经阴道四维子宫输卵管超声造影评价输卵管通畅性的研究

目的:探讨经阴道四维子宫输卵管超声造影(TVS 4D-Hy Co Sy)评价输卵管通畅性的有效性及安全性。方法:回顾性分析TVS 4D-Hy Co Sy后1个月内行腹腔镜手术的57例患者的临床资料,并将其造影结果与腹腔镜美蓝通液结果进行对照。结果:57例患者共显影105条输卵管,TVS 4D-HyCo Sy显示输卵管通畅52条,通而不畅13条,阻塞40条,与腹腔镜通液检查结果比较,符合80条,不符合25条。TVS 4D-Hy Co Sy诊断输卵管阻塞的敏感性为75.0%,特异性为87.7%,阳性预测值为78.9%,阴性预测值为85.1%,阳性似然比6.1,阴性似然比0.3,约登指数0.63。57例患者未发生严重不良反应。结论:TVS 4D-Hy Co Sy是一种有效、安全地评价输卵管通畅性的筛查方法。     

经阴道二维及四维子宫输卵管超声造影评价输卵管通畅性的对比研究

目的比较经阴道二维子宫输卵管超声造影(2D-HyCoSy)和四维子宫输卵管超声造影(4DHyCoSy)评价输卵管通畅性的有效性及其临床价值。方法选择125例女性不孕症患者,采用注射用六氟化硫微泡(SonoVue)造影剂,进行2D-HyCoSy和4D-HyCoSy检查,其中35例结果与腹腔镜下通液术进行比较。对比2D-HyCoSy和4D-HyCoSy评价输卵管通畅性的价值。结果经阴道2D-HyCoSy及4D-HyCoSy评估输卵管阻塞的敏感度、特异度、阳性预测值和阴性预测值分别为84.00%、84.44%、75.00%、90.48%和92.00%、93.33%、88.46%、95.45%;准确率分别为84.28%和92.85%。两者比较,差异均有统计学意义(冇2=36.91,P0.05)。一致性分析显示,2D-HyCoSy与腹腔镜下通液术结果吻合度基本一致,Kappa值为0.667;4D-HyCoSy与腹腔镜下通液术结果吻合度高度一致,Kappa值为0.846。结论 2D-HyCoSy和4D-HyCoSy均可准确、快速地评价输卵管通畅性。4D-HyCoSy对输卵管全程的空间走行显示更具优势,诊断更有效。     

子宫输卵管造影在女性不孕症中的诊断价值

目的:探讨子宫输卵管造影(HSG)用于评价盆腔输卵管性不孕症的可靠性。方法:选取2014年10月至2016年4月行子宫输卵管造影提示输卵管梗阻或盆腔粘连于沧州中西医结合医院治疗的236例患者,行宫腹腔镜探查联合输卵管通液术,比较子宫输卵管造影诊断盆腔输卵管病变与宫腹腔镜探查联合输卵管通液术中诊断的符合率。结果:子宫输卵管造影诊断输卵管近端、远端梗阻的敏感度分别为55.3%和73.4%,两者比较差异有统计学意义(P0.05)。盆腔输卵管粘连仅17条,敏感度为12.1%。结论:子宫输卵管造影可观察输卵管通畅情况,明确输卵管阻塞部位,该法结果准确可靠,在诊断输卵管远端梗阻可靠性更佳,但用于评价盆腔输卵管粘连的可靠性欠佳。     

二维与三维子宫输卵管超声造影对输卵管通畅性诊断价值的比较

目的:比较二维子宫输卵管超声造影(2D-HyCoSy)与三维子宫输卵管超声造影(3D-HyCoSy)对输卵管通畅性的诊断价值。方法:对32例不孕症患者行2D-HyCoSy及3D-HyCoSy,与其腹腔镜结果对照,通过构建受试者应用曲线,比较2种方法对输卵管通畅性的诊断价值。结果:2D-HyCoSy诊断输卵管通畅的敏感性、特异性、阳性预测值、阴性预测值分别为83.3%、100.0%、100.0%、96.3%,准确率89.1%;3D-HyCoSy分别为90.9%、100.0%、100.0%、98.1%,准确率92.2%。构建二者的ROC工作曲线,2D-HyCoSy的AUC为0.981,3D-HyCoSy的AUC为0.991,两者AUC差异有统计学意义(P<0.05)。结论:三维子宫输卵管超声造影图像清晰、客观,能真实展现输卵管的立体空间走形,易于临床判断,具有较好的临床应用前景。     

超声晶氧声学造影与泛影葡胺造影在不孕症诊治中的比较

目的:比较超声晶氧声学造影与泛影葡胺造影对不孕症诊治的效果。方法:随机选择我院不孕症患者142例分为两组,分别行超声晶氧与泛影葡胺输卵管造影,半年后随访。结果:66例患者行超声晶氧声学造影,2例输卵管阻塞,其余64例患者半年内受孕26例,受孕率40.63%,76例患者行泛影葡胺X线造影,12例输卵管阻塞,其余64例患者半年内受孕18例,受孕率28.13%。结论:超声晶氧声学造影与泛影葡胺造影在不孕症诊治方面有同样的效果,且更具优势。     

80对不孕症夫妇解脲支原体感染与输卵管阻塞的关系

目的:探讨夫妇双方生殖道解脲支原体(UU)感染与女方输卵管阻塞的关系.方法:采用聚合酶链反应技术(PCR),对80例不孕妇女(不孕组)和63例早孕拟行人工流产术的妇女(对照组)进行UU检测.不孕患者施行同月经周期子宫输卵管造影(HSG),结果按输卵管通畅和输卵管阻塞分组.不孕患者丈夫精液同步进行UU培养及检测,精液常规分析并计数白细胞.结果:不孕组UU感染率(42.5%)明显高于对照组(17.4%).不孕组中夫妇双方UU检测均阳性16例,输卵管通畅4例,输卵管阻塞12例;仅男方阳性11例,输卵管通畅为4例,输卵管阻塞7例;仅女方阳性18例,输卵管通畅为7例,输卵管阻塞为11例;夫妇双方均阴性35例,输卵管通畅27例,输卵管阻塞8例.夫妇任何一方UU检测阳性与输卵管通畅度成负相关.丈夫精液UU检测阳性与妻子输卵管通畅度成负相关.精液UU阳性组白细胞计数升高率显著高于UU阴性组;精液检测UU阳性组精液常规异常检出率(51.9%)明显高于阴性组(28.3%).结论:UU可能是引起输卵管阻塞的病原体之一,不孕症男方精液中UU感染能够导致精液常规异常,并与女方输卵管阻塞密切相关.     

输卵管性不孕的危险因素分析及检测方法探讨

目的 :观察引起输卵管性不孕的危险因素并对其诊断方法进行评价 ,以研究和预防输卵管阻塞引起的不孕 ,探讨检查输卵管通畅度的方法价值。方法 :回顾性分析34 9例输卵管阻塞性不孕妇女的情况及危险因素 ,并对子宫输卵管碘油造影、腹腔镜检查结果与手术发现进行比较。结果 :盆腔炎病史、人工流产手术史、阑尾炎手术史、结核病史等均在输卵管性不孕的发生中起一定的作用 ,前两者更危险。HSG和腹腔镜检查的符合率为 66% ,但腹腔镜诊断输卵管的通畅度和其他盆腔病变更准确。结论 :盆腔炎和反复的人工流产是引起输卵管性不孕的主要危险因素 ,HSG和腹腔镜对输卵管通畅度的检查均有一定价值     

经阴道四维子宫输卵管超声造影评估不孕症患者输卵管通畅程度及形态的意义

目的 探究经阴道四维子宫输卵管超声造影评估不孕症患者输卵管通畅程度及形态.方法 选取100例不孕症患者,采用经阴道四维子宫输卵管超声造影、宫腹腔镜联合进行检查,观察不同检查方式检查输卵管的通畅程度及形态情况.结果 经阴道四维子宫输卵管超声造影临床诊断为输卵管阻塞准确率为92.11％,通畅准确率为94.12％,通而不畅准...     

子宫输卵管造影诊断符合率及诊断一致性分析

目的:研究不同医师对子宫输卵管造影的诊断符合率以及诊断一致性。方法:选取60例接受宫、腹腔镜手术患者的造影片,由4位临床医师读片诊断。诊断结果分成输卵管积水、输卵管近端阻塞、输卵管远端阻塞、盆腔粘连以及子宫内膜息肉,分别分析各医师的诊断结果与宫、腹腔镜诊断结果的符合率以及一致性(以κ值表示)。结果:造影诊断符合率分别为输卵管积水敏感度83.33%~100.00%,特异度97.22%~98.15%;输卵管近端阻塞敏感度75.00%~83.33%,特异度88.89%~92.60%;输卵管远端阻塞敏感度85.71%~92.86%,特异度77.78%~81.11%;子宫内膜息肉敏感度12.50%~25.00%,特异度94.23%~100.00%;盆腔粘连敏感度58.93%~64.26%,特异度45.31%~64.06%。各医师诊断一致性(κ值):输卵管积水为0.758,输卵管近端阻塞为0.815,输卵管远端阻塞为0.277,盆腔粘连为0.431,子宫内膜息肉为0.658。结论:造影诊断输卵管积水符合率较高;诊断近端阻塞及子宫内膜息肉不易误诊,但易漏诊;诊断远端阻塞不易漏诊,但易误诊;诊断盆腔粘连敏感度及特异度均较低,临床价值有限。不同医师诊断输卵管近端阻塞和输卵管积水一致性较高,输卵管远端阻塞和盆腔粘连诊断一致性较低。     

输卵管阻塞性不孕的介入治疗

输卵管因素占女性不孕症的30%～50%。子宫输卵管造影（HSG）诊断输卵管完全阻塞或部分阻塞的患者，经选择性输卵管造影（SSG）及输卵管再通术（FTR）治疗，既可以排除大部分造影中的假阳性结果，也可疏通输卵管、改善输卵管通畅度，是治疗输卵管阻塞性不孕的一种重要手段。     

Evaluation of 500 hysterosalpingograms with special reference to tubal sterility

457 hysterosalpingograms out of 500 could be analysed which were made from sterility patients of the women's clinic, Wilhelm-Pieck-University Rostock, in the period from 1973 to 1980. A normal uterine cavity was found in 395 cases (86.7%), having a tubal patency on both sides (54%). In 8.7% of the cases only the right tube and in 11% only the left tube was patent for contrast medium. In 48 cases there was a tubal occlusion on either side. Uterus arcuatus was diagnosed in 7%, uterus bicornis in 4% and uterus duplex as well as uterine fibromyoma in 0.5% of the cases. Intracavitary processes were evident only in 6 patients. Abnormal long tubes could be found in 79 cases, tubes in high positions in 87 cases, and rigid and very short tubes in 95 cases. In 176 cases a sactosalpinx could be diagnosed. Ampullar tubal occlusion at one side was observed in 105 cases, and the same one in 49 cases on both sides. Following the hysterosalpingography 71 from a total of 122 pregnancies occurred within a period of 6 months, without any additional treatment being carried out in 32 patients.     

A novel use of vaginoscopic office hysteroscopy for prediction of tubal patency and peristalsis among infertile women: a preliminary study

The objective of this study is to test whether vaginoscopic office hysteroscopy (OH) can predict proximal tubal patency as compared with hysterosalpingography (HSG) and diagnostic laparoscopy (DL) and concomitantly tubal peristalsis in infertile women. This is a prospective cross sectional study. The setting is in the endoscopy unit of a tertiary hospital. A total of 85 infertile patients scheduled for laparoscopy are used as the sample of this study. The method used is the vaginoscopic OH in the outpatient infertility clinic to assess proximal tubal patency. The patency results will be compared to HSG and DL reports. Diagnostic accuracy of OH alone or in combination with HSG for assessment of proximal tubal patency in comparison to HSG and DL is the mean outcome measure. Office hysteroscopic bubble suction test was feasible in 78 cases (91.7 %). Patent tubes were diagnosed in 91 and 88.5, 92.3 and 91, and 93.6 and 93.6 % using OH, HSG, and DL on right and left sides, respectively. The percentage of agreement between OH and DL was 78 % while it was 84 % between HSG and DL regarding tubal patency testing. Diagnostic indices of OH were very close to those of HSG. Adding OH to HSG did not improve diagnostic accuracy. Positive osteal peristalsis was reported in 32 cases (42 %) and 28 cases (36.8 %) for right and left ostea, respectively. Hysteroscopic bubble suction test is a good initial screening test for tubal patency nearly comparable to HSG and DL. It should be attempted in every case of OH prior to referral for more invasive HSG or laparoscopic chromopertubation test. Hysteroscopic documentation of peristalsis of the proximal part of the tube is an interesting cofinding but requires more confirmatory studies.     

宫腔镜下输卵管插管通液术与子宫碘油造影诊断输卵管性不孕作用的研究

目的:比较宫腔镜下输卵管导管通液术与子宫输卵管碘油造影(HSG)诊断输卵管性不孕的临床价值。方法:对2008年1月至2009年12月880例不孕症患者行宫腔镜下输卵管插管通液术,术前均常规行子宫输卵管碘油造影术,比较两者诊断的符合率并分析两种检查方法在评价输卵管通畅度方面的特点和应用价值。结果:子宫输卵管碘油造影和宫腔镜插管通液均诊断输卵管不通784条,通畅799条,通而不畅65条,两者符合率93.6%(1648/1760),不符合率6.4%(112/1760)。HSG检查输卵管通畅度的假阳性率为11.8%(107/906)。结论:宫腔镜下输卵管导管通液术能更精确地判断输卵管的通畅度,患者未接触有害物质,同时可以直接观察宫腔情况并治疗。在判定输卵管梗阻部位方面HSG优于宫腔镜检查。     

Fallopian tube patency using color Doppler

OBJECTIVE: To evaluate a new test for tubal patency using color Doppler ultrasonography in infertile women. METHOD: Between October 1991 and March 1992 results of our new technique were compared with those of hysterosalpingography (HSG) and laparoscopy in 27 cases. The new technique of evaluating tubal patency using color Doppler has been described in detail. RESULT: There was 92.59% agreement, i.e. patency or occlusion of the fallopian tubes when the results of our test were compared with those of hysterosalpingography and laparoscopic chromopertubation. The HSG and laparoscopy findings were in 100% agreement. CONCLUSION: Color Doppler ultrasonography is now a very important investigation in the assessment of fallopian tube patency and compares favorably with the existing ‘gold standards’ namely HSG and laparoscopic chromopertubation.     

Abnormal findings on hysterosalpingography: effects on fecundity in a donor insemination program using frozen semen.

OBJECTIVE: We sought to evaluate the effect of abnormal baseline hysterosalpingography (HSG) on subsequent fecundity during the first six cycles of treatment. METHODS: Hysterosalpingography was performed on 208 asymptomatic ovulatory women with no history of pelvic disease who were referred for donor insemination. The findings were categorized into five groups: 1) normal study, 2) uterine anomaly or filling defect with bilateral tubal patency, 3) normal uterine anatomy with unilateral tubal patency, 4) normal uterine anatomy with bilateral tubal blockage, and 5) normal uterine anatomy with hydrosalpinx. Subjects in groups 4 and 5 received inseminations only if patency of at least one fallopian tube was demonstrated with laparoscopy. Life-table analysis was performed to calculate the average monthly fecundity and cumulative conception rates for each group. The Mantel-Haenszel test was used to compare group fecundities. RESULTS: A total of 1460 donor insemination cycles were performed. The number of cycles in each group were as follows: group 1, 1173 (80%); group 2, 153 (10%); group 3, 90 (6.2%); group 4, 16 (1.1%); and group 5, 28 (1.9%). None of the patients in group 4 or 5 conceived. The cumulative conception rates in the first three groups were 46, 34, and 40%, respectively, and were not significantly different from one another (P greater than .05). Although a high incidence of uterine filling defects and unilateral tubal blockage was observed (19.2%), the incidence of an abnormal HSG finding that significantly decreased fecundity was only 2.8%. CONCLUSION: In women with no history of tubal or uterine disease, routine HSG before initiation of donor insemination is of limited value for identifying decreased treatment fecundity.     

Patient rotation and resolution of unilateral cornual obstruction during hysterosalpingography

OBJECTIVE: Unilateral obstruction of the proximal fallopian tube is identified in 10-24% of patients undergoing hysterosalpingography for evaluation of infertility. Upon further testing, this obstruction spontaneously resolves 16-80% of the time. We hypothesized that patient rotation during hysterosalpingography might resolve proximal tubal obstruction in some cases by altering either the location of intrauterine air bubbles or the spatial relationship of the tube to the uterine fundus. METHODS: In patients in whom unilateral proximal tubal obstruction was detected during hysterosalpingography performed for standard clinical indications, the patient was rotated on her hip approximately 45 degrees such that the obstructed tube was first superior (ventral) to the patent tube, and dye was reinjected. If obstruction did not resolve, the patient was rotated in the opposite direction so that the obstructed tube was inferior (dorsal) to the patent tube and dye reinjected. RESULTS: Unilateral tubal obstruction was found in 15% of cases (24 of 156). Rotating the patient with obstructed tube superior to the patent tube never resulted in tubal patency, whereas rotating the patient with the obstructed tube inferior resulted in resolution of tubal patency in 63% of cases (15 of 24) CONCLUSION: .Unilateral cornual obstruction during hysterosalpingography is often resolved by rotating the patient such that the obstructed tube is more inferior. Although this observation may be the result of dislodging smaller air bubbles, from a fluid dynamics perspective a more likely explanation is unkinking of the more inferior tube.     

ECHOVIST-200 enhanced hystero-sonography: a new technique in the assessment of infertility

Tubal occlusion is one of the most common causes of infertility. Therefore, examination of tubal patency is a very important diagnostic tool. Our aim was to determine whether hysterosalpingo-contrast sonography is able to show tubal patency, whether it has any side effects and what role this technique may have in the future. Echovist-200 hysterosalpingo-contrast sonographic examinations have been used in our service in 195 cases since 1998. We found tubal patency in 157 cases (84.4%), and unilateral or bilateral occlusions in 34 instances (12.5%). In four cases we could not visualize the tubes because they were too long. In the last mentioned cases we performed a laparascopy-dye test for the control of our results. The most common side effect during the check-up procedure was abdominal pain. This the patients tolerated well. We did not experience any other serious side effect. Comparing our results with those reported from abroad, we found them similar to the latter. According to our experience, the HyCoSy method for the evaluation of infertility is quick and well tolerated.     

Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography.

OBJECTIVE: To compare three-dimensional saline sonohysterosalpingography (SHSG) to X-ray hysterosalpingography (HSG) for the evaluation of the uterine cavity and fallopian tubes. PATIENT POPULATION: Fifteen infertile women on whom X-ray HSG had been performed within 1 year prior to this study. METHOD: Fifteen infertile women underwent three-dimensional power Doppler examination of the uterus and fallopian tubes with three-dimensional SHSG during the follicular phase. Distension was achieved using sterile saline injected through a 5 French HSG catheter. Peritoneal accumulation of free fluid surrounding the ovary and tube was required for a diagnosis of a patent tube. Fluid accumulation in the cul-de-sac without visualization of the tubes was considered consistent with at least one tube being patent. RESULTS: three-dimensional saline SHSG was completed in 14 patients. One patient had cervical stenosis and the procedure could not be performed. No significant intrauterine pathology was identified by either X-ray HSG or sonography. Three-dimensional saline SHSG made false positive diagnoses of tubal occlusion in four out of seven fallopian tubes (57%). The sensitivity and specificity for detecting tubal occlusion was 75 and 83%, respectively, with a positive predictive value of 40% and negative predictive value of 95%. Detection of fallopian tube architecture was not possible with three-dimensional saline SHSG in any patient. Simultaneous use of three-dimensional Doppler did not clearly identify the flow of saline through the fallopian tubes. CONCLUSIONS: Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.