Value Of Vaginal Three-dimensional Ultrasound Angiography In The Diagnosis Of Tubal Patency Studies

Research Background: Infertility for clinical common disease,the current use of X-ray uterine tubal lipiodol angiography,tubal fluid and laparoscopy,uterine fallopian tube ultrasound and other methods of tubal lesions and lesions of the diagnosis,but each has its limitations The Transvaginal real-time three-dimensional ultrasound tubal angiography is one of Hy Co Sy's imaging methods,which clearly shows the complete morphology of the fallopian tube,and can be real-time dynamic observation of the uterine cavity,fallopian tube,umbrella and pelvic diffuse imaging effect,especially the new generation of ultrasound Sono Vue applied to clinical greatly improved the contrast resolution of the image,will not damage the patient's body,very little allergic reaction,and microbubbles have good stability in the body for a long time,for the operator in sufficient time Within the multi-angle,multi-section dynamic observation to facilitate,and then accurately analyze and determine the patency of the fallopian tube,walking and specific parts of the lesion for the clinical diagnosis and treatment of infertility to provide an important basis.Objective: To explore the feasibility and advantages of transvaginal real-time 3D-Hy Co Sy technique in evaluating the patency of tubal patency and its clinical application in the diagnosis of lesion site,and to provide an effective screening method for assessing tubal patency.Methods: Selected in June 2015 ~ June 2016 in our hospital by the clinical diagnosis of infertility in patients with 184 cases,356 tubal(excluding ectopic pregnancy resection of the fallopian tube 12),no reproductive system inflammation,the body Sexually transmitted diseases or major organ diseases,aged 21 to 40 years,mean age(32.1 ± 3.9)years,infertility time 1 to 8 years,mean time(3.16 ± 0.69)years.All the infertility factors such as male factors,excessive age and endocrine abnormalities were excluded from acute exacerbation of chronic inflammation or acute exacerbation of internal and external reproductive tract.All cases were treated with vaginal real-time 3D-Hy Co Sy 3 ~ 5 days after menstruation an examination.Ultrasonography before the observation of the uterus and ovarian size,shape,location,uterine rectal fossa in the presence of fluid or other lesions,and for recording.By our hospital obstetrics and gynecology experienced physician operation and evaluation of its fallopian tube state,given the diagnostic results.To observe the distribution of contrast agent in the uterine cavity and bilateral fallopian tubes of the patients,and observe the condition of the fallopian tubes of the patients after the angiography.The three-dimensional images were reconstructed and the interstitial cells,isthmus,ampulla and umbrella were observed.In 6 to 12 months on the clear diagnosis of patients with poor and easy to carry out telephone follow-up to understand their treatment and pregnancy,and then accept the inspection will,such as the patient showed abnormal examination,it should be recommended to the hospital routine ultrasound Etc.,to confirm the diagnosis.The results of contrast-enhanced ultrasonography were observed in all the patients in this group.The results were compared with those of laparoscopy.The adverse effects were observed and the long-term follow-up results were given.Results:1.The group of 184 patients with 356 fallopian tubes(excluding ectopic pregnancy resection of the fallopian tube 12),three-dimensional reconstruction showed 351,accounting for 98.6%(351/356).Which tubal patency 144,accounting for 40.7%;tubal pass and poor 99,accounting for 28.3%;fallopian tube obstruction 113,accounting for 31%.2.There were 52 cases(28 cases,2 cases were poor and poor),and 42 cases(80.8%)were followed up by appropriate follow-up.3.The results showed that 3D-Hy Co Sy diagnosis of tubal patency was achieved by comparing the results of 3D-Hy Co Sy with the gold standard of 50 patients(98 tubal ovaries,including 2 cases of ovariectomy with ectopic pregnancy resection)The positive sensitivity,specificity,positive predictive value and negative predictive value were 86.2%,90.0%,92.6% and 81.8% respectively.The positive likelihood ratio and negative likelihood ratio were 8.61 and 0.17 respectively.There was no significant difference in the accuracy of the above two methods(P <0.05).Kappa analysis showed that transvaginal real-time three-dimensional ultrasound tubal angiography to evaluate tubal patency test results and laparoscopic staining results have a good consistency(Kappa = 0.715,P <0.05).4.Uterine end state judgment results show that the study of 65 cases of diagnosis of umbrella end adhesions,accounting for 18.3%,of which 11 confirmed by laparoscopy.5.In this group of 184 patients were not adverse effects of contrast agent,but in the course of examination and examination after discomfort and pain,which did not respond to 75 cases,accounting for 40.8%,mild response to 73 cases,accounting for 39.7%,moderate response 36 cases,accounting for 19.6%,no severe responders.Ultrasound after the end of the rest of the symptoms disappeared.Conclusions: 1.Transvaginal real-time three-dimensional ultrasound tubal angiography can quickly and accurately diagnose women's infertility patients with tubal patency and lesion.2.3D-Hy Co Sy has obvious advantages in showing the three-dimensional space of the fallopian tube and the umbrella end space structure,which can provide valuable information for the clinical treatment of tubal pass and poor patients.It is safe and reliable,simple in operation,easy to accept and has wide Clinical application prospects.