【作者】 邹晓娟；

【导师】 周晓东； 于铭；

【作者基本信息】 第四军医大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 第一部分超声造影评价输卵管通畅性的价值目的不孕症是一种常见疾病,女性因素占60%。女性可由多种因素而致病,其中多种原因可引起的输卵管狭窄、堵塞、蠕动受限使精子或卵子不能通过输卵管是引起女性不孕的重要原因。既往诊断输卵管病变的方法,主要有输卵管通液术、X线子宫输卵管碘油造影(HSG)和腹(宫)腔镜检查等。其中,输卵管通液术主要依靠药液推注时阻力的大小,以及有无反流来判断输卵管的通畅程度,诊断的主观性较大,准确性较差,且不能对阻塞部位作出明确的诊断;腹(宫)腔镜检查是一种有效,确诊率高的检查方法,但它是有创性检查,对器械要求高且操作复杂,具有一定的风险性;HSG是临床上较为常用的评价输卵管通畅性的方法,但医患均受射线辐射,且对碘过敏者检查受限;碘油吸收慢可导致肉芽肿形成、粘连等,油栓进入血循环可引起肺动脉栓塞的风险。本研究应用超声造影剂SonoVue对222例患者进行子宫输卵管超声造影,以探讨在诊断输卵管源性不孕症中应用经阴道超声造影评价输卵管通畅性的应用价值。方法不孕症妇女222例,常规经阴道二维超声下观察子宫、输卵管及卵巢的相对位置,将造影剂通过双腔子宫输卵管造影导管缓慢注入宫腔内,在B-flow超声模式下观察造影剂在宫腔及输卵管内的显影情况,同时注意推注时压力的大小,及造影结束后子宫直肠窝内无回声区的变化情况,来综合判断输卵管的通畅程度。超声造影结果与输卵管通液术、X线子宫输卵管碘油造影、腹(宫)腔镜检查结果进行对照分析(采用SPSS11.0统计软件,两组间的显著性差异采用χ~2检验)。结果222例不孕症患者(共计435条输卵管):73例(146条)双侧输卵管通畅;60例(120条)双侧梗阻;4例(8条)双侧通而不畅;56例(112条)一侧通畅,一侧梗阻;10例(20条)一侧通畅,一侧通而不畅;10例(20条)一侧通而不畅,一侧梗阻;9例因输卵管妊娠切除一侧输卵管术后,6例(6条)通畅,3例(3条)通而不畅。140例患者(其中有2例患者因输卵管妊娠切除一侧输卵管,共计278条输卵管)超声造影结果同输卵管通液术检查结果比较,经统计学方法处理,结果提示超声造影法与输卵管通液术准确性有显著性差异(χ~2=18.0,P<0.005);48例患者(共计96条输卵管)超声造影及X线子宫输卵管碘油造影结果示双侧或单侧输卵管梗阻的患者行腹(宫)腔镜检查(包括腹腔镜直视下输卵管通液检查、宫腔镜下经输卵管口插管通液检查和腹腔镜联合检查,通液时加用美兰染液),结果显示超声造影与腹(宫)腔镜检查准确性相似,无显著性差异(χ~2=0.10,P=0.75);超声造影诊断输卵管通畅性的诊断符合率、灵敏度、特异度均高于X线子宫输卵管碘油造影。结论应用SonoVue经阴道超声子宫输卵管造影是一种安全,简便,准确性高,无损伤,无副作用的检查方法。具有诊断和治疗的作用,是检查输卵管通畅性的较佳的方法。第二部分超声输卵管造影对输卵管积水的诊断及鉴别诊断目的输卵管积水是慢性输卵管炎症中较为常见的类型。在输卵管炎后,因输卵管粘连闭锁,粘膜细胞的分泌液积存于管腔内;或因输卵管炎症发生峡部及伞端粘连,阻塞后形成输卵管积脓,当管腔内的脓细胞被吸收后,最终成为水样液体。临床常见原因为人工流产、自然流产、药流、引产、不洁性交、盆腔感染等引起输卵管壁粘连、充血、水肿而阻塞,导致精子与卵子不能够结合,最终形成不孕症。因此明确诊断对进一步的临床治疗有着至关重要的意义。本实验是用经阴道二维超声及超声输卵管造影来探讨超声输卵管造影在输卵管积水的诊断及鉴别诊断上的临床实用价值。方法28例患者经阴道二维超声重点观察双侧附件区的无回声区与子宫,卵巢的相对位置关系,形态,囊壁,内部结构,移动度,测量并记录无回声区的大小、范围。然后通过双腔子宫输卵管造影导管缓慢向宫腔内注入造影剂,在B-flow超声模式下观察造影剂在宫腔及输卵管内的显影情况。结果28例患者(共计55条输卵管,1例因输卵管妊娠手术切除一侧输卵管),经阴道二维超声显示诊断为20例一侧输卵管积水,8例双侧输卵管积水。超声造影13例一侧输卵管积水,2例双侧输卵管积水。12例一侧输卵管积水的患者接受了腹腔镜手术治疗,术后结果均与造影结果相符。结论经阴道二维超声联合应用超声造影可提高输卵管积水诊断的准确率,可为患者提供了安全、有效的检查方法,为临床治疗和手术提供重要的帮助。更多还原

【Abstract】 Part one Value of Contrast-enhanced Ultrasonography in Diagnosis tubal patencyObjective: Infertility is a common disease and accounting for 60% of female factors. Many reasons could cause oviduct obstruction, such as appendagitis, pelvic inflammation . There are many diagnoses methods, such as hydrotubation , X-ray hysterosalpingography (HSG) , laparoscopy (hysteroscopy ), and so on. Hydrotubation mainly depends on the resistance to determine , and the result is inaccurate. HSG is a commonly used method of clinical., but the patient and the doctor have to receive radiation. The oil may be noxious to the body. If the oil is not absorpted, it will produce granuloma or abdominal cavity infection. laparoscopy (hysteroscopy ) is an effective, confirmed the high rate of inspection method , but it is a invasive examination and with a certain degree of risk. This research evaluates the value of diagnosis and treatment of fallopian tube patency by using hysterosalpingocontrast sonography (HyCoSy) with SonoVue and transvaginal ultrasound for 222 infertile women.Methods: 222 infertile women were examined by HyCoSy-SonoVue to observe flowing condition in Womb and fallopian tube. Comparing the results with hydrotubation, X-ray hysterosalingography (HSG) and laparoscopy (hysteroscopy).Result: In the 222 cases, 73 cases were both side of fallopian tube patency, 72 cases were single fallopian tube patency, 13 cases were single partial obstruction, 60 cases were both side of fallopian tube pinning, 4 cases were both partial obstruction. There was a significant difference on pregnancy rates between the HyCoSy-SonoVue and hydrotubation (P<0.05). There was no difference on diagnostic rates of fallopian tube patency between the HyCoSy-SonoVue, laparoscopy (hysteroscopy) (P>0.05), the HyCoSy-SonoVue was higher rate of diagnosis than HSG .Conclusion: The HyCoSy-SonoVue method is a safety one. This method would be an effective diagnosis in the evaluation of fallopian tube pathology for infertile women.Part two Value of Contrast-enhanced Ultrasonography in Diagnosis and Differential diagnosis of HydrosalpinxObjective: Hydrosalpinx is one of commonly chronic inflammation in the fallopian tube. After salpingitis tubal atresia adhesion, mucosal cells in the secretion of fluid accumulation within the lumen, or isthmic tubal inflammation and adhesions umbrella side, blocking the formation of fallopian tube, when the lumen is absorbed within the suppurative cells , after eventually become liquid water. For a common cause of clinical abortion, spontaneous abortion, medical abortion, induced abortion, the unclean sexual intercourse, pelvic infections caused by tubal wall adhesions, hyperemia, edema and obstruction, resulting in sperm and eggs can not be combined with the ultimate form of infertility. Therefore it is vital of a clear diagnosis for the clinical further treatment. This research used two-dimensional transvaginal ultrasound and HyCoSy-SonoVue to explore value of contrast-enhanced ultrasonography in diagnosis anddifferential diagnosis of Hydrosalpinx.Methods: 28 cases of patients were examined by two-dimensional transvaginal ultrasound to observe echo-free zone of bilateral annex , to know the relative position of echo-free zone with the uterus and ovary, echo-free zone’s shape, wall, internal structure, mobility, measurement and to record echo-free zone size, scope. And then to slowly inject contrast agent to intrauterine with the double-lumen catheter hysterosalpingography, in the mode of B-flow ultrasound contrast agent were observed in the uterine cavity and fallopian tubes within the developing situation.Results: 28 cases of patients (a total of 55 fallopian tubes, 1 case of tubal pregnancy due to tubal surgery to remove the side), two-dimensional transvaginal ultrasound showed that 20 cases were diagnosed as the side of hydrosalpinx, 8 cases of bilateral hydrosalpinx. Ultrasound contrast showed 3 cases were diagnosed as the side of hydrosalpinx, 2 cases of bilateral hydrosalpinx. 12 cases of the side of hydrosalpinx patients received laparoscopic surgery, postoperative results were in line with the Ultrasound contrast results. Conclusion : Two-dimensional transvaginal ultrasound combined with ultrasound contrast can increase the accuracy of diagnosis in Hydrosalpinx .It is a safe and effective method for patients and can provide an important help for clinical treatment and surgery.更多还原