Objective To analyse the correlation between ovarian surrounding circular enhancement of hysterosalpingo- contrast sonography( HyCoSy) and natural pregnancy outcomes,and investigate the clinical value of ovarian surrounding circular enhancement in the evaluation of the function of fallopian tube. Methods From January 2013 to December 2014,we enrolled 139 patients who received treatment in the Reproductive Assisted Reproduction Center and the outpatient Department of Gynecology and Infertility of the Third Affiliated Hospital of Guangzhou Medical University. HyCoSy was conducted using SonoVue contrast agent,and the ultrasonography features of contrast agent at the end of the fallopian tube were observed. According to whether or not contrast agent form circular enhancement sorrounding ovary,the patients were divided into the group of bilateral fallopian tube ultrasound contrast circular enhancement,the group of bilateral fallopian tube without ultrasound contrast circular enhancement,and the group of unilateral fallopian tube with ultrasound contrast circular enhancement,and circular enhancement was further divided into grade 0,1,2 and 3. Follow - up was conducted on the patients,and the correlation between the ultrasonography features of ovarian surrounding circular enhancement and natural pregnancy outcomes was analyzed. Results 268 fallopian tubes were involved in the 139 patients,including 10 unilateral fallopian tubes(10 patients),258 bilateral fallopian tubes(129 patients),133 left fallopian tubes(133 patients),and 135 right fallopian tubes(135 patient). 54 patients had successful pregnancy,and 85 patients had failed natural pregnancy. After the exclusion of patients with unilateral fallopian tube,there were 57 patients in the group of bilateral fallopian tube ultrasound contrast circular enhancement,among which 41(71. 9% ) patients had successful natural pregnancy;there were 49 patients in the group of bilateral fallopian tube without ultrasound contrast circular enhancement,among which 7(14. 3% )patients had successful pregnancy;there were 23 patients in the group of unilateral fallopian tube with ultrasound contrast circular enhancement,among which 4(17. 4% ) patients had successful natural pregnancy. The groups with different status of fallopian tube ultrasound contrast circular enhancement were significantly different in the rate of successful natural pregnancy(χ2 = 42. 499,P < 0. 001). There were 22, 40,42 and 29 patients with left fallopian tube ultrasound contrast circular enhancement who were grade 0,1,2 and 3 respectively,and there were 2(9. 1% ),5(12. 5% ),21(50. 0% )and 24(82. 8% )patients who had successful natural pregnancy among them respectively. There were 28,41,35 and 31 patients with right fallopian tube ultrasound contrast circular enhancement who were grade 0,1,2 and 3 respectively,and there were 6(21. 4% ),5(12. 2% ),16(45. 7% )and 27 (87. 1% )patients who had successful natural pregnancy among them respectively. Patients with left or right fallopian tube ultrasound contrast circular enhancement of different grades were significantly different in the rate of successful natural pregnancy (χ2 = 45. 516,46. 358;P < 0. 001). Multivariate Logistic regression analysis showed that left fallopian tube ultrasound contrast circular enhancement grade and right fallopian tube ultrasound contrast circular enhancement grade were influencing factors for natural pregnancy outcomes(P < 0. 05). Logistic regression equation predicted that the AUC of natural pregnancy outcome was 0. 845〔95% CI(0. 770,0. 920)〕. Conclusion Ovarian surrounding circular enhancement of HyCoSy has close correlation with natural pregnancy outcomes, and the grade of circular enhancement can effectively predict natural pregnancy outcomes. Obvious circular enhancement is associated with higher grade and higher successful rate of natural pregnancy.%目的：通过分析子宫输卵管超声造影卵巢周边环状增强与自然妊娠结局的相关性，探讨卵巢周边环状增强在评价输卵管功能方面的临床应用价值。方法选取2013年1月—2014年12月在广州医科大学附属第三医院生殖助孕中心及妇科不孕门诊就诊的患者139例。采用六氟化硫微泡（SonoVue）造影剂进行子宫输卵管超声造影术（HyCoSy），观察输卵管末端造影剂在卵巢周边增强的超声特征，根据造影剂是否在卵巢周边形成环状增强，分为双侧输卵管超声造影环状增强组、双侧输卵管超声造影无环状增强组及单侧输卵管超声造影环状增强组；并进一步将环状增强分为0、1、2、3级。对患者进行随访，分析子宫输卵管超声造影卵巢周边环状增强与自然妊娠结局的相关性。结果139例患者包括268条输卵管，单侧输卵管10条（10例），双侧输卵管258条（129例）；左侧输卵管133条（133例），右侧输卵管135条（135例）；54例患者自然妊娠成功，85例患者自然妊娠失败。排除单侧输卵管患者，双侧输卵管超声造影环状增强组57例，自然妊娠成功41例（71.9%）；双侧输卵管超声造影无环状增强组49例，自然妊娠成功7例（14.3%）；单侧输卵管超声造影环状增强组23例，自然妊娠成功4例（17.4%）。不同输卵管超声造影环状增强组自然妊娠成功率比较，差异有统计学意义（χ2=42.499，P <0.001）。左侧输卵管超声造影环状增强0级22例，自然妊娠成功2例（9.1%）；1级40例，自然妊娠成功5例（12.5%）；2级42例，自然妊娠成功21例（50.0%）；3级29例，自然妊娠成功24例（82.8%）。右侧输卵管超声造影环状增强0级28例，自然妊娠成功6例（21.4%）；1级41例，自然妊娠成功5例（12.2%）；2级35例，自然妊娠成功16例（45.7%）；3级31例，自然妊娠成功27例（87.1%）。左、右侧输卵管超声造影不同环状增强分级者自然妊娠成功率比较，差异有统计学意义（χ2=45.516、46.358，P <0.001）。多因素 Logistic 回归分析结果显示，左侧输卵管超声造影环状增强分级、右侧输卵管超声造影环状增强分级是自然妊娠结局的影响因素（P <0.05）。Logistic 回归方程预测自然妊娠结局的受试者工作特征（ROC）曲线下面积为0.845〔95% CI（0.770，0.920）〕。结论子宫输卵管超声造影卵巢周边环状增强与自然妊娠结局密切相关，且环状增强的分级能有效预测自然妊娠结局，即环状增强越明显，分级越高，自然妊娠成功率越高。
展开▼
