發(fā)布時間：2018-05-13 09:36

  本文選題：子宮輸卵管造影 + 高壓注射器��； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：將改良的逐漸加壓法子宮輸卵管造影與傳統(tǒng)的手推法子宮輸卵管造影在輸卵管阻塞性不孕癥診療中的應(yīng)用做對比研究,探討高壓注射器加壓法的優(yōu)越性和可行性,并對兩種方法的影像學(xué)資料進行解剖學(xué)分析,使HSG這一檢查更加安全、規(guī)范,為臨床診斷和治療提供新的科學(xué)依據(jù)。方法：1研究對象收集保定市第二中心醫(yī)院2005年1月—2013年12月期間就診的女性不孕癥患者共200例,年齡20-44歲,平均29.3歲。采用回顧性研究將兩組患者分為兩組,100例患者利用高壓注射器逐漸加壓法子宮輸卵管造影為研究組,100例常規(guī)手推法子宮輸卵管造影為對照組。兩組均排除了子宮先天發(fā)育異常及輸卵管手術(shù)切除術(shù)的病例。所有患者均簽署知情同意書。2研究設(shè)備及方法兩組患者均在月經(jīng)干凈后3-7天內(nèi),由婦科醫(yī)生操作經(jīng)陰道向子宮內(nèi)置入一個雙腔氣囊導(dǎo)管,然后來我科西門子R200數(shù)字胃腸機下行子宮輸卵管造影。實驗組利用Zentith-1710自動推注系統(tǒng)注射碘海醇,速率為0.2ml/s,壓力為200PSI,若一側(cè)或雙側(cè)不通,加壓至300PSI進行加壓造影,同時點片,并記錄注射造影劑用量及X線曝光時間；注意患者的反應(yīng),預(yù)防輸卵管破裂。對照組采用10ml注射器手推碘海醇進行子宮輸卵管造影,遇阻力時可略加大注射壓力,但以患者能忍受的壓力范圍之內(nèi),同時腳踩曝光按鈕進行透視及攝片。兩組在點片完畢用5m1注射器抽出球囊內(nèi)氣體,撤管,觀察盆腔造影劑的彌散情況。3分析方法將輸卵管的HSG表現(xiàn)分為正常和異常兩組,正常者為完全通暢,異常包括完全梗阻、通而不暢和周圍粘連。完全梗阻進一步區(qū)分出近段梗阻和遠段梗阻。記錄兩組正常和異常輸卵管的條數(shù),比較兩種方法各種情況之間的差異,并對兩種方法中造影劑用量、X線曝光時間、造影劑逆流進行對比。根據(jù)影像資料,對通暢輸卵管的近段和遠段的長度及內(nèi)徑進行測量,與體調(diào)值對比,并且進行兩組間比較。對實驗組異常輸卵管加壓前后影像資料進行解剖學(xué)分析。所有結(jié)果采用SPSS軟件建立數(shù)據(jù)庫并進行統(tǒng)計分析,計量資料以均數(shù)±標準差(x±s)表示,兩組對比采用t檢查；計數(shù)資料用χ2檢驗,P0.05有統(tǒng)計學(xué)意義,表示二者差異顯著。結(jié)果：兩組不孕癥患者的年齡、不孕史、妊娠次數(shù)等一般情況對比均無顯著性差異,所以兩組的造影結(jié)果具有可比性。(1)兩組的診療效果對比：兩組均為200條輸卵管,實驗組通暢條數(shù)為138條,對照組為116條,實驗組明顯高于對照組,有統(tǒng)計學(xué)意義。輸卵管完全梗阻的實驗組為43條,對照組為70條,完全梗阻率明顯低于對照組。通而不暢實驗組為9條,對照組為8條；周圍粘連實驗組為10條,對照組為6條,后兩項均無明顯差別。(2)兩組用藥劑量、不良反應(yīng)及曝光時間對比：用藥劑量實驗組高于對照組；兩組的不良反應(yīng)無明顯差別,兩組均未引起嚴重不良反應(yīng)。曝光時間實驗組低于對照組,縮短了曝光時間,降低了患者X線輻射。(3)兩組影像資料的解剖學(xué)分析：HSG正常表現(xiàn)為與子宮角相連的輸卵管呈線狀自內(nèi)側(cè)到外側(cè)由細逐漸變粗,造影劑自輸卵管傘部流出進入腹腔內(nèi),呈條片狀或條紋狀彌散涂抹于卵巢周圍或周圍腸管上,隨著時間延長,逐漸變淡。完全梗阻的影像學(xué)表現(xiàn)為至少一側(cè)輸卵管完全不顯影,或者部分顯影,但遠端未見彌散。完全梗阻進一步區(qū)分,將峽部及其以內(nèi)的梗阻稱為近段梗阻,壺腹部及其以遠至傘端的梗阻為遠段梗阻。通而不暢的影像學(xué)表現(xiàn)為至少有一側(cè)輸卵管的形態(tài)欠規(guī)則、毛糙、增粗或粗細不均,管壁欠光滑,僅有部分造影劑通過,.輸卵管周圍可伴／或不伴有粘連。周圍粘連的影像學(xué)表現(xiàn)為傘端造影劑聚集成團,未彌散或彌散不良。實驗組和對照組通暢輸卵管近段長度分別43.83±7.53mm、41.60± 4.93mm;遠段分別38.29±8.58mm、39.89±6.25mm;近段內(nèi)徑分別為0.63±0.10mm、0.66±0.12m;遠段內(nèi)徑分別為3.99±0.88mm、3.90±0.71mm,兩組各段長度及內(nèi)徑對比,無顯著差異；但兩組通暢輸卵管近段長度均大于體調(diào)數(shù)值,內(nèi)徑值小于體調(diào)數(shù)值,通暢輸卵管遠段的測量值略低于體調(diào)數(shù)值,內(nèi)徑值差別不大。提示兩種方法可拉伸輸卵管近段的長度,但對輸卵管的形態(tài)無明顯改變。根據(jù)HSG可拉伸輸卵管近段這一結(jié)果,可通過測量顯影輸卵管的長度,推測輸卵管的梗阻位置。部分近段梗阻患者通過加壓可促進峽部再通；而遠段梗阻的病例,當壓力升高時,由于不良反應(yīng)明顯加重,再通效果不明顯。加壓法可提高近段梗阻的再通率。通而不暢及周圍粘連的加壓后影像學(xué)改變不明顯。結(jié)論：(1)逐漸加壓法子宮輸卵管造影在輸卵管阻塞性不孕癥診療價值優(yōu)于常規(guī)法。該方法操作簡單,降低了X線的輻射,可取得較滿意的圖像結(jié)果。(2)高壓法HSG可以顯著提高梗阻的復(fù)通率,并且對近段梗阻復(fù)通效果好于遠段梗阻。(3)高壓法HSG對輸卵管壺腹部不完全梗阻和傘端粘連也有改善作用。
[Abstract]:Objective: To compare the application of the improved progressive pressure hysterosalpingography with the traditional hand push hysterosalpingography in the diagnosis and treatment of oviduct obstructive infertility, to explore the superiority and feasibility of the high-pressure syringe compression method, and to make an anatomic analysis of the imaging materials of the two methods, so that the examination of the HSG is more important. Add safety and specification to provide new scientific basis for clinical diagnosis and treatment. Methods: 1 subjects were collected from second central hospitals in Baoding city from January 2005 to December 2013, 200 cases of female infertility, aged 20-44 years old, with an average of 29.3 years. Two groups of patients were divided into two groups with retrospective study, and 100 patients were injected with high pressure injection. Hysterosalpingography was used as a study group, and 100 cases of routine hand push hysterosalpingography were used as the control group. The two groups were excluded from the congenital dysplasia of the uterus and the cases of oviduct resection. All patients signed the informed consent.2 research equipment and methods in two groups of patients within 3-7 days after menstruation. The doctor operates a double cavity balloon catheter into the uterus via the vagina and then comes to our department SIEMENS R200 digital gastrointestinal machine for hysterosalpingography. The experimental group uses a Zentith-1710 automatic injection system to injecting iodiol with a rate of 0.2ml/s and pressure of 200PSI. If one side or two side is not accessible, compression to 300PSI is performed at the same time. Point film, record the dosage of injection contrast agent and X-ray exposure time, pay attention to the response of the patient and prevent the rupture of the tubal. The control group adopts the 10ml syringe hand to push the hysterosalpingography with iodiol, and can slightly increase the injection pressure in the case of resistance, but it is within the range of pressure that the patient can endure, while the exposure button of the foot is taken for perspective and photography. In the two group, the gas was pumped out of the balloon with the 5m1 syringe at the end of the point slice, and the catheter was withdrawn and the dispersion of the pelvic contrast agent was observed. The.3 analysis of the fallopian tubes was divided into two groups of normal and abnormal groups. The normal subjects were completely unobstructed, including complete obstruction, unobstructed and peripheral adhesion. The proximal obstruction and distal segment were divided in the further area of complete obstruction. Obstruction. Record the number of two groups of normal and abnormal fallopian tubes, compare the differences between the two methods, and compare the dosage of contrast agent, X-ray exposure time, and contrast medium in the two methods. According to the image data, the length and diameter of the proximal and distal segments of the tubal are measured, and the value is compared with the body adjustment. Comparison between the two groups. Anatomic analysis of the imaging data before and after the abnormal fallopian tube compression in the experimental group. All the results were made up of SPSS software to establish a database and carried out statistical analysis. The measurement data were expressed in the mean number of standard deviations (x + s). The two groups were compared with the t examination; the count data were tested by chi 2, and P0.05 was statistically significant, indicating that the two differences showed significant difference. Results: there was no significant difference in age, infertility history and pregnancy times between the two groups of infertility, so the results of the two groups were comparable. (1) the comparison of the results of diagnosis and treatment in the two groups: two groups were 200 oviduct, the number of unobstructed strips in the experimental group was 138, the control group was 116, and the experimental group was significantly higher than the control group. There were obviously higher than the control group. Statistical significance. The total obstruction of oviduct was 43 in the experimental group and 70 in the control group. The total obstruction rate was significantly lower than that in the control group. The experimental group was 9, the control group was 8, the peripheral adhesion experimental group was 10, the control group was 6, and the two items were not significantly different. (2) the dosage of drug use, adverse reaction and exposure time comparison of the two groups were compared: (2) the contrast of the adverse reactions and exposure time: The drug dose in the experimental group was higher than that in the control group; there was no significant difference in the adverse reaction between the two groups. The two groups did not cause serious adverse reactions. The exposure time experimental group was lower than the control group. The exposure time was shortened and the X-ray radiation was reduced. (3) the anatomical analysis of the two groups of images: HSG is often shown as a linear self of the fallopian tubes connected with the horns of the uterus. The medial to lateral is gradually thickened, and the contrast agent outflows into the abdominal cavity from the parachute part of the fallopian tube and spreads on the ovary around the ovary or the surrounding intestines, and gradually dilute with time. The image of complete obstruction is at least on the side of the fallopian tube, or partial development, but the distal end is not diffuse. The obstruction of the isthmus and its internal obstruction is called the proximal obstruction. The ampullary and the obstruction from the distal to the parachute end is a distal obstruction. The unobstructed imaging shows that at least one side of the fallopian tube is under the irregular shape, coarse, coarse or coarse, and the tube wall is less smooth and only a part of the contrast agent passes, around the fallopian tube. The imaging findings of peripheral adhesions were cluster of parachute end contrast agents, which were not diffuse or diffuse. The length of the proximal segment of the fallopian tube in the experimental group and the control group was 43.83 + 7.53mm and 41.60 4.93mm, respectively, 38.29 + 8.58mm and 39.89 + 6.25mm in the distal segment, respectively 0.63 + 0.10mm and 0.66 0.12M, respectively. The length and diameter of the two groups were 3.99 + 0.88mm and 3.90 + 0.71mm, but there was no significant difference between the length and diameter of the two groups. However, the length of the tubal proximal segment in the two groups was larger than the body modulation value. The inner diameter was less than the body modulation value. The measured value of the unobstructed fallopian tube far segment was slightly lower than the volume modulation value. The length of the inner diameter was not significant. But the length of the proximal segment of the fallopian tube could be drawn by two methods, but the length of the proximal segment of the tubal was stretched. There is no obvious change in the shape of the fallopian tubes. According to the results of the HSG extensible tubal proximal segment, the position of the oviduct obstruction can be speculated by measuring the length of the oviduct. The patients with proximal obstruction can promote the repassage of the isthmus through pressure; and the cases of distal obstruction, when the pressure is increased, the adverse reaction is obviously aggravated and reacting. The pressure method can improve the recanalization rate of the proximal obstruction. It is not obvious that the imaging changes after the pressure and the pressure of the surrounding adhesion are not obvious. Conclusion: (1) the value of the hysterosalpingography in the diagnosis and treatment of oviduct obstructive infertility is better than that of the conventional method. The method is simple and the X-ray radiation can be reduced, and a satisfactory image can be obtained. Results. (2) high pressure method HSG can significantly improve the repassage rate of obstruction, and the effect of proximal obstruction is better than that of distal obstruction. (3) high pressure method HSG can improve the incomplete obstruction of the oviduct and the parachute end adhesion.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.6
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本文編號：1882615