宫腔压力检测辅助四维宫腔输卵管超声造影评估输卵管通畅性的临床价值

Clinical value of uterine cavity pressure measurement in assisting with four-dimensional hysterosalpingo-contrast sonography in assessing tubal patency

摘要

目的 探讨宫腔压力检测在四维宫腔输卵管超声造影(4D-HyCoSy)评估输卵管通畅性中的辅助作用及临床价值。方法 选择2019年2月至2022年9月在永州市中心医院就诊并接受治疗的132例疑似卵管性不孕患者为研究对象.所有患者均接受4D-HyCoSy检查.以腹腔镜通液检测结果为诊断金标准,与4D-HyCoSy检查结果的诊断进行对比分析.采用受试者工作特征(ROC)曲线和Logistic回归模型分析宫腔压力检测辅助4D-HyCoSy检查在输卵管通畅性诊断中的应用价值。结果 对132例患者完成了4D-HyCoSy检查,在264条输卵管中,145条通畅(54.92%)、77条通而不畅(29.17%)、42条完全阻塞(15.91%);腹腔镜通液检测结果显示,有132条通畅(50.00%)、77条通而不畅(29.17%)、55条完全阻塞(20.83%).在4D-HyCoSy检查中,有216条输卵管符合腹腔镜通液检测结果,诊断符合率为81.82%(216/264);其中4D-HyCoSy检查与腹腔镜通液检测输卵管通畅的诊断符合率最高,为93.18%(123/132).从输卵管的功能角度分层评估,4D-HyCoSy检查与腹腔镜通液检测输卵管的诊断符合率为86.36%(114/132).双侧通畅(A组)、不完全通畅(B组)、双侧阻塞(C组)三组宫腔压力峰值比较差异有统计学意义(F=39.334,P<0.001).A组与B组、A组与C组、B组与C组之间的宫腔压力峰值比较差异均有统计学意义(t值分别为28.178、66.049、30.774,P<0.001),阻塞越严重,宫腔压力峰值越大.ROC曲线分析显示,宫腔压力检测辅助4D-HyCoSy评估输卵管通畅性预测模型的曲线下面积(AUC)为0.853、灵敏度为88.13%、特异度为79.46%,明显高于4D-HyCoSy单项诊断结果。结论 宫腔压力检测辅助4D-HyCoSy检查可显著提高输卵管通畅性的诊断效能,其可作为临床评估输卵管通畅性的有效诊断方法,可在临床推广应用.

Abstract

Objective Explore the auxiliary role and clinical value of uterine cavity pressure measurement in assessing tubal patency in four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy). Methods 132 suspected tubal infertility patients treated at The Central Hospital of Yongzhou from February 2019 to September 2022 were selected as the research objects. All patients underwent 4D-HyCoSy examination. The diagnostic results of 4D-HyCoSy were compared with those of laparoscopic fluid test, taken as the gold standard. The application value of uterine cavity pressure measurement in assisting 4D-HyCoSy examination in diagnosing tubal patency was analyzed using receiver operating characteristic (ROC) curve and logistic regression model. Results Among the 132 patients who completed 4D-HyCoSy examination, out of 264 fallopian tubes, 145 were patent (54.92%), 77 were patent with partial blockage (29.17%), and 42 were completely blocked (15.91%). Results of laparoscopic fluid test showed 132 tubes were patent (50.00%), 77 were patent with partial blockage (29.17%), and 55 were completely blocked (20.83%). Taking laparoscopic fluid test results as the gold standard, in 4D-HyCoSy examination, 216 tubes matched the results of laparoscopic fluid test, with a diagnostic accuracy rate of 81.82% (216/264). The highest diagnostic consistency rate was found for tubes diagnosed as patent, at 93.18% (123/132). Stratified evaluation based on tubal function showed a diagnostic accuracy rate of 86.36% (114/132) between 4D-HyCoSy examination and laparoscopic fluid test. There were statistically significant differences in uterine cavity pressure peak values among the bilateral patent (Group A), incomplete patent (Group B), and bilateral blocked (Group C) tubes (F=39.334, P<0.001). The differences in uterine cavity pressure peak values between Group A and Group B, Group A and Group C, and Group B and Group C were all statistically significant (t=28.178, 66.049, and 30.774, respectively, P<0.001), with increasing severity of blockage associated with higher uterine cavity pressure peak values. ROC curve analysis showed that the area under the curve (AUC) of the predictive model for assessing tubal patency using uterine cavity pressure measurement as an adjunct to 4D-HyCoSy was 0.853, with a sensitivity of 88.13% and specificity of 79.46%, significantly higher than the single diagnostic result of 4D-HyCoSy. Conclusion Uterine pressure measurement assisted 4D-HyCoSy can significantly improve the diagnostic efficiency of tubal patency and serve as an effective diagnostic method for clinical assessment of tubal patency, with potential for clinical application.

关键词

不孕症 / 输卵管疾病 / 宫腔压力 / 四维宫腔输卵管超声造影

Key words

infertility / fallopian tube disease / uterine cavity pressure / four-dimensional hysterosalpingo-contrast sonography

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