本文選題：子宮輸卵管造影 + 腹腔鏡檢查��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:分析子宮輸卵管造影對比腹腔鏡在診斷輸卵管通而不暢中的準(zhǔn)確率,以及兩者的對比差異,了解子宮輸卵管造影對診斷輸卵管通而不暢的價值及對臨床選擇合適的腹腔鏡手術(shù)時機(jī)提供建議與依據(jù)。方法:收集浙江大學(xué)附屬婦產(chǎn)科醫(yī)院門診與住院資料,選取2014.1.1至2016.12.31在我院門診行子宮輸卵管造影診斷為輸卵管通而不暢,同時在我院住院部行腹腔鏡檢查的患者;對比子宮輸卵管造影結(jié)果與腹腔鏡檢查結(jié)果,收集患者年齡、檢查間隔時間、生育史、盆腹腔手術(shù)史、對側(cè)輸卵管通暢程度及是否存在盆腔其他異常;分析各條件下腹腔鏡下檢查結(jié)果的區(qū)別。結(jié)果:錄入患者199位,共397條輸卵管,其中290條HSG診斷為通而不暢。HSG診斷為通而不暢的輸卵管腹腔鏡檢查提示167條為通暢,17條通而欠暢,52條通而不暢,10條通而極不暢,22條近端堵塞,8條遠(yuǎn)端堵塞,14條積水,符合率為17.9%;患者年齡與輸卵管通暢程度分析時,選取35歲為節(jié)點(diǎn)分為兩組,高齡組與低領(lǐng)組,高齡組(n=34)術(shù)中輸卵管堵塞占26.5%,術(shù)中輸卵管狀態(tài)評分5.06±7.71,低齡組(n=256),術(shù)中輸卵管堵塞占13.7%,術(shù)中輸卵管狀態(tài)評分3.46±6.21。低齡組輸卵管通暢程度及狀態(tài)評分顯著優(yōu)于高齡組,具有統(tǒng)計學(xué)差異(P0.05)。以患者的不孕類型分組,分為原發(fā)不孕組(n=173)與繼發(fā)不孕組(n=153),術(shù)中原發(fā)不孕組輸卵管狀態(tài)評分為2.58±5.19,術(shù)中堵塞輸卵管占11.6%;繼發(fā)不孕組輸卵管通暢程度評分為5.22±7.63,術(shù)中輸卵管堵塞占20.5%,繼發(fā)不孕組輸卵管通暢程度及輸卵管狀態(tài)評分顯著低于原發(fā)不孕組,具有統(tǒng)計學(xué)差異(P0.05)。根據(jù)患者生育史分為平產(chǎn)組(n=29)與剖宮產(chǎn)組(n=16)進(jìn)行對比分析,兩組之間術(shù)中卵管狀態(tài)及通暢程度均無顯著性差異(P0.05)。腹腔鏡檢查與HSG檢查相隔時間≤12個月(n=267條),術(shù)中輸卵管狀態(tài)評分為3.85±6.28,間隔時間12個月(n=23條),術(shù)中輸卵管狀態(tài)評分為4.87±7.84.間隔時間小于12個月組患者術(shù)中輸卵管狀態(tài)評分優(yōu)于大于12個月組患者,但兩者無明顯統(tǒng)計學(xué)差異(P0.05)。近期組術(shù)中輸卵管堵塞率為14.1%低于遠(yuǎn)期組(30.4%),兩者具有統(tǒng)計學(xué)差異(P0.05)根據(jù)患者手術(shù)史分為無手術(shù)史組(n=188),宮腔手術(shù)史(n=74)、腹腔手術(shù)史組(n=21),提示,腹腔手術(shù)史組對比無手術(shù)史組在術(shù)中輸卵管狀態(tài)及輸卵管通暢程度上均無統(tǒng)計學(xué)差異。宮腔手術(shù)史組術(shù)中輸卵管狀態(tài)評分(5.50±7.65)高于無手術(shù)組術(shù)中輸卵管狀態(tài)程度評分(2.74±5.38),具有統(tǒng)計學(xué)意義(P0.05);宮腔手術(shù)組堵塞輸卵管占20.3%明顯高于無手術(shù)組(6.9%)具有統(tǒng)計學(xué)意義(P0.05)。根據(jù)對側(cè)輸卵管情況分為優(yōu)組(通暢/通而欠暢)與差組(堵塞/積水),優(yōu)組(n=55)術(shù)中輸卵管狀態(tài)評分為2.69±4.99,術(shù)中堵塞輸卵管占5.7%;差組(n=51)術(shù)中卵管狀態(tài)評分為8.37±8.34,術(shù)中輸卵管堵塞占27.5%,優(yōu)組輸卵管狀態(tài)評分及輸卵管通暢程度顯著優(yōu)于差組,兩組間有明顯顯著學(xué)差異(P0.05)。腹腔鏡檢查患者中其中術(shù)前診斷合并子宮肌瘤有13條,合并腺肌病1條,合并畸胎瘤2條,合并內(nèi)異26條,合并積水20條。其中合并子宮肌瘤、內(nèi)異囊腫的患者與無其他盆腔異常的患者術(shù)中檢查輸卵管通暢程度均無明顯統(tǒng)計學(xué)差異(P0.05)。術(shù)前無明顯盆腔異常的患者術(shù)中輸卵管狀態(tài)評分為2.80±5.56,堵塞占11.7%;合并積水組術(shù)中輸卵管狀態(tài)評分為12.15±6.64,堵塞占35%。合并積水的患者術(shù)中輸卵管堵塞率及輸卵管狀態(tài)評分均明顯高于無手術(shù)組患者,具有統(tǒng)計學(xué)差異(P0.05)。選擇檢查間≤12個月,年齡35歲,排除合并異位囊腫、積水必要行腹腔鏡檢查的患者,排除對側(cè)輸卵管為堵塞或積水,排除宮腔手術(shù)史,共77個患者,127條HSG診斷為通而不暢的輸卵管,術(shù)中腹腔鏡診斷結(jié)果通暢86條,通而欠暢6條,通而不暢26條,通而極不暢2條,近端堵塞5條,遠(yuǎn)端堵塞3條。其中可以通過腹腔鏡下手術(shù)處理(術(shù)中輸卵管評分8分的)共4人,的僅占5.2%。結(jié)論:子宮輸卵管造影對于診斷輸卵管通而不暢的符合率較低。合并有高齡、宮腔手術(shù)史、對側(cè)輸卵管條件差、積水、HSG檢查間隔時間12個月的患者更建議行腹腔鏡檢查明確輸卵管狀態(tài)。未合并以上因素的患者術(shù)中輸卵管通暢率較高。
[Abstract]:Objective: to analyze the accuracy of hysterosalpingography compared with laparoscopy in the diagnosis of tubal obstruction, and the difference between them, and to understand the value of hysterosalpingography in the diagnosis of tubal obstruction and to provide advice and basis for the selection of appropriate laparoscopic operation time. Methods: to collect the affiliated obstetrics and Gynecology of Zhejiang University. The data of hospital outpatient and hospitalization were selected from 2014.1.1 to 2016.12.31 in the outpatient department of our hospital with hysterosalpingography, which was diagnosed as fallopian tube and unobstructed, and in the hospital of our hospital, the patients were examined by laparoscopy, and compared with the results of hysterosalpingography and laparoscopy, the age of the patients, the interval time, the history of birth, and the pelvic and abdominal surgery were collected. History, the degree of patency of the lateral fallopian tube and the presence of other pelvic abnormalities; analysis of the differences in the results of laparoscopy under various conditions. Results: 199 patients were enrolled and 397 oviducts were recorded, of which 290 HSG were diagnosed as unobstructed.HSG diagnosis of tubal laparoscopy, and 167 were unobstructed, 17 unobstructed and 52. And not smooth, 10 passage and very poor, 22 proximal blockage, 8 distal blockage, 14 hydrops, the rate of 17.9%. When the age and tubal patency analysis, selected two groups of 35 years old, the age group and the low collar group, the elderly group (n=34) oviduct blockage accounted for 26.5%, the intraoperative oviduct status score 5.06 + 7.71, low age group (n=256), The oviduct blockage in the operation accounted for 13.7%. The oviduct status score in the 3.46 + 6.21. group was significantly better than that in the elderly group (P0.05). The patients' infertility group was divided into primary infertility group (n=173) and secondary infertility group (n=153), and the oviduct status score of the Zhongyuan infertility group was 2.58. The oviduct blockage in the operation was 11.6%, and the level of tubal patency was 5.22 + 7.63 in secondary infertility group and 20.5% of oviduct obstruction in the operation. The level of tubal patency and tubal status in secondary infertility group was significantly lower than that of the primary infertility group (P0.05). According to the history of childbirth, the patients were divided into the flat production group (n=29) and caesarean section (n =16) contrast analysis, there was no significant difference in the state and patency of the oviduct between the two groups (P0.05). The interval between the laparoscopy and the HSG examination was less than 12 months (n=267), the oviduct status score was 3.85 + 6.28, the interval time was 12 months (n=23), and the oviduct status score in the operation was 4.87 + 7.84. interval less than 12 months. The oviduct status score of the patients was better than those in the 12 months group, but there was no significant difference between the two groups (P0.05). The rate of tubal blockage in the recent group was 14.1% lower than that in the long-term group (30.4%), and the difference was statistically significant (P0.05) according to the patient's operation history (n=188), the history of uterine cavity surgery (n=74), and the history of abdominal surgery (n=21). It was suggested that there was no statistical difference in the oviduct status and the patency of the oviduct in the group without operation history. The oviduct status score in the uterine cavity surgery group was 5.50 + 7.65 higher than that in the non operative group (2.74 + 5.38), with statistical significance (P0.05); the uterine cavity operation group blocked the fallopian tubes. 20.3% was significantly higher than that in the non operative group (6.9%) (P0.05). The oviduct status in the superior group (n=55) was 2.69 + 4.99, the oviduct was 5.7% in the operation, and the oviduct status in the operation group (n=51) was 8.37 + 8.34 during the operation and the oviduct in the operation. The blockage accounted for 27.5%. The oviduct status score and the degree of tubal patency were significantly better than those in the poor group. There were significant differences between the two groups (P0.05). Among the laparoscopic patients, 13 were diagnosed with uterine myoma, 1 with adenomyosis, 2 with teratoma, 26 with endometriosis, and 20 in the combined hydromyoma. There was no significant difference in the degree of tubal patency in patients with abnormal cysts and other pelvic abnormalities (P0.05). The oviduct status score of the patients without obvious pelvic abnormalities before operation was 2.80 + 5.56, and the blockage accounted for 11.7%, and the oviduct status score in the combined hydropic group was 12.15 + 6.64, and the blockage accounted for the patients with 35%. combined with water accumulation. The oviduct blockage rate and the oviduct status score of the patients were significantly higher than those in the non operation group (P0.05). The selection examination room was less than 12 months, the age 35 years old, excluding ectopic cysts, the necessary laparoscopic examination, the exclusion of the lateral oviduct obstruction or water, the exclusion of the history of uterine cavity surgery, a total of 77 patients, 127 HSG was diagnosed as unobstructed fallopian tube, and the results of laparoscopy were unobstructed in 86 cases, through and unobstructed 6, through and unobstructed 26, through and unobstructed 2, 5 in the proximal end and 3 in the distal end. Among them, 4 people could be treated by laparoscopy (intraoperative oviduct score 8), only 5.2%. conclusion: hysterosalpingography for diagnosis The conforming rate of unobstructed fallopian tubes was low. The patients who had the history of uterine cavity surgery, poor lateral fallopian tube conditions, water accumulation, and HSG examination interval of 12 months were more recommended for the diagnosis of fallopian tube status.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R711.6
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本文編號：1989077