摘要
目的探讨子宫输卵管四维超声造影过程中逆流发生的影响因素。方法选择2017年1月至2018年12月在安徽省中医药大学第一附属医院超声科行子宫输卵管四维超声造影的235名女性不孕症患者,年龄22~47岁,不孕时间1~13年,对其中101名出现逆流现象的患者资料进行回顾性分析,观察出现逆流现象的声像图,从年龄、不孕时间、输卵管通畅程度、疼痛程度、子宫位置、子宫内膜厚度、月经后检查时间、不孕类型、流产史、子宫畸形、宫外孕史、妇科炎症、宫腔占位、盆腔手术史、宫腔粘连带这15个因素中分析探索原因。结果本组病例造影剂逆流的发生率为42.9%。单因素分析显示,内膜厚度、流产史、月经后检查时间、宫腔粘连带、不孕类型及输卵管通畅程度均可能与逆流的发生相关(P<0.05)。多因素Logistic回归分析显示,逆流的发生与内膜厚度、月经后检查时间、不孕类型及输卵管通畅程度密切相关(P=0.036、0.045、0.025、0.004),其中子宫内膜厚度、月经后检查时间与逆流的发生呈负相关(B=-0.834、-0.802);不孕类型、输卵管阳性组与逆流的发生呈正相关性(B=1.122、0.898)。结论内膜厚度<6 mm、月经后3~4 d进行造影检查、继发性不孕及输卵管堵塞是导致逆流产生的主要原因。可选择在内膜厚度≥6 mm、月经后5~7 d时进行造影检查,同时尽可能地避免内膜损伤,降低宫腔压力,有利于降低逆流的发生率。
Objective To investigate the influencing factors of contract agent reflux during four-dimensional hysterosalpingo-contrast sonography.Methods A total of 235 infertility women(aged from 22 to 47 years,with an infertility duration of 1 to 13 years)who undertook four-dimensional hysterosalpingo-contrast sonography in the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2017 to December 2018 were enrolled in this study.Retrospective analyses were conducted on the 101 patients who experienced reflux of contract agent during the examination.Ultrasonograms of their reflux were observed,and reasons for that were probed from the following 15 aspects:age,infertility time,tube patency,pain level,uterine position,endometrial thickness,menstruation examination time,infertility type,abortion history,uterine malformation,ectopic pregnancy history,gynecological inflammation,uterine space-occupying lesions,pelvic surgery history,and intrauterine adhesion.Results The incidence of contrast reflux was 42.9%in this cohort.Univariate analyses showed that endometrial thickness,history of abortion,menstruation examination time,intrauterine adhesion,type of infertility and tubal patency were associated with occurrence of contract reflux(P<0.05).Multivariate logistic regression analyses indicated that endometrial thickness,menstruation examination time,type of infertility and tube patency were closely related with the reflux(P=0.036,0.045,0.025,0.004),and endometrial thickness and menstruation examination time were negatively correlated with the reflux(B=-0.834,-0.802),while type of infertility and obstruction of fallopian tubes were positively correlated(B=1.122,0.898).Conclusion Endometrial thickness<6 mm,examination 3 to 4 d after menstruation,secondary infertility and tubal occlusion are the main causes of contrast reflux.Therefore,it is advisable to have the examination when the endometrial thickness is≥6 mm and the menstruation is over for 5 to 7 d.Meanwhile,endometrial damage should be avoided and uterine cavity pressure be reduced as much as possible,which may be beneficial to keep incidence of reflux low.
作者
王瑞
王金萍
张超学
WANG Rui;WANG Jinping;ZHANG Chaoxue(Department of Ultrasonography, First Affiliated Hospital, Anhui Medical University, Hefei, Anhui Province, 230031;Department of Ultrasonography, First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, Anhui Province, 230031, China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2019年第15期1473-1477,共5页
Journal of Third Military Medical University
基金
安徽省2018年度重点研究与开放计划项目(1804h08020248)~~
关键词
子宫输卵管四维超声造影
逆流
造影剂
不孕症
four-dimensional hysterosalpingo-contrast sonography
reflux
contrast agent
infertility
