本文選題：經(jīng)陰道四維超聲造影　切入點(diǎn)：輸卵管妊娠　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:育齡期女性的輸卵管是早期受精和胚胎發(fā)育的場(chǎng)所,它的結(jié)構(gòu)以及功能的異常改變常常會(huì)導(dǎo)致不孕或輸卵管妊娠的發(fā)生。利用經(jīng)陰道四維超聲輸卵管造影(Four-dimensional Hysterosalpingo-contrast sonography,4D-HyCoSy)來評(píng)價(jià)輸卵管妊娠患者經(jīng)藥物保守治療后以及經(jīng)保守性手術(shù)治療后雙側(cè)輸卵管的通暢狀態(tài),探討經(jīng)陰道4D-HyCoSy在藥物保守治療后及保守性手術(shù)治療后輸卵管妊娠患者中應(yīng)用的臨床價(jià)值,為這部分患者再次妊娠選擇合適的時(shí)間和方式或早期進(jìn)行臨床干預(yù)提供依據(jù)。方法:選擇2015年1月~2016年9月在濱州醫(yī)學(xué)院附屬醫(yī)院婦產(chǎn)科門診以及生殖醫(yī)學(xué)科門診就診的120例經(jīng)藥物保守治療以及經(jīng)保守性手術(shù)治療后的輸卵管妊娠患者。將120例患者分為三組:A組為保守性藥物治療的患者(40例);B組為腹腔鏡下保守性手術(shù)治療的患者(40例);C組為開腹保守性手術(shù)治療的患者(40例),所有患者均行經(jīng)陰道4D-HyCoSy,觀察雙側(cè)輸卵管通暢狀況,來客觀評(píng)價(jià)輸卵管妊娠患者保守治療后雙側(cè)輸卵管通暢情況。隨機(jī)選擇其中40例與腹腔鏡下美蘭通液(金標(biāo)準(zhǔn))結(jié)果對(duì)照,比較兩種方法的一致性。結(jié)果:1、經(jīng)陰道4D-HyCoSy與腹腔鏡下美蘭通液檢查評(píng)價(jià)輸卵管通暢性的結(jié)果一致性較高。Kappa值為0.732(P0.001),經(jīng)陰道4D-HyCoSy診斷的敏感性為88.9%(24/27)、特異性為92.5%(49/53)、陽性預(yù)測(cè)值為85.7%(24/28)、陰性預(yù)測(cè)值為94.2%(49/52)、準(zhǔn)確率為91.3%(73/80)。2、腹腔鏡治療組患側(cè)患側(cè)輸卵管通暢率(32.5%)明顯高于藥物治療組(7.5%)、開腹治療組(10.0%);腹腔鏡治療組患側(cè)輸卵管通而不暢率及阻塞率(37.5%、30.0%)明顯低于藥物治療組(47.5%、45.0%)、開腹治療組(45.0%、45.0%);三個(gè)不同治療組間差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、經(jīng)陰道4D-HyCoSy對(duì)輸卵管通暢性的評(píng)估結(jié)果與腹腔鏡下美蘭通液檢查的一致性較高(Kappa值為0.732)。2、腹腔鏡保守性手術(shù)治療更有助于輸卵管功能的保留和恢復(fù),可在有生育要求的患者中推廣應(yīng)用。3、經(jīng)陰道4D-HyCoSy安全可靠,操作簡單,可以實(shí)時(shí)觀看輸卵管內(nèi)造影劑的走向,可對(duì)輸卵管通而不暢的患者起到一定的治療作用,值得臨床推廣使用。
[Abstract]:Objective: the fallopian tubes of women of childbearing age are the place for early fertilization and embryonic development. Abnormal changes in structure and function often lead to infertility or tubal pregnancy. Four-dimensional Hysterosalpingo-contrast sonography4D-HyCoSysystem was used to evaluate the patients with tubal pregnancy after drug conservative treatment and conservative treatment. The patency of bilateral fallopian tubes after sexual surgery, To explore the clinical value of transvaginal 4D-HyCoSy in patients with tubal pregnancy after conservative drug therapy and conservative surgical treatment. Methods: from January 2015 to September 2016, we selected the Department of Obstetrics and Gynecology and the Department of Reproductive Medicine in the affiliated Hospital of Binzhou Medical College. 120 cases of tubal pregnancy were treated with conservative drug therapy and conservative surgery. 120 cases were divided into three groups: group A: 40 cases treated with conservative drugs, group B: conservative surgery under laparoscope. 40 patients in group C were treated with laparotomy and conservative surgery. All the patients were treated with 4D-HyCoSys via vagina to observe the patency of bilateral fallopian tubes. Objective to evaluate the patency of bilateral fallopian tubes in patients with tubal pregnancy after conservative treatment. Results the consistency of the two methods was higher than that of vaginal 4D-HyCoSy and laparoscopic methylene blue liquid test. Kappa value was 0.732kappa, the sensitivity of transvaginal 4D-HyCoSy diagnosis was 88.9 / 27, the specificity was 92.5 / 49 / 53, and the positive prediction was positive. The value was 85.7 / 28, and the negative predictive value was 94.20.49 / 52g, and the accuracy was 91.373 / 80 / 2. The patency rate of the affected side of the affected side in the laparoscopic treatment group was significantly higher than that in the drug treatment group (7.5V) and the laparotomy treatment group (10.0); the rate of tubal patency and obstruction in the laparoscopic treatment group was 37.5% and 30.0% (P < 0.05). The difference between the three different treatment groups was statistically significant (P 0.05). Conclusion: 1. The results of transvaginal 4D-HyCoSy in evaluating the patency of fallopian tubes are higher than those in laparoscopy. [WT5HZ] the results of the evaluation of the patency of fallopian tubes by transvaginal 4D-HyCoSy are consistent with those of laparoscopy. The value of Kappa was 0.732n.2.Laparoscopic conservative surgery was more helpful for the preservation and recovery of fallopian tube function. It can be popularized and applied in patients with fertility requirement. The transvaginal 4D-HyCoSy is safe and reliable, easy to operate, and can watch the direction of the contrast agent in the fallopian tube in real time. It can play a certain therapeutic role in the patients with tubal patency. It is worth popularizing in clinic.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.22;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 香鈺婷;白文佩;;超聲影像學(xué)診斷輸卵管通暢性的臨床應(yīng)用進(jìn)展[J];國際生殖健康/計(jì)劃生育雜志;2016年02期

2 楊君梅;馬曉芹;張春云;王瑤;;經(jīng)陰道四維超聲造影技術(shù)評(píng)價(jià)輸卵管的通暢性[J];中國醫(yī)藥科學(xué);2016年03期

3 黃平;陳光元;;異位妊娠腹腔鏡保守手術(shù)中行輸卵管逆行通液的應(yīng)用價(jià)值[J];河北醫(yī)學(xué);2015年03期

4 楊志芹;黃學(xué)惠;;持續(xù)性異位妊娠的診治及預(yù)防進(jìn)展[J];生殖與避孕;2015年02期

5 文曉琰;詹安娜;肖卉;;注射泵加輸卵管通液管在子宮輸卵管碘油造影中的應(yīng)用[J];現(xiàn)代醫(yī)院;2015年01期

6 郭俊;王莎莎;程琦;朱賢勝;李葉闊;王泓;馬靜麗;;經(jīng)陰道實(shí)時(shí)三維子宮輸卵管超聲造影劑逆流分析[J];中國醫(yī)學(xué)影像技術(shù);2014年07期

7 田利玲;黃秀虹;黃濤;鐘子輝;黃淑清;劉婷婷;文達(dá)輝;;經(jīng)陰道四維子宮輸卵管超聲造影在不孕癥診斷中的應(yīng)用價(jià)值[J];中國中西醫(yī)結(jié)合影像學(xué)雜志;2014年02期

8 周月華;陳麗;;輸卵管妊娠腹腔鏡保守性手術(shù)聯(lián)合藥物防治PEP的臨床研究[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2012年21期

9 蔡彥;鄭欣;溫清霞;;超聲引導(dǎo)局部注射MTX治療早期未破裂型異位妊娠臨床研究[J];中國實(shí)用醫(yī)藥;2012年07期

10 胡雙龍;楊淑君;盧玲;彭雪芳;;輸卵管通暢性的超聲造影研究進(jìn)展[J];臨床超聲醫(yī)學(xué)雜志;2012年01期

，

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