The Clinical Value Of Transvaginal 4D-HyCoSy For Evaluation In Tubal Patency Of The Patients With Tubal Pregnancy After Conservative Treatment

Objective:In the reproductive age,the fallopian tube is the place of early fertilization and embryonic development,changes of its structure and related function often lead to Infertility or tubal pregnancy.Transvaginal 4D-HyCoSy was used to evaluate the patency of bilateral tubal after conservative drug treatment and conservative operation treatment in patients with tubal pregnancy,and the investigation its clinical value.It can help those patients to choose the appropriate time or way of pregnancy and provide evidence for early clinical intervention.Method:Our study is based on the conservative treatment and conservative operation treatment on 120 tubal pregnancy patients from January 2015 to September 2016 in the Affiliated Hospital of Binzhou Medical College.They are divided into three groups.A: Conservative drug treatment group(40 cases),B: Laparoscopic conservative surgery group(40 cases)and C: Laparotomy group(40 cases).All cases were underwent transvaginal 4D-HyCoSy to observe the patency of bilateral fallopian tubes.In order to compare the consistency of the two methods,40 cases were randomly selected to compared with Laparoscopic Meilan Hydrotubation(gold standard).Result:1.The consistency of Transvaginal 4D-HyCoSy and Laparoscopic Meilan Hydrotubation test is high.The Kappa value was 0.732(P <0.001),The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Transvaginal 4D-HyCoSy diagnosis were 88.9%(24/27),92.5%(49/53),85.7%(24/28)(49/52),91.3%(73/80).2.The ipsilateral tubal unobstructed rate(32.5%)was significantly higher in the Laparoscopic conservative surgery group than in the Conservative drug treatment group(7.5%)and in the Laparotomy group(10.0%),while the ipsilateral tubal partially passable rate and obstructed rate(37.5%?30.0%)in Laparoscopic conservative surgery group was significantly lower than that in Conservative drug treatment group(47.5%,45.0%)and Laparotomy group(45.0%,45.0%).The difference was statistically significant(P <0.05).Conclusion:1.The consistency of Transvaginal 4D-HyCoSy and Laparoscopic Meilan Hydrotubation test is high(The Kappa value was 0.732).2.Conservative laparoscopic surgical treatment is more benefit for the retention and recovery of tubal function,it can be promote among the patients who have fertility requirement.3.Transvaginal 4D-HyCoSy is safe and reliable.Also,the operation is easy to do.Real-time viewing the direction of contrast agent in the fallopian tube,it also has a therapeutic effect to partially passable tubal.It is worthy of clinical application and promotion.