诊断。HyCoSy具有安全、操作简便、费用低等优势,成为近年快速发展的临床诊断输卵管堵塞所致不孕症的新技术。近年新型造影剂及三维、四维超声实时显像技术应用于HyCoSy,提高了HyCoSy对输卵管通畅性诊断的准确率。笔者拟就HyCoSy对于临床诊断输卵管堵塞所致不孕症的研究进展,尤其是新型造影剂及三维、四维超声技术,应用于临床诊断输卵管堵塞所致不孕症的研究进展进行综述如下,旨在推广HyCoSy在输卵管堵塞所致不孕症中的应用。     

Gynaecomastia and male infertility as symptoms of a nonpalpable Leydig cell tumour

A 35-year-old man and his partner were referred for intracytoplasmic sperm injection treatment (ICSI) because of secondary infertility due to severe oligoasthenoteratospermia. Three years earlier he had presented elsewhere with left unilateral gynaecomastia. A hypertrophic mammary gland had been excised one year later. Histopathological investigation showed benign hypertrophy. One year later he developed gynaecomastia on the other side. Physical examination and incomplete hormonal screening showed no abnormalities. The couple were referred to our tertiary clinic for ICSI treatment. The patient still had unilateral gynaecomastia. Hormonal screening showed not only severe oligoasthenoteratospermia, but also an elevated serum oestrogen level. Scrotal ultrasound revealed a 17 mm mass in his right testicle. Subsequently unilateral orchidectomy was performed. Histology showed a benign Leydig cell tumour for which no further therapy was required. Four months after surgery the gynaecomastia diminished, oestrogen levels became normal and improvement in semen parameters followed. Patients with severe male infertility or gynaecomastia are at a higher risk of developing a testicular neoplasm. Besides history taking, physical examination of breasts and testicles, hormonal screening and scrotal sonography should be performed as some testicular neoplasms are not apparent on palpation.     

输卵管超声造影的临床实践

目前,不孕症的发病率越来越高。对于因不孕症就诊的女性,输卵管通畅性检查是必不可少的环节。诊断输卵管通畅性的“金标准”是腹腔镜下美蓝通液术,目前一线检查方法是子宫输卵管造影（HSG）。但腹腔镜下美蓝通液术需住院在全身麻醉下进行,HSG又存在碘过敏、放射线暴露等风险,因此学者们一直致力于研究输卵管超声造影技术。目前常见的输卵管超声造影技术包括盐水灌注超声造影（SIS）、子宫输卵管超声造影（HyCoSy）、子宫输卵管超声泡沫造影（HyFoSy）等,尤其以HyCoSy应用最广。与传统的腹腔镜下美蓝通液术及HSG相比,HyCoSy诊断效果可靠,操作过程简便,耐受性好,又避免了上述缺点,有望成为评估输卵管通畅性的一线方法。     

宫腔镜在辅助生殖技术前的应用价值

随着辅助生殖技术的开展,移植前宫腔镜检查评估宫腔越来越受到重视,尤其对于体外受精-胚胎移植(IVF-ET)反复着床失败的患者,宫腔镜检查和治疗有助于改善IVF-ET的妊娠结局。在不孕女性中,子宫内异常病变发生率为10%~15%,这些异常包括子宫内膜息肉、子宫黏膜下肌瘤、子宫纵隔、宫腔粘连、子宫内膜炎。经阴道二维超声(TVS)、子宫输卵管造影(HSG)、宫腔注水超声(SIS)可用于评估宫腔情况,而宫腔镜检查仍是诊断宫内病变的金标准,但对于子宫内膜炎组织病理学才是诊断的金标准。宫腔镜手术是治疗宫内病变的有效方法,宫腔镜下子宫内膜息肉电切术、子宫肌瘤电切术、子宫隔膜切除术及宫腔粘连分离术,术后妊娠率均有显著提高,宫腔镜手术后进行辅助生殖的时机因手术方式不同而不同,通常术后1~3个月不等。值得肯定的是宫腔镜检查在不孕症诊治中发挥了重要作用,但是否对于所有拟进行IVF-ET的患者常规进行宫腔镜检查尚有争议。     

宫腔镜与腹腔镜联合在诊治不孕中的临床应用分析

目的通过对宫腔镜与腹腔镜联合手术效果的临床分析,旨在探讨更有效治疗不孕的临床手术方法。方法选择2009年1月至2011年12月在我院接受宫腔镜与腹腔镜联合手术治疗不孕的130例患者,分析统计导致患者不孕的原因,同时记录接受手术后是否出现妊娠反应。结果分析原发性与继发性不孕症患者不孕的原因发现在慢性盆腔炎、子宫内膜异位、多囊卵巢综合征、宫腔粘连、输卵管堵塞、子宫腺肌症等诸多病因比较下差异并不显著,其中大多数患者不孕是由慢性盆腔炎引起的,极少数是由子宫腺肌症引起;接受手术治疗后输卵管通畅率均较高;接受治疗后原发性不孕患者术后妊娠率显著高于继发性不孕患者(P<0.05),有统计学意义。结论宫腔镜与腹腔镜联合手术治疗不孕有良好的治疗效果,同时由于创伤相对较小,给患者自身减轻了痛苦,且手术后很少出现并发症,极大地增加了患者术后妊娠率,是一种安全科学且高效的临床治疗方法。     

Infertility, infertility treatment and behavioural problems in the offspring

Behavioural patterns in children of infertile couples may be influenced by both the underlying causes of infertility and stress in the couples. Treatment procedures, such as culture media and manipulation of gametes and embryos, may also result in developmental problems. We examined behavioural problems in children as a function of infertility and infertility treatment, using data from three population-based birth cohorts in Denmark (Aalborg-Odense Birth Cohort, Aarhus Birth Cohort and Danish National Birth Cohort). Information on time to pregnancy and infertility treatment was collected during pregnancy. Children aged between 7 and 21 years were assessed using the Strengths and Difficulties Questionnaire (SDQ). The SDQ was completed by mothers in all cohorts and, in addition, by teachers in the Aarhus cohort and by children themselves in the Aalborg-Odense cohort. Children born after a time to pregnancy of >12 months and no infertility treatment had a behavioural pattern similar to children of fertile parents. Teachers reported a higher total difficulties score for children born after infertility treatment, but no significant differences were seen on any subscales of the teachers' report, and neither the mothers nor the children reported any differences on the total difficulties score and the prosocial behaviour score. Our results are thus overall reassuring regarding behavioural problems in children born to infertile couples, regardless of infertility treatment.     

THE EFFECT OF AN INFERTILITY DIAGNOSIS ON TREATMENT-RELATED STRESSES

The purpose of this study was to determine the effect of an infertility diagnosis on treatment-related stresses. One hundred infertile Chinese couples participated in this study. Three structured questionnaires were used to analyze the differences between husbands and wives. As a group wives appear to experience significantly more stress from infertility tests and treatment than their husbands, regardless of whether female infertility was present. Husbands with mixed or idiopathic infertility experienced less stress to infertility than husbands with only male infertility or female infertility. Wives with mixed or idiopathic infertility experienced less stress to infertility than wives with only a female infertility. Marital duration, time in treatment, and the number of AIH or IVF procedures were positively related to the wives' stress level, whereas only number of IVF procedures was positively related to the husbands' stress level. Interventions to enhance the infertility treatment experience are suggested.