The Value Of Micro-syringe Pump In Hysterosalpingography: Compared With Conventional Manual Injection

Objective: Infertility is one of the most important diseases affecting human fertility.Hysterosalpingographyis(HSG)is one of the most common gynecological examination methods for infertility patients.There are some shortcomings in HSG examination using traditional manual injection method.Therefore,performing HSG examination using micro-syringe pump to inject contrast agent has gained great interest.The aim of this study is to investigate the value of micro-syringe pump in HSG examination.Methods: One hundred and forty cases of infertility patients who were going to perform HSG in Cangzhou Maternal and Child Health Hospital between June 2015 and December 2015 were included into the study.Using a method of random digit table,they were allocated into test group(n=70)and control group(n=70),with the test group using the micro-syringe pump to inject contrast medium in HSG examination,and the control group using the traditional method of manual injection.The injection speed,pressure,time of spot radiography,and adverse reaction were recorded.The image quality and the uterine tubal patency were evaluated by radiologists who had not participated in the HSG examination of this study(Observer1 and 2 are attending physicians,and Observer 3 is an associate chief physician),and unknown the method of injection,The successful rate of HSG examination and the repeat-ability of the diagnosis of fallopian tube obstruction between the two groups were compared.The image quality was evaluated using a grade scale of excellent,good,and poor,with the excellent and the good grade judged as HSG successful.The uterine tubal patency was evaluated as unobstructed and smooth,unobstructed and not smooth,and obstructed,with the first two situation judged as unobstructed,and the last situation judged as obstructed.SPSS13.0 software was used for statistical analysis.The differenceof patients' age and duration of infertility between the two groups was compared using a single sample t test.The difference of infertility category,HSG successful rate and the incidence of adverse reaction between the two groups were compared using ?2 test.P<0.05 was considered statistically significant.Comparison of the repeat-ability of the diagnosis of Fallopian tube obstruction between the two groups was performed by paired four grid test.Kappa value was calculate,with the Kappa value of 0~0.20 indicating a slight consistency,the Kappa value of 021~0.40 indicating a moderate consistency,the Kappa value of 041~0.60 indicating a substantial consistency,and the Kappa value of 081~1 indicating an almost perfect consistency.Results: There were no significant difference(P>0.01)in general information(age,duration of infertility,and the infertility category)between the test group and the control group.The image quality and the successful rate of HSG examination in test group was significantly better than those of the control group,the difference was statistically significant(P<0.01).Using the results of tubal patency evaluated by Observer 3 as the golden standard,the sensitivity,specificity,positive and negative predictive value and the diagnostic coincidence rate of Observer 1 and Observer 2 for diagnosing salpingemphraxis in test group were higher than those in control group respectively.Using the results of tubal patency evaluated by Observer 3 as the golden standard,the Kappa value of Observer 1 and Observer 2 for diagnosing salpingemphraxis in test group were 0.755 and 0.754 respectively,and the diagnostic results of the two observers achieved a substantially consistent.Using the results of tubal patency evaluated by Observer 3 as the golden standard,the Kappa value of Observer 1 and Observer 2 for diagnosing salpingemphraxis in test group were 0.570 and 0.557 respectively,and the diagnostic results of the two observers achieved a moderately consistent.The injection rate was uniform and slow in test group,and the inject time was between 120 s and 180 s,averaged(147.2±15.4)s.The injection rate was uneven and quick in control group,and the inject time was between 30 s and60 s,averaged(48.6±10.3)s.The incidence of nausea,vomiting,andabdominal pain in test group were lower than those in the control group,and the abdominal pain was often relieved automatically.The difference of the incidence of abdominal pain between the two groups was statistically significant(P<0.05).Conclusion: Compared with manual injection,HSG examination using micro-syringe pump can achieve a more slow and stable injection speed,and a moderate injection pressure.The new method can not only observe the filling and diffusion of the contrast medium directly and dynamically,improve the image quality and achieve a better accuracy and consistency in diagnosing of uterotubal disease,it can also reduce the incidence of adverse reactions,and reduce the radiation damage to the medical staff.