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。

The Clinical Diagnostic Evaluation of Hysterosalpingography and Hysteroscopic Hydrotubation in Fallopian Tube Infertility

Objective：To compare the clinical value of hysteroscopic hydrotubation （HH） and hysterosalpingography （HSG） in tubal infertility diagnosis. Methods：1 452 infertility cases，which was diagnosed from Nov. 2009 to Nov. 2011 in the Affiliated Hospital of the Chinese People′s Armed Forces Logistic College were selected randomly according to the inclusion criteria，and every patient under intravenous anesthesia was treated with HH under the monitor of B ultrasound. Patients suffered from tubal infertility underwent hysteroscopic and laparoscopic operation，and patients whose oviducts were patent were arranged to conceive，and would be examined by hysteroscope and laparoscope one year later if they cannot conceive naturally. The diagnosis rate of HH and HSG will be compared with reference to the result of hysteroscope and laparoscopes operation. Results：The coincidence rate, sensitivity and specificity of HH is 86.1%（2 500/2 904），98.7%（2 370/2 401），and 58.6%（295/503） respectively，and 74.3%（2 130/2 866），93.7%（2 252/2 404），42.4%（196/462） is that of HSG. Statistical difference is found between HSG and HH （P＜0.01）. Conclusions：HH is more accurate when diagnosing tubal patency than HSG，and HH does no obvious harm to patients，and it can observe the abnormality in uterine cavity and treat directly，so HH is superior to HSG on initially diagnosis of tubal infertility.