四维子宫输卵管超声造影在辅助生殖技术孕前筛查中的临床价值

目的探讨四维子宫输卵管超声造影（TVS-4D-HyCoSy）在辅助生殖技术孕前筛查中的临床应用价值。 方法选取2016年3月至2019年6月在无锡市妇幼保健院拟行辅助生殖技术的不孕症患者678例，对678例患者共计1338条输卵管行TVS-4D-HyCoSy。所有病例术后均行腹腔镜下亚甲蓝通液检查，其中177例行宫腔镜检查和治疗。分析TVS-4D-HyCoSy对输卵管通畅性及宫腔病变的诊断效能，并通过Kappa检验分析其与宫腹腔镜检查的一致性。 结果以腹腔镜下亚甲蓝通液检查结果为诊断金标准，TVS-4D-HyCoSy诊断输卵管通畅、通而不畅及不通畅的符合率分别为93.64%（663/708）、82.95%（321/387）、91.89%（204/222）。2种方法诊断输卵管通畅性的一致性较好（Kappa值=0.812）。678例患者中，TVS-4D-HyCoSy诊断子宫畸形及宫腔异常285例（285/678，42.04%）。以177例患者的宫腔镜诊断结果为金标准，常规超声和正性造影剂诊断宫腔异常的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为40.00%、22.03%、88.89%、6.25%、44.44%和62.96%、60.00%、94.44%、13.04%、31.09%；负性造影剂诊断宫腔异常的敏感度、特异度、阳性预测值、阴性预测值及准确性分别为98.15%、80.00%、98.15%、80.00%、48.31%。仅负性造影剂与宫腔镜诊断宫腔异常的一致性较好（Kappa值=0.781）。 结论TVS-4D-HyCoSy可准确判断输卵管的通畅性，且对子宫畸形及宫腔内病变也具有重要诊断价值，可作为辅助生殖技术助孕前筛查的有效、全面的检查手段。

Clinical value of four-dimensional hysterosalpingography in pre-pregnancy screening with assisted reproductive technology

ObjectiveTo assess the clinical value of four-dimensional hysterosalpingography (TVS-4D-HyCoSy) in pre-pregnancy screening with assisted reproductive technology. MethodsA retrospective analysis was performed on 678 infertility patients who planned to undergo assisted reproductive technology procedures at Wuxi Maternity and Child Health Hospital from March 2016 to June 2019. A total of 1338 fallopian tubes in 678 patients underwent TVS-4D-HyCoSy. All cases underwent laparoscopic examination with methylene blue solution after operation, of whom 177 underwent hysteroscopy and treatment. The diagnostic efficacy of TVS-4D-HyCoSy on tubal patency and uterine cavity lesions was calculated, and its consistency with hysteroscopy was analyzed using Kappa test. ResultsWith the results of laparoscopic examination with methylene blue solution as the diagnostic gold standard, the coincidence rates of TVS-4D-HyCoSy in diagnosing patency, partial patency, and obstruction of fallopian tubes were 93.64% (663/708), 82.95% (321/387), and 91.89% (204/222), respectively. The two methods were more consistent in the diagnosis of tubal patency (Kappa value=0.812). Among 678 patients, TVS-4D-HyCoSy diagnosed uterine malformations and uterine cavity abnormalities in 285 cases (285/678, 42.04%). Taking the hysteroscopic diagnosis results of 177 patients as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional ultrasound and positive contrast agents in the diagnosis of uterine cavity abnormalities were 40.00%, 22.03%, 88.89, 6.25%, and 44.44%, and 62.96%, 60.00%, 94.44%, 13.04%, and 31.09%, respectively; the corresponding values of negative contrast agents in the diagnosis of uterine cavity abnormalities were 98.15%, 80.00%, 98.15%, 80.00%, and 48.31%. Only negative contrast media and hysteroscopy were consistent in the diagnosis of uterine cavity abnormalities (Kappa value = 0.781). ConclusionTVS-4D-HyCoSy can accurately determine the patency of the fallopian tube, and also has important diagnostic value for uterine malformations and intrauterine lesions. It can be used as an effective and comprehensive method for pre-pregnancy screening with assisted reproductive technology.