Research On Methods And The Value For Tubal Patency Of Real-Time Three-Dimensional Contrast Ultrasound

Objective:Analyse the reasons of symptoms caused during SonoVue hysterosalpingo-contrast sonography (HyCoSy) under three dimensional transvaginal sonography (3D-TVS) to find the physical and chemical methods to alleviate them that influence on image quality,Assess the value of SonoVue realtime coding contrast in HyCoSy under 3D-TVS judging tubal patency.Methods:375 research object are examed under TVR3D-HyCoSy in The People’s Hospital of Zhengzhou University from 1 January 2013 to October 2013. First step:40 cases are questionnaire surveyed including symptoms, appeared time, grade, cause, menstrual period also, easy and difficult intubation, fallopian tubal patency, the disperse state of contrast agents in pelvic,. Second:300 cases were divided into 6 groups randomly, each 50, group A injected atropine with room temperature contrast agent; Group B injected placebo with room temperature contrast agent; Group C injected of atropine with 37℃contrast agent; Group D injected placebo with 37℃ contrast agent; Group E:injected lidocaine into uterine cavity before contrastion. group F:injected lidocaine into uterine cavity after ontrastion. Symptom grade divided into 0-10 points,0 points is no pain,10 points is very painful. There are three image levels according to image of uterine cavity and tubal reconstructed are clear and continuous, are there artifacts and interference, good for 3 points, general for 2 points, poor for 1 points. Comparing group A and B, C and D, A and C, B and D and group E and F respectively,41 cases undergoing laparoscopic examination in 1 month after HyCoSy. compearing the results of contrast and chromolaporoscopy as well as using the diagnostic test to judge the technology efficiency.Instrument:GE company Voluson E8, transvaginal probe RIC5-9-D. Contrast agents:Italy Bracco SonoVue.Statistics:Measurement data is with mean ±standard deviation, correlation analysis is using Kruskal-Wallis test, the Mann-Whitney U test, Spearman rank correlation analysis respectively, with P< 0.05Results:1) Symptoms during TV RT-3d-HyCoSy including abdominal pain, waist paiu, sweating, nausea, headache, weakness, and desire to defecate, there are good correlation with easy and difficult intubation, fallopian tubal patency, the disperse state of contrast agents in pelvic, but nothing to do with menstrual period.2) Symptom grade had no significant difference of injecting atropine or placebo 30 minutes before contrastion by compared group A and B, group C and D, symptom grade is lower with 37°contrast agent than with room temperature by compared group A and C, group B and D, symptom grade had significant difference while image levels had no difference by compared group F and D, symptom grade had no significant difference by compared group E and F, image quality in more cases of group E is worse than in group F.3) The result of Lap and Dye as the gold standard, the sensitivity of diagnosis of tubal obstruction under TV RT-3 d-HyCoSy is 89.7%, specificity 94.1%, positive likelihood ratio 15.2, negative likelihood ratio 0.10.Conclusion:TV RT-3d-HyCoSy is a effective measure of diagnosis of tubal obstruction, which is simple operation, easy to master. Using warmed contrast agents and injecting lidocaine into uterine cavity after contrast can relieve the discomfort during contrastion and let the operation become tolerated.