99TcmO4-显像与X线造影检查不孕症患者输卵管病变的对比分析

摘要

Objective To compare the value of X-ray hysterosalpingography and 99Tcm pertechnetate oviduct imaging in identifying the tubal cause of infertility.Methods One hundred and fifty patients with infertility having unilateral or bilateral patent tubes were examined by both 99TcmO4- imaging and X-ray hysterosalpingography in our hospital from January 2008 to June 2009.The result of the oviduct examination by X-ray hysterosalpingography was classified as normal,tortuous,stiff,dilated or hydrops.The result by 99TcmO4- imaging was classified as having normal,mild,moderate or severe damage,nonfunctioning and tubal obstruction.The results of the two imaging modalities were compared by x2 test.Results The detection rate of tubal abnormalities by radionuclide imaging (81.6％,230/282) was higher than that by X-ray (69.9％,197/282 ; x2 =14.14,P ＜ 0.05 ) and significantly higher ( 89.4％,252/282) when combining X-ray and 99TcmO4- imaging.The incidence rate of tortuous tubes with positive 99TcmO4- imaging was significantly higher than that with normal 99TcmO4- imaging ( 15.3％,8/52).And the incidence rate increased with the severity of damage revealed by 99TcmO4- imaging (30.8％,32/104; 31.4％,16/51; 37.1％,13/35; 42.5％,17/40).The incidence rate of dilated tubes with different severity of damage revealed by 99TcmO4- imaging (16.3％,17/104; 11.8％,6/51; 17.1％,6/35; 20.0％,8/40) was significantly higher than that with normal 99TcmO4- imaging (9.6％,5/52).The incidence rates of stiff tubes in the mildly,moderately and severely damaged and nonfunctioning oviducts were 27.9％ (29/104),29.4％ ( 15/51 ),28.6％ (10/35) and 15.0％ (6/40),respectively.Conclusions Radionuclide imaging of the oviduct can determine the extent of tubal dysfunction ; while,X-ray hysterosalpingography is better for the detection of morphological abnormalities of the uterus and oviducts.Therefore,combined imaging can maximize the likelihood of identifying the tubal cause of infertility.%目的 对比X线子宫输卵管造影与99TcmO4-输卵管显像对不孕症患者输卵管病变的诊断价值.方法 选择2008年1月至2009年6月间,至少一侧输卵管通畅或通而不畅的不孕症患者150例(通畅输卵管85条,通而不畅输卵管197条,单侧不通输卵管18条),分别行X线子宫输卵管造影及99TcmO4-输卵管显像.X线造影判别输卵管形态分类为正常、迂曲、僵直、扩张或积水;99TcmO4-显像诊断输卵管功能类型分别为正常、轻度、中度、重度损伤、无功能和输卵管阻塞.对检查结果进行对比分析,2种方法对输卵管异常检出率比较采用x2检验.结果 共282条通畅或通而不畅输卵管.99TcmO4-显像对这些输卵管的异常检出率(81.6％,230/282)明显高于X线造影组(69.9％,197/282),x2=14.14,P＜0.05.2种方法结合,可明显提高输卵管异常检出率(89.4％,252/282).在99TcmO4-显像示功能损伤输卵管中,输卵管迂曲的发生率明显高于功能正常者(15.3％,8/52),且随功能损伤程度的加重(轻度、中度、重度、无功能)而逐渐增高(30.8％,32/104;31.4％,16/51;37.1％,13/35;42.5％,17/40);功能损伤输卵管的扩张发生率(16.3％,17/104;11.8％,6/51;17.1％,6/35;20.0％,8/40)也明显高于功能正常者(9.6％,5/52).输卵管僵直的发生率在轻、中及重度受损输卵管中分别为27.9％(29/104)、29.4％( 15/51)、28.6％( 10/35),而在输卵管无功能时则较低,为15.0％ (6/40).结论 X线子宫输卵管造影检查对输卵管形态的判断有优势,而99TcmO4-输卵管显像能较好地判断输卵管功能损伤的程度.两者结合有助于全面正确了解输卵管情况.