| BackgroundFallopian tube disease is one of the most common causes of infertility in women,most of the fallopian tube diseases are closely related to the patency of fallopian tubes.Therefore,clinical infertility patients generally need to be tested the patency of fallopian tubes,that can be given a reasonable and effective treatment.Uterine tubal four-dimensional CEUS is a four-dimensional ultrasound technology based on conventional ultrasound.Fourdimensinonal hysterosalpingo-contrast sonography(4D-HyCoSy)is a four-dimensional ultrasound contrast technique based on conventional ultrasound,The real-time dynamic subjects of uterine cavity and fallopian tube.To observe the morphology and patency.Data display,Its operation is simple and the price is low,and it has the same accuracy as the "laparoscopic pass dyeing".At present,it has become an important method to assess the patency of the fallopian tube.Research shows that uterine cavity pressure measurements in the 4D-HyCoSy process,can draw the fallopian tube patency index and make the examination result more accurate.The study about uterine cavity pressure measurements in the 4D-HyCoSy process was short of systematicness and depth.So,this study was to investigate the 4D-HyCoSy tube patency value in the diagnosis of tubal,and to explore the application value of intrauterine pressure measurement in 4D-HyCoSy.Objective1.To evaluate the value of four-dimensional ultrasound in diagnosis of tubal patency.2.The pressure of uterine cavity in four dimensional hysterosalpingography was measured and the role of pressure measurement in four dimensional hysterosalpingography was discussed.MethodsFrom January 2017 to February 2018,158 infertile patients were selected from outpatient department of gynecology and obstetrics department in our hospital.All the patients were in accordance with the indication of hysterosalpingography.HSG was performed in 45 of 158 patients within 2 weeks of 4D-HyCoSy.Among the 158 cases,60 patients were connected to the pressure measuring device before 4d-hycosy examination.The patency of fallopian tubes,the surrounding of contrast media around the ovary,the diffusion degree of contrast agents in the pelvis by 4D-HyCoSy and the occurrence of adverse reactions were observed,and then compared with the results of HSG.In addition,the effect of intrauterine pressure on four-dimensional hysterosalpingography was observed.Results1.There were 182 tubal patency,55 complete obstruction and 79 partially passable.Among them,both sides of fallopian tube were patency in 68 cases(136 pieces);bilateral obstruction of oviduct was found in 13 cases(26 pieces);One side patency and the other side obstructed were in 12 cases(12 / 12);one side of the fallopian tube partially passes,and the other side obstructed were 17 cases(17 / 17);patients of bilateral partial passage of fallopian tube were 14 cases(28);Partial patency of one side of fallopian tube,and the other side unobstructed were 34 cases(34/34).There were 11 cases of arcuate uterus,5 cases of incomplete mediastinal uterus,3 cases of endometrial polyps and 4 cases of intrauterine adhesions.2.In the patency group,96.70% of the ovaries around the oviduct were circumscribed in a circular way,which was compared with that in the partial adoption group(46.84%),and in the obstructed group(3.64%),P<0.05;In the obstructive group,87.27% of the oviducts were ipsilateral,compared with the unobstructed group(1.10%)and the partial unobstructed group(7.59%),P<0.05;In partial patency group,45.57% of the ovaries around the oviduct in the ipsilateral side were semi-annular,compared with the unobstructed group(2.20%)and the blocking group(9.09%),the difference was statistically significant(P<0.05).3.The majority of patients with uniform pelvic dispersion were bilateral tubal patency,98.53% of the patency group,compared with the other the number of uniform cases of pelvic dispersion groups,the difference was statistically significant(P< 0.05);The majority of patients with uneven pelvic dispersion were bilateral partial patency,obstruction on one side and patency on the other,obstruction on one side and patency on the other,78.57% of each group,82.31% and 83.00%,respectively,compared with the patients with uneven diffusion of bilateral occlusion group,bilateral patency group,unilateral patency group and partial patency group,the difference was statistically significant(P< 0.05);The majority of patients without pelvic diffusion were bilateral obstruction,84.60% of the blocking group,compared with no diffuse cases in pelvic cavity of other groups,the difference was statistically significant(P< 0.05).4.The4D-HyCoSy and HSG results indicated that the highest coincidence rate was obstruction(92.31%),the lowest coincidence rate was partial patency(63.64%),and the coincidence rate of patency patients was 85.71%.For 4D-HyCoSyin the diagnosis of tubal patency,its sensitivity and specificity was 88.00%(44/50)and 90.00%(36 / 40).Besides,its positive predictive and negative predictivevalue was 85.71 %(36 / 42)and 92.31%(24 / 26).Mcnemar's test showed that there was no significant difference between the two tests(P > 0.05).The results of consistency test showed that the value of kappa was 0.765,P< 0.001,which indicated that the two methods had high consistency.5.During the 4D-HyCoSy examination of 158 patients,the main adverse reactions were pain,there was no allergic reaction caused by contrast agent.The adverse reaction was 40 cases of grade 0(25.32 %),62 cases of grade I(39.24%),42 cases of grade II(28.48%),14 cases of grade ?(8.86%).Grade IV adverse reactions didn't occurre.The incidence of adverse reactions in grade III was compared with that in grade 0 and grade I and grade II,respectively,the difference was statistically significant(P<0.05).6.The results of pressure measurement for 60 cases of 4D-HyCoSy examination showed,the pressure of bilateral occlusion group,bilateral patency group,one side obstruction and the other side partial patency group were compared with other groups,respectively,the difference was statistically significant(P<0.05 or P<0.01).Bilateral partial patency group,one side blocking the other side patency group,one side patency and the other side partial patency group were compared,the difference was not statistically significant(P> 0.05).7.The pressure of partially unobstructed oviduct in complete development was significantly higher than that in unobstructed fallopian tube,P<0.05.8.In the bilateral partial patency group,the pressure and the time of appearance of the uterine cavity and fallopian tube during peak development were compared in two pairs respectively,the difference was statistically significant(P<0.05).Conclusion1.4D-HyCo Sy can observe the flow of fallopian tubes in real time,dynamically,intuitionisticly and accurately.There was a high degree of consistency compared with HSG results.It is a non-invasive,safe and effective method.2.In the 4D-HyCoSy test,the value of uterine cavity pressure can be used as a quantitative index to judge the patency of fallopian tube.The size of the pressure of the uterine cavity is closely related to the patency of the tubal. |
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