子宫输卵管碘油造影在输卵管性不孕中的应用分析

目的:评价子宫输卵管碘油造影在输卵管性不孕中的应用价值。方法:前瞻性研究分析119例行子宫输卵管碘油造影(HSG)和腹腔镜检查的病例资料。结果:子宫输卵管碘油造影诊断输卵管内部通畅情况的总符合率为84.3%(194/230),诊断盆腔粘连的灵敏度为96.3%(52/54),特异度为63.6%(7/11),但HSG后有17条输卵管在腹腔镜检查时出现梗阻。结论:作为一种经济的检查方法,子宫输卵管碘油造影(HSG)可以较准确地判断输卵管内部的通畅情况及盆腔粘连情况,但如果输卵管中有碘油残留,应及时行腹腔镜手术清除防止输卵管进一步梗阻。     

联合应用宫腔镜腹腔镜和子宫输卵管通液及子宫输卵管碘油造影检查诊断不孕症110例分析

目的　通过宫腔镜、腹腔镜检查和子宫输卵管通液及子宫输卵管碘油造影检查 ,了解输卵管通畅性 ,探讨引起不孕症的原因。方法　对 110例不孕妇女进行输卵管通液检查 ,子宫输卵管碘油造影 (HSG)、宫腔镜和腹腔镜及镜下通液检查。结果　以宫腔镜和腹腔镜镜下通液 33例双侧通畅为对照标准 ,110例患者中 ,宫腔镜和腹腔镜镜下通液准确率为 30 0 0 % ,输卵管通液检查准确率为 6 5 45 % ,两者间比较有极显著性差异 (P <0 0 1) ;镜下通液与HSG准确率比较 ,宫腔镜和腹腔镜镜下通液 2 1 33 % (16 / 75 ) ,HSG33 33 % (2 5 / 75 ) ,两者间比较无显著性差异(P >0 0 5 )。结论　宫腔、腹腔炎症与不孕症有关 ,宫腔粘连、子宫内膜炎等仍为不孕症的主要原因 ,宫腔镜和腹腔镜通液检查在诊断治疗不孕症中有一定的价值。     

联合应用宫腔镜腹腔镜和子宫输卵管通液及子宫输卵管 碘油造影检查诊断不孕症11O例分析

目的通过宫腔镜、腹腔镜检查和子宫输卵管通液及子宫输卵管碘油造影检查,了解输卵管通畅性,探 讨引起不孕症的原因。方法对110例不孕妇女进行输卵管通液检查,子宫输卵管碘油造影(HSG)、宫腔镜和腹腔 镜及镜下通液检查。结果以宫腔镜和腹腔镜镜下通液33例双侧通畅为对照标准,110例患者中,宫腔镜和腹腔 镜镜下通液准确率为30.00％,输卵管通液检查准确率为65.45％,两者间比较有极显著性差异(P＜0.01);镜下通 液与HSG准确率比较,宫腔镜和腹腔镜镜下通液21.33％(16/75),HSG3.33％(25/75),两者间比较无显著性差异 (P＞0.05)。结论宫腔、腹腔炎症与不孕症有关,宫腔粘连、子宫内膜炎等仍为不孕症的主要原因,宫腔镜和腹腔 镜通液检查在诊断治疗不孕症中有一定的价值。     

碘油造影、宫腔镜下输卵管通液诊断输卵管性不孕的临床价值

目的：比较碘油造影（HSG）和宫腔镜下输卵管插管通液（HH）两种方法诊断输卵管性不孕的临床价值。方法：按纳入标准随机抽取2009年11月—2011年11月就诊曾行输卵管碘油造影（HSG）不孕症患者1 452例,行B型超声监护下无痛HH,诊断输卵管性不孕的患者行宫腹腔镜联合探查术。诊断输卵管通畅建议调整试妊娠,如1年仍未自然妊娠行宫腹腔镜联合探查术,以宫腹腔镜探查术结果为金标准比较HSG、HH对输卵管性不孕的诊断符合率。结果：HH和宫腹腔镜诊断输卵管不通+通而不畅的符合率为86.1%（2 500/2 904）,HH诊断输卵管不通+通而不畅的敏感度为98.7%（2 370/2 401）,特异度为58.6%（295/503）。HSG和宫腹腔镜诊断输卵管不通+通而不畅的符合率为74.3%（2 130/2 866）,HSG诊断输卵管不通+通而不畅的敏感度为93.7%（2 252/2 404）,特异度为42.4%（196/462）,两者诊断符合率差异存在统计学意义（P＜0.01）。结论：HH检查输卵管通畅度较HSG更为精确,而且HH对患者身体无明显损害,并可诊治宫腔内异常情况,故作为输卵管性不孕的初筛实验更具有优越性。     

腹腔镜联合宫腔镜诊治输卵管性不孕52例分析

目的探讨应用宫、腹腔镜对输卵管性不孕的诊断价值及治疗效果.方法对52例经子宫输卵管碘油造影(HSG)诊断为输卵管性不孕的患者,单用腹腔镜下子宫导管内加压注入美蓝液检查证实双侧输卵管通畅者8例,一侧通畅者4例,双侧因各不同部位梗阻而不通者40例.对双侧及一侧不通的44例患者,根据不同部位病变进行治疗,如盆腔粘连松解,伞端扩张、造口及宫腔镜下输卵管间质部插管加压通液,开腹显微外科输卵管吻合、宫角植入等.结果52例输卵管性不孕患者中,双侧榆卵管通畅40例(77%),单侧通畅10例(19%),完全不通2例(3.9%).结论应用宫、腹腔镜联合检查、治疗输卵管性不孕,可避免单独使用宫腔镜、腹腔镜或开腹整形的局限性,提高诊断的准确性及治疗效果.     

输卵管通畅性检查方法的临床进展

临床中检查输卵管是否通畅的方法有输卵管通液术、子宫输卵管X线造影(hysterosalpingography,HSG)、子宫输卵管超声造影(hysterosalpingo contrast sonography,HyCoSy)和腹腔镜输卵管通液术检查。输卵管通液术因其盲通、不可视的缺点已较少应用于临床。HSG根据碘油对比剂分布评价输卵管的通畅性,目前是输卵管通畅性检查的首选方法,但会出现对比剂不良反应及辐射损伤。腹腔镜输卵管通液术检查作为输卵管是否通畅的"金标准",因其价格高昂不作为输卵管检查的首选方法。HyCoSy因其实时动态、可视化、无辐射等优点已成为研究热点,随着超声造影剂的发展及低压推注泵和压力监测仪在临床中的应用,HyCoSy有望超越HSG成为输卵管通畅性检查的首选方法。     

子宫输卵管碘油造影及腹腔镜检查在输卵管性不孕中的应用

目的:通过子宫输卵管碘油造影(HSG)及腹腔镜检查,分析其对输卵管及盆腔粘连病变检查的临床诊断价值。方法:回顾性分析我院2008年1月至2010年12月收治的89例输卵管性不孕患者,行HSG检查及腹腔镜治疗的临床资料。结果:176条输卵管中,HSG与腹腔镜检查结果相符的有140条,符合率79.55%;腹腔镜诊断输卵管通畅的灵敏度为77.89%,特异度为71.70%;HSG诊断通畅的灵敏度为72.22%,特异度为64.41%。结论:HSG检查可作为不孕症患者的初步筛查手段,腹腔镜检查准确性高,在不孕症患者的诊断中有重要的作用。     

两种输卵管通液检查方法对比与验证的研究

本文报告43例不孕症患者先后在B 超监护下进行输卵管常规通液术和宫腔镜下输卵管插管通液术。证实常规通液术结果受宫腔压力和通液量两种因素的影响,插管通液术结果受输卵管子宫口形态的影响。常规通液术与插管通液术两组在诊断输卵管通畅度时的符合率为87.5%,诊断不通畅时的不符合率为71.4%(P<0.01)。因此,对常规通液术诊断输卵管不通者应进一步做插管通液术检查。插管通液术诊断可靠,并具有诊断宫腔疾病,治疗疏通输卵管作用。     

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。     

宫腹腔镜下输卵管插管通液联合导丝介入治疗输卵管近端梗阻的临床研究

目的:探讨宫腹腔镜下双侧输卵管插管通液联合Cook导丝介入治疗输卵管近端梗阻的疗效。方法:选择23例经子宫输卵管碘油造影诊断为双侧输卵管近端梗阻的患者行宫腔镜下双侧输卵管插管通液联合Cook导丝介入治疗。结果:23例不孕症患者45条输卵管近端梗阻输卵管插管通液成功27条,经Cook导丝介入治疗后通液成功15条,手术再通率93.33%。术后随访21例妊娠9例,妊娠率39.13%。结论:宫腹腔镜下双侧输卵管插管通液联合Cook导丝介入治疗输卵管近端梗阻具有微创、输卵管再通率高、妊娠率高的特点。     

宫、腹腔镜联合诊治术在输卵管性不孕中的应用

目的 :探讨宫、腹腔镜联合手术在输卵管性不孕症诊治中的应用价值。方法 :1997年 8月至 2 0 0 0年 9月 ,输卵管性不孕症患者 114例 ,采用宫、腹腔镜联合手术 ,进行粘连分离、输卵管伞端成形术、输卵管造口术、腹腔镜监视下宫腔镜插管通液。结果 :术后≥ 6个月的 67例随访者 ,有 2 8例受孕 ,妊娠率 41. 79% ( 2 8/67)。 2 6例为宫内妊娠 ,2例为宫外妊娠。结论 :宫、腹腔镜联合诊治术是输卵管性不孕的有效诊治方法     

腹腔镜和宫腔镜在不孕症诊治中的应用

本文对320例不孕症患者行腹腔镜检查,其中47例同时行宫腔镜检查及治疗。腹腔镜检查结果表明,盆腔炎症和子宫内膜异位症是本组病例中最常见的病因,占77.5％,由此引起的盆腔粘连和输卵管阻塞占71.33％,而这些病例56.9％(110/255)没有临床表现,因此腹腔镜检查是诊断盆腔炎和子宫内膜异位症的可靠方法。47例宫腔镜检查发现异常占21.3％,其中27例49条阻塞输卵管在宫腔镜下加压通液及行插管术,其中8例11条输卵管通畅,占29.6％,4例妊娠。因此对HSG或腹腔镜检查发现的输卵管阻塞,特别是近端阻塞,可在腹腔镜监视下,行宫腔镜加压通液或输卵管插管再通术以减少误诊。     

Combined diagnostic approach of laparoscopy and hysteroscopy in the evaluation of female infertility: results of 612 patients

AIM: To clarify the role of a combined diagnostic approach using laparoscopy and hysteroscopy in the evaluation of female infertility in developing countries. METHODS: In a prospective study, 612 consecutive infertile women underwent complete fertility evaluation at a tertiary university infertility clinic: 300 complained of primary infertility, 221 of secondary infertility, and 91 were requesting reversal of a previous tubal ligation. All the patients were examined by simultaneous combined laparoscopy and hysteroscopy as a part of their routine infertility evaluation. Focused hysteroscopic evaluation of the region of utero-tubal junction was attempted. RESULTS: Laparoscopy was successful in 608 and hysteroscopy in 597 patients. The most frequent pathologies detected hysteroscopically in the infertile group were adhesive in nature and believed to be post-traumatic and/or post-phlogistic. The number of intrauterine abnormalities found by hysteroscopy was significantly greater than by hysterosalpingography. The rate of diagnosis of significant lesions by laparoscopy of 64.3% rose to 76.6% when the hysteroscopic findings were included. A significant number of women with secondary infertility had abnormal hysteroscopic findings when compared to either women with primary infertility or those requesting sterilization reversal. Hysteroscopic evaluation of the region of utero-tubal junction revealed significant lesions believed to have caused infertility in comparison with those requesting sterilization reversal. CONCLUSION: The combined diagnostic approach of laparoscopy and hysteroscopy is recommended in the evaluation of female infertility in communities where the risk of pelvic infections is great.     

Uterine cavity-myoma fistula after hysteroscopic myomectomy mimicking uterine perforation at hysterosalpingography: case report

Fistula formation between the uterine cavity and the cavity of a subserosal myoma was diagnosed at laparoscopy/hysteroscopy in a 39-year-old woman with primary infertility. The patient had undergone 2 previous hysteroscopic resection procedures for removal of a submucosal myoma as part of infertility treatment. Hysterosalpingography demonstrated leakage of contrast medium from the uterine cavity, a characteristic feature of uterine perforation. At hysteroscopy/laparoscopy, a defect was observed in the posterior wall of the uterine cavity with connection to the cavity of a subserosal myoma without any tract to the peritoneal cavity. Laparoscopic myomectomy was performed to repair the uterine wall defect at the site of the fistula. Subsequently, the patient conceived after an office-based gonadotropin cycle therapy and is currently 20 weeks pregnant.     

A clinical comparison of sonographic hydrotubation and hysterosalpingography.

OBJECTIVE--To assess the value of vaginal sonographic hydrotubation as a preliminary test of uterine configuration and tubal patency in infertility investigation, and to compare this new test with hysterosalpingography. DESIGN--A prospective blind comparison of the two tests in an unselected group of infertile women. SETTING--Hillbrow Hospital, Johannesburg, South Africa. SUBJECTS--Sixty women undergoing routine infertility investigations agreed to participate in the study. There were no refusals. INTERVENTIONS--Within 4 weeks before or after hysterosalpingography sonographic hydrotubation was performed as follows: The uterus and tubes were identified using a 5 MHz vaginal ultrasound probe and between 10 and 20 ml of normal saline were injected into the uterine cavity through an endocervical catheter. MAIN OUTCOME MEASURES--The shape of the uterus and its cavity, the flow of saline through the tubes, the presence of hydrosalpinges before and after injection of saline and the presence of free fluid in the pouch of Douglas. RESULTS--The sonographic and hysterosalpingographic findings were similar in 82% of the women with respect to uterine assessment and in 72% with respect of tubal findings. In seven women (12%) found to have bipolar tubal disease on sonography and cornual block on hysterosalpingography, the sonographic diagnosis was confirmed at laparoscopy. Septate uterus in three women was diagnosed with greater certainty with sonographic hydrotubation. CONCLUSIONS--Sonographic hydrotubation is a simple office procedure which should be used in the preliminary assessment of the uterine cavity and fallopian tubes. Its use will reduce the need for hysterosalpingography and in some cases laparoscopy.     

子宫内膜损伤宫腔粘连评价指标的临床应用北大核心CSCD

各种原因引起的子宫内膜基底层损伤可导致子宫内膜纤维化及宫腔形态学破坏。临床上最常见的子宫内膜损伤代表性疾病是宫腔粘连。子宫内膜损伤宫腔粘连的主要临床表现为月经量减少、闭经、不孕;临床评价指标包括影像学、宫腔镜形态学及子宫内膜容受性指标。中华医学会妇产科学分会妇科内镜学组制定的宫腔粘连评分分级标准纳入了更全面有效的评价指标,对于子宫内膜损伤的精准评估、诊断及生殖预后结局的有效预测具有更高的临床应用价值。     

Incidence of pathological factors not revealed by hysterosalpingography but disclosed by laparoscopy in 500 infertile women

Hysterosalpingography and laparoscopy were performed in 500 infertile women. Results obtained by both techniques were compared. Taking into consideration only the tubal patency, the present study shows an agreement in 90% of cases. In total of 980 fallopian tubes examined, fimbrial conglutination was suspected in 79 tubes (8%) and diagnosed by laparoscopy in 154 tubes (15.7%). Peritubal adhesions with tubal patency are a frequent pathology (23.8%) and hysterosalpingography alone permits the diagnosis in only 68.8% of the cases confirmed by laparoscopy. Other additional findings by laparoscopy are frequent: endometriosis was found in 124 women. Isolated periovarian adhesions were disclosed in 48 women. The high incidence of unsuspected pathology is an additional support in favor of laparoscopy in each case of infertility.     

Pregnancy rates after hysteroscopic polypectomy depending on the size or number of the polyps

Objective To assess the reproductive benefits of hysteroscopic polypectomy in previous infertile women depending on the size or number of the polyps. Design and methods In this retrospective study, from February 2000 to September 2005, totally 83 selected women were included with: a) diagnoses of primary or secondary infertility, endometrial polyp/polyps and abnormal uterine bleeding. Endometrial polyps were diagnosed by transvaginal ultrasound followed by diagnostic hysteroscopy, to confirm diagnosis, and hysteroscopic polypectomy. All 83 subjects who consisted the study group, met inclusion criteria: age under 35 years, at least 12 months of infertility, from 3 to 8 months menstrual disorders (intermenstrual bleeding or spotting, menometrorrhagia or menorrhagia) and from 3 to 18 months of follow-up with attempts to conceive after hysteroscopic polypectomy. The endometrial polyp/polyps appeared to be the only reason to explain their infertility after infertility workup of the couples. There was a comparison of fertility rates after hysteroscopic polypectomy between patients having endometrial polyp ≤ 1 cm and patients with bigger or multiple polyps. Results Of the 83 subjects, all were found to have endometrial polyps in diagnostic hysteroscopy, confirmed at histologic examination after hysteroscopic polypectomy. Among patients of the study group, there were no significant differences in age, type or length of infertility, or follow-up period after the procedure. The mean size of the endometrial polyps was 1.9 ± 1.4.cm. Thirty-one patients had endometrial polyp ≤ 1 cm and 52 patients had bigger or multiple endometrial polyps. Following polypectomy, menstrual pattern was normalized in 91.6% of patients. Spontaneous pregnancy and delivery at term rates, in the total population of the study, increased after the procedure and were 61.4% and 54.2% respectively. There was no statistical difference in fertility rates between patients having polyps ≤ 1 cm and patients having >1 cm polyps or multiple polyps. Spontaneous abortion rate in the first trimester of pregnancy was 6% of the total number of patients and there was no statistical difference between patients with small or bigger/multiple polyps. Type of infertility did not affect fertility rates after hysteroscopic polypectomy. Complication rate after hysteroscopic polypectomy was as low as 2.4%, while recurrence rate of the procedure reached 4.9% of patients. Conclusion Hysteroscopic polypectomy of endometrial polyps appeared to improve fertility and increase pregnancy rates in previous infertile women with no other reason to explain their infertility, irrespective of the size or number of the polyps. Type of infertility of patients seems not to affect fertility rates after hysteroscopic polypectomy. Menstrual pattern was normalized in the majority of patients after hysteroscopic polypectomy. In addition, hysteroscopic polypectomy is a safe procedure with low complication rate.