子宫输卵管造影术逆流18例分析

目的：分析子宫输卵管造影术逆流的原因,X线表现及预防措施。方法：回顾性分析行子宫输卵管造影术发生逆流的18例患者。结果：逆流是多种因素综合作用的结果。结论：提高对子宫输卵管造影逆流的认识,在术前,术中做好充分准备,可以避免或减少逆流的发生。     

子宫输卵管造影术中造影剂逆流分析

目的:分析子宫输卵管造影术(HSG)中的造影剂流,找出逆流的原因及防止的办法。材料和方法:总结48例造影剂逆流的资料,临床诊断均为不孕症,使用油质或水质碘造影剂。结果:48例中淋巴逆流25例、静脉逆流19例,混合逆流4例,二种造影剂的逆流表现基本相似,但“辐射征”是水质碘造影剂淋巴逆流的一种特殊表现。结论:HSG中用水质碘造影剂较油质碘造影剂所需时间短,即使逆流也不会出现严重的后果,但也应尽量减少逆流的发生。     

子宫输卵管造影碘油逆流体会

子宫输卵管造影是临床诊断不孕症的常用方法之一，目前，临床上经常选择碘油作为造影剂，其优点为显影清晰，停留时间长、进入腹腔后对腹膜刺激性小，但吸收缓慢。可以引起异物反应。如果碘油逆流入血管，还可造成梗塞，引起肺栓塞、脑栓塞，甚至死亡。本人从事影像诊断多年，在此想谈一些体会，和大家共勉。     

子宫输卵管造影时逆流征象的临床评估(附72例报告)

目的：探讨子宫输卵管造影时，对比剂逆流的临床价值。方法；搜集72例子宫输卵管造影时，逆流征象明显的病例，与临床病史资料进行对照。结果：72例逆流征象明显的患者，65例临床上有各种不同的病变，其中炎性病变（包括结核）居多。结论：子宫输卵管造影时，逆流征象的出现，虽不是某种病变所特有的X线征象，但它对临床上病变的诊断和治疗，是非常有价值的。     

子宫输卵管造影术对输卵管结核的诊断能力

目的评价子宫输卵管造影术对输卵管结核的诊断能力,并分析其特征性X线征象。方法84例经临床与病理组织学证实的输卵管结核患者均经子宫输卵管造影检查,该项操作是采用70%的复方泛影葡胺作为造影剂进行的。对全部患者的影像表现结合文献复习进行了回顾性分析。结果子宫输卵管造影证实,在84例输卵管结核患者中,表现为僵直型9例,壶腹部呈囊状积水型7例,锈铁丝型11例,串珠状型9例,管旁结节阴影型6例,峡部梗塞型17例,宫角阻塞变形型14例,伞端呈烟斗嘴型8例,以及输卵管阻塞合并管旁静脉返流型3例。同时,子宫腔粘连见于35例(41%),静脉及淋巴管造影剂逆流见于13例(15%)。结论子宫输卵管造影可显示输卵管结核的特征性X线征象,并能对输卵管与子宫的损伤程度做出明确诊断。     

子宫输卵管造影碘油逆流处理新法──即时仰卧位处理法

造影剂碘油逆流是子宫输卵管造影术中的并发症,量较大的静脉回流可能引起碘油肺栓塞,造成严重反应.笔者在工作中摸索到一种新的处理方法,经过3年多的实践,收到良好效果,与传统处理方法比较具有明显优点,现将方法报告如下.     

输卵管堵塞数目及子宫内膜厚度对不孕症患者动态子宫输卵管超声造影检查中造影剂逆流影响

目的探讨输卵管堵塞数目和子宫内膜厚度对不孕症患者动态子宫输卵管超声造影检查中造影剂逆流的影响。方法回顾性分析2017年5—11月于沈阳市第二中医医院行动态子宫输卵管超声造影检查的100例不孕症患者的临床资料,比较不同输卵管堵塞数目和不同子宫内膜厚度对检查中造影剂逆流发生率的影响。结果 100例不孕症患者中,46例患者在动态子宫输卵管超声造影检查中发生造影剂逆流。其中,33例双侧输卵管堵塞患者中,19例发生造影剂逆流,发生率为57.6%;47例单侧输卵管堵塞患者中,21例发生造影剂逆流,发生率为44.7%;20例双侧输卵管通畅患者中,6例发生造影剂逆流,发生率为30.0%。两两比较,差异均有统计学意义(P<0.05)。46例发生造影剂逆流的患者中,子宫内膜厚度6~8 cm者14例(30.4%),子宫内膜厚度3~5 cm者32例(69.6%),差异有统计学意义(P<0.05)。结论在动态子宫输卵管超声造影检查中,输卵管堵塞数目、子宫内膜厚度与造影剂逆流密切相关。因此,在对患者实施动态子宫输卵管超声造影检查前,应对患者进行全面检查,避免造影剂逆流发生。     

碘普罗胺在子宫输卵管造影中的应用

目的：探讨碘普罗胺造影在诊断女性不孕症中的应用。方法对549例不孕症妇女进行碘普罗胺子宫输卵管造影,根据 X 线影像表现分析造影结果。结果少数民族原发不孕中子宫发育不良的患病率显著高于汉族;梗阻因素在输卵管不通原因中占首位,其次为积水和伞端重度粘连;92.3%的不孕症患者患有慢性盆腔炎;碘普罗胺子宫输卵管造影可根据需要增加对比剂剂量。结论子宫发育不良具有一定的民族差异,输卵管不孕因素中梗阻最常见,碘普罗胺对比剂应用于子宫输卵管造影安全性高。     

高压注射器不同速率 对子宫输卵管造影的影响

目的 用高压注射器采用不同速率行子宫输卵管造影(HSG)检查,分析患者在受检过程中出现对比剂逆流、球囊弹出及疼痛情况,明确不同速率的优缺点.方法 将行HSG检查的患者随机分为2组,即常规速率组(0.3 mL/s)和低速率组(0.15 mL/s),记录2组受检患者出现对比剂逆流、球囊弹出及疼痛情况.采用t检验比较2组间年龄的差异;采用χ2检验比较2组间诊断结果、对比剂逆流及球囊弹出的差异;采用Wilcoxon秩和检验比较2组间出现疼痛的差异.结果 2组间年龄、诊断结果和对比剂逆流无显著性差异(t=1.237、χ2=0.004、χ2=1.521,P>0.05);2组间出现球囊弹出有显著性差异(χ2=17.319,P<0.05);不同速率组出现疼痛有显著性差异(U=-2.337,P<0.05).结论 用高压注射器低速率注入对比剂行HSG比较好.     

不同浓度非离子型碘对比剂对 HSG 的比较研究

目的：比较不同浓度非离子型碘对比剂在子宫输卵管造影术(HSG)中的图像质量及不良反应。方法将本研究中接受 HSG 的99例女性不孕患者平均分为 A、B、C 组。对比剂用法如下：A 组使用碘美普尔注射液(400 mg I/mL),B 组使用碘帕醇注射液(370 mg I/mL),C 组使用碘海醇注射液(300 mg I/mL)。2名医师采用3分制(1~3分),独立评价图像质量,并记录不良反应。结果(1)图像质量评分：所有图像都满足诊断要求,A 组(2.55±0.51)分,B 组(2.42±0.50)分,C 组(2.21±0.42)分,组间差异有统计学意义(H=7.790,P=0.022)。图像评分的 Kappa 值：A 组0.693,B 组0.687,C 组0.672。(2)不良反应：A 组4例(12.12%),B组3例(9.09%),C 组2例(6.06%),差异无统计学意义(χ2=0.733,P =0.693)。结论3种浓度的非离子型碘对比剂均可应用于HSG。碘浓度越高,图像对比度越好。     

Multidetector computed tomography virtual hysterosalpingography in the investigation of the uterus and fallopian tubes

OBJECTIVE: To compare the efficacy of multidetector CT virtual hysterosalpingography (MDCT-VH) with conventional X-ray hysterosalpingography (HSG) in the evaluation of patients with diagnosis of infertility. METHODS: Sixty patients with diagnosis of infertility scheduled to perform a HSG, were evaluated with 16-row (n=50) and 64-row (n=10) MDCT-VH. In 35 patients the examination was performed without a tenaculum. The HSGs were carried out using standard technique. The HSG and MDCT-VH findings were compared. The duration for both examinations and patient discomfort were documented. The sensitivity and specificity of MDCT-VH for the detection of uterine pathology and tubal obstruction were calculated using the exact binomial method. Agreement between the two methods was assessed by the Cohen's kappa method (k). RESULTS: The mean duration for MDCT-VH (16 and 64-rows) was 5+/-3min, whereas for HSG was 28+/-3. The MDCT-VH without a tenaculum was the procedure with less patient discomfort. Sensitivity, specificity and inter-method agreement for the detection of uterine pathology were 100%, 92% and k=0.92 for 16-row MDCT-VH and 100%, 100% and k=1 for 64-row MDCT-VH, respectively. Sensitivity and specificity for detection of tubal obstruction were 80% and 80% for 16-row MDCT-VH and 100% and 100% for 64-row MDCT-VH, respectively; inter-method agreement for the visualization of the tubes was k=0.54 for 16-row MDCT-VH and k=1 for 64-row MDCT-VH. CONCLUSION: This study demonstrated the feasibility of evaluating the female reproductive system by MDCT-VH. 64-Row MDCT-VH could be an alternative diagnostic technique in the infertility workup algorithm. A larger study is in progress to validate these encouraging results.     

子宫输卵管超声造影和X线碘油造影的对比研究

目的：探讨经阴道子宫输卵管超声造影评价输卵管通畅情况的临床价值。方法：48例患者接受子宫输卵管超声造影和X线子宫输卵管碘油造影,并采用腹（宫）腔镜检查为标准,来对比两种方法对输卵管通畅性的检查效果。结果：子宫输卵管超声造影与X线子宫输卵管碘油造影评价输卵管是否通畅及通畅程度的准确性相似,无显著性差异（P〉0.05）;子宫输卵管超声造影诊断输卵管通畅性的诊断符合率、灵敏度、特异度均高于X线子宫输卵管碘油造影。结论：子宫输卵管超声造影对输卵管显像清晰、诊断准确、安全性高,且造影过程还起到一定的治疗作用,可作为输卵管通畅性检查的一种有效方法。     

The role of multidetector CT virtual hysterosalpingography in the evaluation of female infertility

Purpose

To assess the role of 64-row multidetector computed tomography virtual hysterosalpingography (MDCT VHSG) in the evaluation of the female reproductive tract in infertile patients and compare it with conventional X-ray hysterosalpingography (HSG).

Methods and material

The studied group included 25 patients with infertility. All patients were evaluated with 64-row MDCT VHSG and X-ray HSG. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both examinations for uterine pathology, fallopian tube pathology and per lesion pathology were calculated. The duration for both examinations, patient discomfort and patient effective dose were documented.

Results

The mean duration for MDCT VHSG and X-ray HSG was 6.5 ± 1.9 and 26.9 ± 2.9 min respectively, MDCT VHSG has a significantly less median patient discomfort and mean patient effective dose. Sensitivity, specificity, PPV and NPV for uterine pathology were 100%, 100%, 100% and 100% respectively for MDCT VHSG and 90%, 93.3%, 90% and 93.3% respectively for X-ray HSG, the inter-method agreement for uterine pathology was k = 0.83. Sensitivity, specificity, PPV and NPV for the detection of fallopian tube pathology were 100%, 93%, 91 and 100% respectively for MDCT VHSG and 100%, 86%, 85% and 100% respectively for X-ray HSG and k = 0.76. Sensitivity, specificity, PPV and NPV for per patient pathology were 100%, 91%, 93% and 100% respectively for MDCT VHSG and 87%, 80%, 87% and 80% respectively for X-ray HSG and k = 0.75.

Conclusion

MDCT VHSG could be an excellent new alternative diagnostic procedure in the infertility assessment workup.     

子宫输卵管碘油造影诊断价值分析

目的探讨子宫输卵管碘油造影的诊断价值。方法对120例资料较完整的子宫输卵管碘油造影的x线片进行分析。结果正常26例，宫腔异常5例，单侧输卵管不通39例，双侧输卵管不通27例，输卵管通而不畅23例，造影剂逆流14例。结论子宫输卵管碘滔造影是行之有效且简便实用的诊断方法。     

输卵管性不孕的X线诊断与腹腔镜对照(附34例分析)

目的：通过子宫输卵管造影和腹腔镜检查的对照,提高对输卵管性不孕的Ｘ线诊断。方法：输卵管不孕症患进行了输卵管造影和腹腔镜检查,将其结果进行比较。结果：子宫输卵管造影;输卵管各部阻塞１５支,通而不畅２１支,输卵管未通１５支,输卵管积水９支,输卵管通畅７支。