原发不孕症患者超液化碘油子宫输卵管造影不同时间行延迟片拍摄后结果的比较分析

Comparative analysis of delayed radiography at different time points following hysterosalpingography with lipiodol ultra-fluide in patients with primary infertility

摘要

目的 分析对原发不孕患者超液化碘油子宫输卵管造影不同时间行延迟片拍摄的应用价值。方法 选择2023年7月至2025年2月广州市妇女儿童医疗中心柳州医院收治的200例不孕症患者为研究对象,研究小组成员向患者明确告知两种造影剂的优缺点,患者知情自愿选择造影剂类型,符合患者自愿选择原则,根据造影剂类型将患者分为对照组和试验组,各100例。试验组行超液化碘油子宮输卵管造影术,对照组行碘水造影剂(碘佛醇320)子宫输卵管造影术。试验组分别于术后4h、6h、24h行延迟片拍摄,采用 Gwet's ACI检验分析超液化碘油子宮输卵管造影术后4h、6h诊断输卵管通畅度及宫腔形态与24h诊断的一致性,并采用线性化分析4h、6h诊断输卵管通畅度及宫腔形态的一致性系数差异,受试者工作特征(ROC)曲线评估4h、6h延迟片对输卵管通畅度及盆腔粘连程度的诊断效能,对照组术后15~30min拍摄盆腔复查片,记录两组不良反应发生情况。结果 试验组术后24h诊断17例输卵管通畅度0级、20例输卵管通畅度1级、28例输卵管通畅度2A级、35例2B级。超液化碘油子宮输卵管造影术后4h与24h延迟片对输卵管通畅度诊断结果,具有高度一致性(Gwet's ACI=0.71,P<0.001),具有良好的诊断效能(AUC为0.790~0.870),超液化碘油子宮输卵管造影术后6h与24h延迟片对输卵管通畅度诊断结果具有高度一致性(Gwet's ACI=0.77,P<0.001),具有较好的诊断效果(AUC为0.951~0.986)。试验组术后24h诊断75例宫腔粘连度0级、11例宫腔粘连度1级、6例宫腔粘连度2级、8例宫腔粘连度3级。液化碘油子宮输卵管造影术后4h与24h延迟片对宫腔形态诊断结果,具有较差一致性(Gwet's ACI=0.58,P<0.001),具有较差的诊断效能(AUC为0.614~0.800),超液化碘油子宮输卵管造影术后6h与24h延迟片对盆腔粘连程度诊断结果具有较高的一致性(Gwet's ACI=0.89,P<0.001),具有较好的诊断效果(AUC为0.812~0.953)。试验组术中VAS评分、术后0.5h VAS评分低于对照组,差异具有统计学意义(t=-24.688、-65.280,P<0.05),术后0.5h阴道流血发生率比较差异无统计学意义(P>0.05)。结论 超液化碘油子宮输卵管造影术后6h延迟片与术后24h诊断输卵管通畅度及宫腔形态具有较好的一致性,且具有疼痛阈值低、安全性良好的优势,临床可行性较好。

Abstract

Objective To evaluate the clinical value of delayed radiography at different time points after hysterosalpingography (HSG) using lipiodol ultra-fluide in patients with primary infertility. Methods A total of 200 patients with infertility admitted to Guangzhou Women and Children's Medical Center Liuzhou Hospital from July 2023 to February 2025 were included. The research team clearly informed the patients of the advantages and disadvantages of the two contrast agents. Patients voluntarily chose the type of contrast agent based on informed consent, adhering to the principle of voluntary selection. According to the contrast agent type, patients were divided into a control group and an experimental group, with 100 cases in each group. The experimental group underwent HSG with lipiodol ultra-fluide, while the control group received a water-soluble contrast agent (iopromide 320). In the experimental group, delayed radiography was performed at 4h, 6h, and 24h post-procedure. Gwet's ACI was used to assess the agreement between the diagnostic results of tubal patency and uterine cavity morphology at 4h and 6h compared with the 24h reference. Linearized analysis was used to compare the differences in agreement coefficients between the two time points. Receiver operating characteristic (ROC) curves were applied to evaluate the diagnostic performance of delayed radiography at 4h and 6h for tubal patency and pelvic adhesions. In the control group, pelvic review radiographs were taken 15-30 minutes post-procedure. Adverse reactions were recorded in both groups. Results In the experimental group, the 24h post-procedure diagnosis identified 17 cases with tubal patency grade 0, 20 cases with grade 1, 28 cases with grade 2A, and 35 cases with grade 2B. The diagnostic consistency between the 4h and 24h delayed radiography for tubal patency demonstrated high agreement (Gwet's ACI=0.71, P<0.001) with good diagnostic performance [area under the curve (AUC): 0.790-0.870]. The 6h delayed radiography showed even higher agreement with the 24h results (Gwet's ACI=0.77, P<0.001) and excellent diagnostic performance (AUC: 0.951-0.986). Regarding uterine cavity morphology, the 24h post-procedure diagnosis in the experimental group identified 75 cases with uterine cavity adhesion grade 0, 11 cases with grade 1, 6 cases with grade 2, and 8 cases with grade 3. Agreement between the 4h and 24h results was poor (Gwet's ACI=0.58, P<0.001) with limited diagnostic ability (AUC: 0.614-0.800), while the 6h delayed radiography showed high agreement (Gwet's ACI=0.89, P<0.001) and good diagnostic performance (AUC: 0.812-0.953). Visual analogue scale (VAS) scores during the procedure and at 0.5h post-procedure were significantly lower in the experimental group compared with the control group (t=-24.688 and -65.280, respectively, P<0.05). There was no statistically significant difference in the incidence of vaginal bleeding at 0.5 hours post-procedure between the two groups (P>0.05). Conclusion Delayed radiography performed 6h after HSG with lipiodol ultra-fluide shows strong agreement with 24h findings in evaluating tubal patency and uterine cavity morphology. Combined with lower pain scores and favorable safety, this approach demonstrates good clinical feasibility.

关键词

原发性不孕症 / 超液化碘油 / 子宫输卵管造影 / 延迟片拍摄

Key words

primary infertility / lipiodol ultra-fluide / hysterosalpingography / delayed radiography

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基金资助

自治区卫生健康委自筹经费科研课题(Z-B20232045)