本文關(guān)鍵詞： 子宮輸卵管超聲造影 聲諾維 碘油X線造影 四維超聲造影 陰道超聲 輸卵管性不孕癥　出處：《承德醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：不孕癥是困擾每個區(qū)域乃至全球許多育齡女性的一個重要疾病問題,其患病率約占7%~10%。據(jù)統(tǒng)計(jì):不孕癥出現(xiàn)持續(xù)上漲的趨向。在眾多不孕癥患者中,輸卵管病變是導(dǎo)致不孕的最重要病因之一,在國外:30%~35%與輸卵管病因相關(guān),在我國:50%與輸卵管梗阻和通而不暢因素有關(guān),各種病變因素(輸卵管發(fā)育不全、盆腔炎后遺癥、子宮內(nèi)膜異位癥、慢性輸卵管炎等多種因素)以致輸卵管功能性障礙或梗阻是輸卵管性不孕癥的主要影響因素。評價輸卵管暢通性是診治不孕癥的一個關(guān)鍵環(huán)節(jié),輸卵管是否病變對不孕癥病因的探討具備關(guān)鍵性意義。精準(zhǔn)評估輸卵管的結(jié)構(gòu)、功能也是醫(yī)治輸卵管性不孕癥的首要環(huán)節(jié),4D-子宮輸卵管Sono Vue超聲造影能同時準(zhǔn)確診斷宮腔內(nèi)狀況、輸卵管結(jié)構(gòu)、暢通度、梗阻的位置,其無創(chuàng)、操作簡單、成本低、數(shù)據(jù)存儲持久。4D-HyCoSy準(zhǔn)確評估輸卵管暢通情況是醫(yī)治不孕癥的關(guān)鍵,同時也為臨床醫(yī)師醫(yī)治提供了主要依據(jù),成為了輸卵管性不孕不可缺少的輔助性檢查,對輸卵管性不孕癥患者的診治有著重要臨床價值。目的:本研究探討4D-經(jīng)陰道子宮輸卵管Sono Vue超聲造影(four-dimensional Hysterosalpingo contast sonography,4D-HyCoSy)、X線子宮輸卵管碘化油造影術(shù)(Hysterosalpingography,HSG)分別與宮腹腔鏡結(jié)果進(jìn)行比較,分析二者診斷雙側(cè)輸卵管暢通度的診斷價值(正確率)、敏感性、一致性、特異性。追蹤隨訪6個月后自然受孕率,統(tǒng)計(jì)成功妊娠例數(shù)及各種情況,剖析4D子宮輸卵管Sono Vue超聲造影在診斷輸卵管通暢度中的有效性,以探究4D-HyCoSy對輸卵管暢通性的診斷意義及臨床價值。方法:選用America生產(chǎn)的GE Voluson E8彩色多普勒診斷儀對58例不孕癥女性患者進(jìn)行4D-HyCoSy檢查,選用SIMENS數(shù)字胃腸機(jī)ICON200對40例不孕女性患者進(jìn)行HSG檢查,同期記錄受檢者的檢查結(jié)果以及記錄雙側(cè)輸卵管的暢通度及微泡盆腔內(nèi)的擴(kuò)散情況,以宮腹腔鏡檢查為金標(biāo)準(zhǔn),統(tǒng)計(jì)分析其一致性、特異性及敏感性,追蹤回訪6個月后患者的受孕率,比較分析歸納4D-HyCoSy關(guān)于診斷輸卵管暢通度的價值及重要的臨床意義。結(jié)果:98例不孕女性患者,2例患者行單側(cè)輸卵管摘除術(shù)或者行單側(cè)附件摘除術(shù),58例患者(114條輸卵管)行4D-HyCoSy:輸卵管通暢17條,占14.9%(17/114),輸卵管阻塞72條,占63.2%(72/114),輸卵管通而不暢(狹窄)25條,占21.9%(25/114)。40例(80條輸卵管)HSG中輸卵管暢通25條,占31.25%(25/80),輸卵管梗阻47條,占58.75%(47/80),輸卵管通而不暢(狹窄)8條,占10%(10/80)。腹腔鏡檢查中輸卵管通暢35條(其中HyCoSy組19條,HSG組16條),輸卵管梗阻128條(其中HyCoSy組76條,HSG組52條),輸卵管通而不暢(狹窄)33條(其中HyCoSy組21條,HSG組12條)。以宮腹腔鏡檢查為標(biāo)準(zhǔn)對照分析,HyCoSy組:敏感性(%)=97.8%;特異性(%)=84.2%;準(zhǔn)確性(%)=92.2%。HSG組:敏感性(%)=88.5%;特異性(%)=81.3%;準(zhǔn)確性(%)=83.8%,98例輸卵管復(fù)通術(shù)后半年,HyCoSy組半年后的正常復(fù)孕率明顯高于HSG組(P0.05),2種造影方法對輸卵管診斷準(zhǔn)確率的對比分析:4D-HyCoSy的準(zhǔn)確率顯著高于HSG(P0.05)。2組檢查方式的特異性、一致性及敏感性對比:4D-HyCoSy對輸卵管梗阻的診斷的一致性、特異性及敏感性都均高于HSG(P0.05)。結(jié)論:超聲造影是評估輸卵管暢通情況的新方法,其具有相對創(chuàng)傷小、安全、操作簡便、準(zhǔn)確、費(fèi)用低廉、重復(fù)性好、資料保存持久并且可以長期使用等優(yōu)點(diǎn)。與碘油X線相比,4D-HyCoSy診斷輸卵管通暢性的診斷正確率,一致性、敏感性、特異性以及半年后正常妊娠的受孕率均明顯高于HSG,并且還能實(shí)時觀察微氣泡在宮腔內(nèi)的流動和擴(kuò)散程度判斷雙側(cè)輸卵管暢通度,并同時知道卵巢、子宮和盆腔的種種情況,乃至檢測宮腔形態(tài)、觀察子宮肌層和卵巢的情況等方面具備特別高的靈敏度和特異度,最重要的是對輕度的腹膜粘連、輸卵管的暢通度有一定的治療功能,受孕時間也不受限制,受到大眾的不斷好評,是當(dāng)前可作為檢查輸卵管暢通度或術(shù)后輸卵管再通暢通度的首選的診斷價值最高的無創(chuàng)傷性醫(yī)學(xué)影像學(xué)檢查方法。
[Abstract]:Infertility is an important disease problem in each region and even the whole world many women of childbearing age, the prevalence rate of about 7%~10%. according to the statistics: the rising trend of infertility. In many patients with infertility, tubal disease is one of the most important causes of infertility in foreign countries: 30%~35% and tubal cause in our country. And the poor: factors associated with tubal obstruction and 50% lesions, various factors (tubal hypoplasia, sequelae of pelvic inflammatory disease, endometriosis, chronic salpingitis and other factors) so that the function of fallopian tube disorders or obstruction are the main influencing factors of tubal infertility. Evaluation of fallopian tube patency is a key link in the treatment of infertility, tubal whether on etiology of infertility lesions have key significance. Accurate assessment of tubal structure, function also treat tubal infertility The first step, the 4D- Sono Vue uterine tubal contrast-enhanced ultrasound can accurately diagnosis of uterine cavity, fallopian tube structure, smooth degree of obstruction, position, non-invasive, simple operation, low cost, data storage lasting.4D-HyCoSy accurate assessment of tubal patency is the key to cure infertility, but also provides the main on the basis of treatment for the clinician to become auxiliary examination of tubal infertility indispensable, has important clinical value in the diagnosis and treatment of patients with tubal infertility. Objective: This study investigated the Sono Vue transvaginal ultrasound contrast hysterosalpingography (4D- four-dimensional Hysterosalpingo contast sonography, 4D-HyCoSy), X-ray hysterosalpingography lipiodol angiography (Hysterosalpingography HSG), compared with the results of laparoscopy, the analysis of the two diagnostic value of diagnosis of bilateral tubal smooth degree (accuracy), sensitivity, a Consistency and specificity. The natural pregnancy rate after 6 months of follow-up, the statistical number of cases of successful pregnancy and various situations, the effectiveness analysis of tube patency in Sono Vue contrast-enhanced ultrasound in diagnosis of fallopian tubal uterine 4D, and the clinical diagnostic significance of 4D-HyCoSy on smooth tube price on the value of oviduct. Method: 4D-HyCoSy examination of 58 cases of female infertility patients with GE Voluson E8 color Doppler diagnostic instrument of America production, using SIMENS digital gastrointestinal machine ICON200 HSG was performed in 40 cases of female infertility patients during the same period, record examination results and record double oviduct smooth degree and micro bubble diffusion in the pelvic cavity, to the palace laparoscopy is the gold standard, analyze the consistency of statistics, specificity and sensitivity, the follow-up patients with pregnancy rate after 6 months, a comparative analysis of inductive 4D-HyCoSy on the diagnosis of tubal smooth degree and weight value 瑕佺殑涓村簥鎰忎箟.緇撴灉:98渚嬩笉瀛曞コ鎬ф?zhèn)ｈ�，

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