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目的:探讨经阴道四维输卵管超声造影评估输卵管通畅性的临床价值。方法:对6096名不孕症患者行输卵管四维超声造影,与腹腔镜检查比较其诊断输卵管通畅性的准确度,记录造影剂静脉逆流情况,观察患者术中疼痛程度、副反应及术后并发症。结果:输卵管四维超声造影与腹腔镜检查相比,两者一致程度较高(Kappa=0.84,P<0.05),经阴道四维输卵管超声造影诊断输卵管通畅的敏感度95.1%,特异度88.4%,阳性预测值89.6%,阴性预测值94.4%,假阳性率11.6%,假阴性率4.9%,总符合率91.8%。6096例不孕症患者中共2665条输卵管判断为输卵管阻塞,阳性率21.9%;9456条判断为输卵管通畅,阴性率78.0%;造影剂静脉逆流率为5.0%。术中患者无疼痛或轻度疼痛76.1%,中等疼痛17.3%,重度疼痛6.6%。出现人流综合征者占2.4%。检查后阴道有血性分泌物者32.1%。感染率为0.016‰。结论:经阴道子宫输卵管四维超声造影安全、准确、对生殖时间窗影响小,是目前除腹腔镜检查外评估输卵管通畅性诊断效能较高的方法,大样本研究表明该方法有一定假阳性率,有进一步改善的空间。
Objective: To investigate the clinical value of transvaginal four-dimensional tubal contrast-enhanced ultrasound in the evaluation of tubal patency. Methods: The accuracy of tubal patency in diagnosing tubal patency was compared with laparoscopy in 6096 infertility patients. The venous reflux was recorded and the intraoperative pain, side effects and postoperative complications were observed . Results: Compared with laparoscopy, tubal four-dimensional contrast echocardiography had a higher degree of agreement (Kappa = 0.84, P <0.05). The sensitivity and accuracy of transvaginal four-dimensional tubal ultrasonography in diagnosing tubal patency were 95.1% and 88.4% The predicted value was 89.6%, the negative predictive value was 94.4%, the false positive rate was 11.6%, the false negative rate was 4.9% and the total coincidence rate was 91.8%. A total of 2696 tubal obstructions were detected in 6096 cases of infertility, with a positive rate of 21.9%. 9456 cases were diagnosed as tubal patency with a negative rate of 78.0% and contrast medium venous rate of 5.0%. Intraoperative patients had no pain or mild pain 76.1%, 17.3% of moderate pain, severe pain 6.6%. Emergence of people with flow syndrome accounted for 2.4%. After checking vaginal bloody secretions were 32.1%. The infection rate was 0.016 ‰. Conclusion: Transvaginal uterine tubal four-dimensional ultrasonography is safe and accurate, and it has little effect on the reproductive time window. It is the most effective method to evaluate tubal patency except laparoscopy. Large sample studies show that this method has a certain false positive rate, There is room for further improvement.