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宫腔镜联合子宫输卵管超声造影对不孕症诊治的临床价值
作者:周敏霞1  杨清2  王迎春3  鲍莉1  姚晓华1  柴亚娟1  邵春娟4 
单位:1. 上海健康医学院附属嘉定区中心医院 妇产科超声室, 上海 201800;
2. 同济大学附属第一妇婴保健院 妇产科超声室, 上海 200126;
3. 上海健康医学院附属嘉定区中心医院 超声室, 上海 201800;
4. 上海交通大学附属第一人民医院 超声科, 上海 200080
关键词:不孕症 宫腔镜 子宫输卵管超声造影 子宫输卵管碘油造影 
分类号:R711.6
出版年·卷·期(页码):2021·49·第五期(501-505)
摘要:

目的:探讨宫腔镜联合子宫输卵管超声造影(HyCoSy)对不孕症诊治的价值。方法:选择2016年4月至2019年4月诊断为不孕症并行宫腔镜联合HyCoSy检查的174例患者,既往均行子宫输卵管碘油造影术(HSG)检查。记录患者的一般资料、造影结果以及疼痛视觉模拟评分(VAS),记录宫腔镜联合HyCoSy术中内膜处理人数及术后妊娠情况,分析内膜处理对妊娠结果的影响。结果:174例患者中,宫腔镜联合HyCoSy诊断双侧通畅的比例大于HSG,差异有统计学意义(Kappa=0.582,P<0.001)。宫腔镜联合HyCoSy术后患者疼痛感较轻,其VAS为(4.59±1.06)分,低于HSG的(5.88±1.42)分,差异有统计学意义(t=9.603,P<0.001)。合并内膜疾病的患者在接受宫腔镜治疗后可以获得与未合并内膜疾病患者近似的妊娠率(P=0.957)。结论:宫腔镜联合HyCoSy可更准确地诊断输卵管性不孕症,且术中针对内膜疾病的处理可提高患者妊娠概率,可作为临床一线诊治方法。

Objective: To explore the clinical value of hysteroscopy with hysterosalpingo contrast sonography(HyCoSy) in the diagnosis and treatment of infertility. Methods: A total of 174 patients with infertility examined by hysteroscopy with HyCoSy between April 2016 and April 2019 were enrolled in this study. All patients had previously received the hysterosalpinography(HSG) examination. The general information, angiographic results, and the visual analogue scores(VAS) were collected. The number of endometrial treatments during hysteroscopy with HyCoSy and the postoperative pregnancy were recorded; the influence of endometrial treatment on pregnancy outcome was analyzed.Results: Among the 174 patients, the proportion of bilateral patency diagnosed by hysteroscopy with HyCoSy was higher than that by HSG, and the difference was statistically significant(Kappa=0.582, P<0.001). The postoperative pain after hysteroscopy with HyCoSy was lighter. The VAS was (4.59±1.06), which was lower than that of HSG(5.88±1.42), and the difference was statistically significant(t=9.603, P<0.001). Patients with endometrial diseases could obtain comparable pregnancy rates as those without endometrial diseases after hysteroscopy(P=0.957).Conclusion: Hysteroscopy with HyCoSy is more accurate in the diagnosis of tubal infertility, and the treatment of endometrial diseases during the operation may increase the probability of pregnancy. Therefore, hysteroscopy with HyCoSy could be used as a clinical front-line diagnosis and treatment method.

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