经阴道四维超声子宫输卵管造影中造影剂逆流高危因素分析

  目的  分析经阴道四维超声子宫四维超声子宫输卵管造影(4D-HyCoSy)中引起造影剂逆流的主要高危因素，旨在为4D-HyCoSy造影剂逆流的预防提供参考依据。  方法  选择2018年1月—2019年12月温州市中西医结合医院行4D-HyCoSy检查的658例女性作为研究对象。比较逆流组(248例)与未逆流组(410例)患者临床资料的差异，分析发生造影剂逆流的高危因素。  结果  逆流组与未逆流组比较，继发不孕(77.82% vs. 69.51%)、宫腔操作史(59.68% vs. 37.07%)、子宫腺肌病(14.52% vs. 9.27%)、检查时间为经期后＜5 d(47.18% vs. 38.54%)、子宫内膜息肉(22.18% vs. 14.88%)比例差异具有统计学意义(均P＜0.05)；逆流组与未逆流组比较，双侧输卵管阻塞(6.05% vs. 2.44%)、双侧输卵管通畅(4.44% vs. 14.63%)比例差异具有统计学意义(均P＜0.001)；子宫肌层主逆流组与宫旁静脉主逆流组比较，子宫内膜息肉比例(27.92% vs. 12.77%)差异具有统计学意义(P＜0.05)；宫腔操作史、子宫腺肌病、子宫内膜息肉、双侧输卵管阻塞是造影剂逆流的独立危险因素(均P＜0.05)。  结论  4D-HyCoSy中发生造影剂逆流的发生率较高，与子宫内膜损伤及双侧输卵管阻塞有关。 

Analysis of high-risk factors of contrast agent reflux in 4D-hysterosalpingo contrast sonography

  Objective  This study aimed to analyse the main risk factors of contrast agent reflux in four-dimensional ultrasonography of vagina (4D HyCoSy) to provide reference basis for the prevention of contrast agent reflux.  Methods  Women who underwent 4D HyCoSy in our hospital from January 2018 to December 2019 were selected as the study objects. The differences of clinical data and tubal patency between the reflux group (n=248) and non-reflux group (n=410) were compared, and the risk factors of contrast agent reflux were analysed.  Results  Secondary infertility (77.82% vs. 69.51%), history of uterine cavity operation (59.68% vs. 37.07%), adenomyosis (14.52% vs. 9.27%), examination time < 5 days after menstruation (47.18% vs. 38.54%) and endometrial polyp (22.18% vs. 14.88%) were significantly different between the reflux group and non-reflux group (all P < 0.05). Statistically significant differences in the proportion of bilateral fallopian tube obstruction (6.05% vs. 2.44%) and bilateral fallopian tube patency (4.44% vs. 14.63%) were found between the reflux group and non-reflux group (all P < 0.001). The proportion of endometrial polyps (27.92% vs. 12.77%) was significantly different between the myometrium main reflux group and the parathyroid main reflux group (P < 0.05). History of uterine cavity operation, adenomyosis, endometrial polyps and bilateral fallopian tube obstruction were independent risk factors for contrast medium counter current (all P < 0.05).  Conclusion  The incidence of contrast agent reflux was high in 4D HyCoSy, which was related to endometrial injury and bilateral oviduct obstruction.