输卵管妊娠保守手术后子宫输卵管造影的意义

目的:探讨输卵管妊娠保守手术后子宫输卵管造影(HSG)对再次妊娠预测的临床价值。方法:选取 有生育要求的异位妊娠妇女67例在腹腔镜下行输卵管切开取胚或成型术,术后进行HSG,对不同HSG情况的术 后妊娠率进行分析。结果:输卵管妊娠腹腔镜下保守手术后宫内妊娠率为46.3%,双侧输卵管通畅者宫内妊娠率 为66.7%,一侧输卵管通畅者宫内妊娠率为45.5%,二者相比差异无显著性(P>0.05)。而一侧或双侧通畅者宫 内妊娠率为57.7%,明显高于双侧不通者(P<0.05)。结论:输卵管妊娠保守性手术后输卵管的功能取决于其通 畅情况,术后行HSG能有效判断输卵管的通畅情况,预测宫内妊娠几率,为指导受孕方式提供重要信息。     

Diagnostic Value of Sonohysterography in the Determination of Fallopian Tube Patency as an Initial Step of Routine Infertility Assessment

Objectives. Infertility is defined as the failure to conceive after 1 year of regular unprotected intercourse. It affects 10% to 15% of couples. Sonohysterography (SHG) is an accurate method for the assessment of fallopian tube patency, reflected in its high positive predictive value compared with hysterosalpingography (HSG) and laparoscopy with chromopertubation. In this study, our goal was to determine the diagnostic value of SHG for the diagnosis of bilateral tubal obstruction by comparison of SHG with HSG and laparoscopic results. Methods. This study was based on the evaluation of tubal patency by SHG and by the combination of HSG and laparoscopy in 40 patients. All patients underwent HSG as a routine infertility workup, and all patients with bilateral proximal tubal obstruction diagnosed by HSG subsequently underwent SHG. Results. Among 1024 infertile women referred to an infertility clinic, 117 (11.4%) had a diagnosis of a tubal factor as the cause of their infertility. Forty-two patients with HSG findings of bilateral proximal tubal obstruction were enrolled. Forty patients underwent SHG. In 32 patients (80%), at least 1 fallopian tube was patent, and 8 patients (20%) were reported to have bilateral tubal obstruction. Those 8 patients with SHG evidence of bilateral tubal obstruction underwent laparoscopy. Eventually, 6 of those were laparoscopically confirmed to have bilateral tubal obstruction. Conclusions. Sonohysterography is an accurate method for the determination of fallopian tube patency. It is a simple, safe, and well-tolerated technique with a low risk of adverse effects and severe complications.     

经阴道注水腹腔镜诊治输卵管性不孕50例分析

目的 使用经阴道注水腹腔镜(THL)评价子宫输卵管造影(HSG)中输卵管通畅性的准确性,并探讨THL的治疗价值.方法 于2008年1月～2009年2月应用THL对50例术前已行子宫榆卵管造影(HSG)的不孕症患者进行输卵管通畅性准确性的评价,并对盆腔病变进行治疗.术中同时施行宫腔镜检查及宫腔镜下输卵管口插管通液术.结果 ①输卵管通畅性评价:HSG诊断输卵管阻塞的准确性仅为64.7%.HSG的敏感性和特异性分别为80.5%和69.5%.②手术治疗:在THL显示阻塞的41条输卵管中,7条伞端闭锁.其余34条输卵管中的18条经宫腔镜下输卵管口插管通液后被疏通,疏通率52.9%.术中发现轻度盆腔粘连15例、中度粘连2例、重度粘连2例.所有轻度和中度粘连患者的薄膜粘连绝大部分被松解;有1个卵巢与盆壁间存在致密粘连,未能松解;对2例重度粘连患者未行粘连松解.另外,对6例患者的子宫内膜异位病灶,均予以电凝治疗.对2例氯米芬抵抗的PCOS患者行卵巢打孔治疗.③无术中术后并发症发生.④术后随访6～19个月,3例失访,除外2例重度粘连病例,其余45例患者妊娠18例,妊娠率40%.结论 HSG诊断输卵管阻塞时的结果不太可靠;THL可以对一些简单的盆腔病变进行手术治疗,联合宫腔镜效果更好.     

HSG碘油与泛影葡胺影像诊断质量对比研究

目的 探讨碘化油及泛影葡胺两种造影剂行子宫输卵管造影（hysterosalpingography,HSG）对不孕症的影像诊断质量.方法 随机抽取我院自2012年1～8月使用碘化油和泛影葡胺行子宫输卵管造影的患者各200例,统计分析两种造影剂的影像诊断质量.结果 两种造影剂在宫腔、输卵管、盆腔弥散及逆流显示方面具有显著性差异（P〈0.01）,在输卵管积液显示方面具有统计学意义（P〈0.05）.结论 碘化油影像质量高于泛影葡胺,碘油应作为子宫输卵管造影首选造影剂.     

Role of hysteroscopy in the evaluation of tubal patency in infertile women

Study objectiveTo evaluate the effectiveness of hysteroscopy as a method for the diagnosis of tubal patency using saline distention media.DesignProspective cohort study.SettingInfertility clinic of the Ain-shams University maternity hospital.Materials & methodsSixty-four infertile women underwent hysteroscopy (HSC) and hysterosalpingography (HSG) on two consecutive days. Transvaginal ultrasonography (TVS) was carried out before and after hysteroscopy in order to measure the fluid in the cul-de-sac. The difference between the two methods in the diagnosis of tubal patency was compared using laparoscopy/chromotubation as a gold standard.Main outcome measuresFluid volume measurements were used to determine a cut off value for tubal patency. Pain was recorded at the end of the process.ResultsAccording to the laparoscopy, the sensitivity and specificity of HSC and HSG in detecting tubal patency were 94.6% and 100% vs. 92.8% and 50%, respectively. The best cut off point of the fluid volume in the cul-de-sac at which both tubes are patent is 6 ml. All of the patients reported significantly less pain during hysteroscopy in response to HSG.ConclusionsOffice hysteroscopy combined with TVS may be used as an alternative to HSG, as an effective, easy, safe and minimal invasive office procedure that can be offered as a first line method for the evaluation of the uterine cavity along with the tubes in infertile women.     

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。     

High incidence of tubal dysfunction is determined by laparoscopy in cases with positive<Emphasis Type="Italic">Chlamydia trachomatis</Emphasis> antibody despite negative finding in prior hysterosalpingography

Aim:  Hysterosalpingography (HSG) is one of the most commonly used methods in order to evaluate the condition of fallopian tubes in infertility clinics. In the present paper, we retrospectively compared the findings of HSG and laparoscopy to elucidate the relationship between tubal dysfunction and background factors, such as Chlamydia trachomatis infection, endometriosis and previous surgery.
Methods:  We retrospectively reviewed clinical records of 314 patients who were examined by both HSG and laparoscopy between 1996 and 2001 in the Department of Obstetrics and Gynecology, University of Tokyo.
Results:  When HSG findings were evaluated in reference to those of laparoscopy, sensitivity and specificity for tubal patency were 0.63 and 0.79, respectively, whereas those for peri-tubal adhesion were 0.65 and 0.61, respectively. We compared the percentage of existence of background factors between the patients who were diagnosed as normal by both HSG and laparoscopy (Group L[+]) and those whose fallopian tubes were observed as patent by HSG, but were not patent by chromopertubation under laparoscopy (Group L[–]). The percentage of patients with positive chlamydial antibodies in Group L(–) (42.9%, 15/35) was significantly higher than that of patients with positive chlamydial antibodies in Group L(+) (22.8%, 44/193, P  < 0.05).
Conclusions:  These finding suggested that even if HSG showed normally patent tubes in a patient with positive Chlamydia trachomatis antibodies, the possibility of tubal occulusion still remains high and further examination by laparoscopy is recommended. (Reprod Med Biol 2007; 6 : 39–43)     

Tubal Pregnancy Treated with Trichosanthin and Followed up by Hysterosalpingography

ＴｕｂａｌＰｒｅｇｎａｎｃｙＴｒｅａｔｅｄｗｉｔｈＴｒｉｃｈｏｓａｎｔｈｉｎａｎｄＦｏｌｌｏｗｅｄｕｐｂｙＨｙｓｔｅｒｏｓａｌｐｉｎｇｏｇｒａｐｈｙＺｈｏｎｇＨｕｉ－ｐｉｎｇ（钟慧萍）；ＬｕＰｅｉ－ｘｉｎ（陆培新）；ＪｉｎＹｕ－ｃｕｉ（金毓翠）ａｎｄ...     

环脱落与子宫内膜腔形态的关系

研究了１１２例育龄妇女的子宫内膜腔形态与宫内节育器脱落的关系。发现实验组（３９例）和对照组（７３例）所测宫腔各径线的均数与模拟的宫腔形态均无差异，而在Ｘ线片测环外缘切线的长度和子宫角距两组间差异有高度显著性Ｐ＜０．０１。在宫腔上部形态的５个主型中，仅１型两组有差异，在子宫腔下部形态的４个亚型中，Ｃ型和Ｄ型两组间差异有高度显著性Ｐ＜０．０１，宫腔第一横径与第二横径之差＜５ｍｍ，子宫腔呈桶状，环易下移、脱落或带环受孕。     

宫腔镜检查对不孕症的诊断价值

目的探讨宫腔镜检查对不孕症的诊断价值。方法对2011年1月-2013年1月因不孕症需行试管婴儿治疗的1 231例患者的临床资料进行回顾性分析。所有患者均行阴道B超及宫腔镜检查,评估宫腔镜检查对宫腔内病变的显示情况,并比较阴道B超、造影、宫腔镜三种诊断方法对不孕症患者宫腔内病变的诊断能力。结果 1 231例不孕患者中,宫腔镜检查显示宫内病变有502例,B超检查显示宫腔内病变224例,子宫输卵管造影显示宫腔内病变185例。宫腔镜检查的诊断阳性率明显高于B超和造影,而B超和造影检查在不同方面有各自的优势。结论宫腔镜检查可作为不明原因不孕症患者拟行试管婴儿前的常规检查方法,其对不孕症患者宫腔内病变有重要的诊断价值。