经阴道实时三维子宫输卵管超声造影剂逆流分析

目的 探讨经阴道实时三维子宫输卵管超声造影（TVS RT-3D-HyCoSy）中发生造影剂逆流的影响因素。方法 观察533例不孕症患者TVS RT-3D-HyCoSy中发生逆流者的声像图特征，比较不同输卵管通畅度患者的逆流发生率及造影剂推注压力。分析TVS RT-3D-HyCoSy中发生逆流的影响因素。结果 533例患者中199例发生逆流（199/533，37.34%），包括原发性不孕59例（59/199，29.65%），继发性不孕140例（140/199，70.35%）。双侧输卵管通畅患者与其他通畅度患者相比，逆流发生率的差异均有统计学意义（P均<0.05）。双侧输卵管通畅、双侧阻塞、双侧通而不畅患者中，无逆流与子宫肌层逆流者造影剂推注压力的差异均无统计学意义（P均>0.05）；双侧输卵管阻塞、双侧通而不畅患者中，无逆流与宫旁静脉丛逆流者造影剂推注压力的差异均有统计学意义（P均<0.05）。 Logistic回归分析显示，不孕类型、输卵管通畅性是逆流发生的影响因素。结论 TVS RT-3D-HyCoSy可清晰显示逆流部位，逆流的发生与不孕类型、输卵管通畅度有关，宫旁静脉丛逆流影响压力指标对输卵管通畅性的评估。

Analysis on the countercurrent of contrast medium in transvaginal real-time three-dimensional hysterosalpingo-contrast sonography

Objective To explore the related fators of contrast agent reflux during transvaginal real time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy). Methods The tubal patency of 533 infertile women were evaluated by TVS RT-3D-HyCoSy and the sonographic features of contrast agent reflux were analyzed. And then the incidence and injection pressure were compared among patients with the different tubal patency. The related factors of contrast agent relux during TVS RT-3D-HyCoSy were analyzed. Results In all 533 patients, reflux was observed in 199 patients (199/533, 37.34%). There were 59 primary infertility (59/199, 29.65%) and 140 secondary infertility (140/199, 70.35%). The differences of reflux incidence betweent patients with bilateral tubal patency and other tubal patency were statistically significant (all P<0.05). The differences of injection pressure between patients with contrast agent reflux in myometrium and without reflux were not statistically significant in patients with bilateral tubal patency, bilateral passable and bilateral barrier, respectively (P>0.05). The differences of injection pressure between patients with venous countercurrent and without reflux were statistically significant in patients with bilateral tubal passable and bilateral barrier, respectively (both P<0.05). Logistic regression analysis showed that the type of infertility and tubal patency were related factors for contrast agent reflux. Conclusion The TVS RT-3D-HyCoSy can clearly show the location of countercurrent which occurs with the type of infertility and tubal patency. Venous countercurrent impact pressure indicator as a reference to evaluate tubal patency.