子宫输卵管造影梗阻假阳性分析及方法改进研究

摘要

Objective To analyze the imaging features of false-positive results in hysterosalpingography(HSG),and to explore the role of modified HSG in improvement in diagnostic accordance rate reduction in false-positive rate.Methods 200 women undergoing conventional HSG(group A)or modified HSG(group B)were included in this study,with 100 women for each group.98 patients with 183block fallopian tubes received laparoscopic surgery.The diagnostic rate and the diagnostic accordance rate were compared between the two groups.Group A(a total of 200 fallopian tubes)received HSC without contrast;while group B received intramuscular 654-2 of 10mg before HSG.Dynamic observation was applied during angiography.As suspected proximal tubal obstruction occurred,pressure and pulling through double-lumen balloon catheter were applied for repeat HSG.Results Among the 200 tubes of group A,95(47.50％)were unobstructed,and 74(37.00％)obstructed at the near-end and 31(15.50％)obstructed at the mediate-and far-end;of the 105 obstructed tubes,75 were confirmed by laparoscopy,with a diagnostic coincidence rate of 85.00％ and a false positive rate of 21.10％.Among the 200 tubes of group B,122(61.00％)were unobstructed,and 51(25.50％)obstructed at the near-end and 27(13.50％)obstructed at the mediate-and far-end;Among the 78 obstructed ones,71 were confirmed by laparoscopy,with a diagnostic coincidence rate of 96.50％ and a false positive rate of 5.70％.There were differences in diagnostic coincidence rate and false positive rate between group A and B(P＜0.0l).Conclusions Preoperative intramuscular injection of 654-2,contrast dynamic observation,when there is tubal obstruction,pressure and pulling through the double-lumen balloon catheter method is better,can significantly improve the diagnostic accuracy of tubal obstruction,and lower the tubal obstruction of false positive rate.%目的 分析子宫输卵管造影(HSG)输卵管梗阻假阳性的特征,探讨改进的子宫输卵管造影方法对提高临床诊断符合率、降低假阳性率的作用.方法 选择用常规方法(A组)及改进方法(B组)行HSG的不孕症患者各100例,共400条输卵管,200例中有98例共183条输卵管梗阻,患者均接受宫腹腔镜手术,比较常规方法及改进方法的诊断率及诊断符合率.A组100例共200条输卵管,不作任何处理就造影;B组100例肌肉注射10 mg 654-2后造影,造影采用动态观察,当怀疑有输卵管近端梗阻时,通过加压及牵拉双腔球囊导管再次造影以证实输卵管是否为真的梗阻.结果 A组200条输卵管中,经HSG诊断,通畅95条(47.50％),近端梗阻74条(37.00％),中远端梗阻31条(15.50％);105条HSG诊断为梗阻的输卵管中,腹腔镜诊断为梗阻的75条,诊断符合率为85.0％,假阳性率为21.1％.B组200条输卵管中,经HSG诊断,通畅122条(61.00％),近端梗阻51条(25.50％),中远端梗阻27条(13.50％);78条HSG诊断为梗阻的输卵管中,腹腔镜诊断为梗阻的为71条,诊断符合率为96.50％,假阳性率为5.70％.A组与B组诊断符合率及假阳性率差异均有统计学意义(P＜0.01).结论 术前肌肉注射654-2,造影采用动态观察,当有输卵管梗阻时,通过加压及牵拉双腔球囊导管的方法,可明显提高输卵管梗阻的诊断准确率,降低输卵管梗阻的假阳性率.