宫腔压力测量辅助四维宫腔输卵管超声造影评价输卵管通畅性的临床价值

Clinical value of uterine pressure detection combined with 4D-HyCoSy in diagnosis of fallopian tubal patency

摘要:

目的??探讨宫腔压力测量辅助四维宫腔输卵管超声造影 （4D-HyCoSy） 评价输卵管通畅性的临床价值。 方法??选取 2015 年 1 月—2016 年 12 月上饶市人民医院拟诊断为输卵管性不孕的 104 例患者为研究对象。所有患者均进行 4D-HyCoSy 检测，采用造影注射装置进行造影剂注射和宫腔压力监测。以腹腔镜通液检测为金标准， 采用受试者操作特征（ROC）曲线确定宫腔压力峰值临界值，并比较 4D-HyCoSy 检测和宫腔压力辅助联合诊 断的的敏感性、特异性、ROC 曲线下面积。结果??104 例患者共检测到 208 条输卵管，4D-HyCoSy 检测的符合 率为 72.59%， 敏感性为 78.04%， 特异性为 85.63%； 根据其功能分为双侧通畅、 不完全通畅、 一侧通而不畅一侧阻塞、双侧阻塞，以腹腔镜通液检测结果为金标准，104 例患者诊断符合率为 79.81%，ROC 曲线下面积为 0.813。宫腔压力峰值在双侧通畅、不完全通畅、一侧通而不畅一侧阻塞、双侧阻塞之间差异有统计学意义（ P <0.05） ，对应的宫腔压力峰值临界值分别为 ： 24.65、35.27 和 46.83 kPa，ROC 曲线下面积分别为 0.781、0.806 和 0.831。宫腔压力峰值辅助4D-HyCoSy联合诊断的ROC曲线下面积为0.942， 敏感性为92.31%， 高于单项检测 （ P <0.05） ，特异性为 80.77%，与单项检测差异无统计学意义（ P >0.05） 。结论??宫腔压力测量辅助 4D-HyCoSy 评价输卵管通畅性具有极高的诊断价值， 值得临床运用推广。目的??探讨宫腔压力测量辅助四维宫腔输卵管超声造影 （4D-HyCoSy） 评价输卵管通畅性的临床价值。方法??选取 2015 年 1 月—2016 年 12 月上饶市人民医院拟诊断为输卵管性不孕的 104 例患者为研究对象。所有患者均进行 4D-HyCoSy 检测，采用造影注射装置进行造影剂注射和宫腔压力监测。以腹腔镜通液检测为金标准，采用受试者操作特征（ROC）曲线确定宫腔压力峰值临界值，并比较 4D-HyCoSy 检测和宫腔压力辅助联合诊断的的敏感性、特异性、ROC 曲线下面积。结果??104 例患者共检测到 208 条输卵管，4D-HyCoSy 检测的符合率为 72.59%， 敏感性为 78.04%， 特异性为 85.63%； 根据其功能分为双侧通畅、 不完全通畅、 一侧通而不畅一侧阻塞、双侧阻塞，以腹腔镜通液检测结果为金标准，104 例患者诊断符合率为 79.81%，ROC 曲线下面积为 0.813。宫腔压力峰值在双侧通畅、不完全通畅、一侧通而不畅一侧阻塞、双侧阻塞之间差异有统计学意义（ P <0.05） ，对应的宫腔压力峰值临界值分别为 ： 24.65、35.27 和 46.83 kPa，ROC 曲线下面积分别为 0.781、0.806 和 0.831。宫腔压力峰值辅助4D-HyCoSy联合诊断的ROC曲线下面积为0.942， 敏感性为92.31%， 高于单项检测 （ P <0.05） ，特异性为 80.77%，与单项检测差异无统计学意义（ P >0.05） 。结论??宫腔压力测量辅助 4D-HyCoSy 评价输卵管通畅性具有极高的诊断价值， 值得临床运用推广。

Abstract:

Objective To study the clinical value of uterine pressure detection combined with four-dimensional hysterosalpingo-constrast sonography (4D-HyCoSy) in the diagnosis of fallopian tubal patency. Methods From January 2015 to December 2016, 104 patients who were diagnosed as tubal infertility in Shangrao People's Hospital of Jiangxi Province were selected as subjects. All patients underwent 4D-HyCoSy test, and contrast injection was used for contrast injection with intrauterine pressure monitoring. The laparoscopic fluid test was used as the gold standard. The receiver operating characteristic (ROC) curve was used to determine the peak value of uterine pressure peak, and the sensitivity, specificity, and ROC of 4D-HyCoSy test and intrauterine pressure-assisted combined diagnosis were compared. The area under the curve. Results Totally 208 fallopian tubes were detected in 104 cases, the coincidence rate of 4D-HyCoSy detection was 72.59%, and the sensitivity and specificity were 78.04% and 85.63%, respectively. According to its function, it was divided into bilateral patency, incomplete patency, one obstruction/ the other one incomplete patency, and bilateral obstruction. Taking the result of laparoscopy as gold standard, the diagnostic coincidence rate was 79.81%, the area under the ROC curve was 0.813. The uterine pressure between bilateral patency, incomplete patency, one obstruction/the other one incomplete patency, and bilateral obstruction showed significant difference (P < 0.05), the corresponding critical values of the peak pressure of the uterine cavity were 24.65, 35.27 and 46.83 kpa, respectively, the area under the ROC curve was 0.781, 0.806 and 0.831. The area under the ROC curve of uterine pressure detection combined with 4D-HyCoSy was 0.942, the sensitivity was 92.31%, both significantly higher than single detection (P < 0.05), the specificity was 80.77%, which showed no significant difference with single detection (P > 0.05). Conclusions Uterine pressure detection combined with 4D-HyCoSy has a high diagnostic value in the diagnosis of fallopian tubal patency, which is worthy of promoting.