四维子宫输卵管超声造影假阳性与假阴性的原因分析

目的:调查与分析四维子宫输卵管超声造影假阳性与假阴性的原因。方法:选择2015年6月到2019年8月在本院妇产科临床初步诊断为输卵管不孕症患者125例,所有患者都给予X线子宫输卵管碘油造影(Hysterosalp ingography,HSG)与四维子宫输卵管超声造影,记录诊断效果、不良反应,判断假阳性与假阴性的发生原因。结果:在125例患者中,HSG诊断输卵管通畅33例,通而不畅72例,阻塞20例;四维超声造影诊断为输卵管通畅33例,通而不畅74例,阻塞18例。将HSG检查作为金标准,四维超声造影检查输卵管阻塞准确率93.6%,Kappa值=0.929(P<0.05),出现假阳性与假阴性共8例。四维超声造影检查期间发生的阴道少量出血、造影剂过敏、恶心呕吐、腹痛等不良反应发生率为2.4%,显著低于HSG检查的13.6%(P<0.05)。单因素分析结果显示合并糖尿病、产次、初潮年龄、孕次与四维子宫输卵管超声造影的假阳性与假阴性显著相关(P<0.05);多因素Logistic回归分析结果显示合并糖尿病、产次、初潮年龄为导致四维子宫输卵管超声造影假阳性与假阴性的主要原因(P<0.05)。结论:四维子宫输卵管超声造影可实时动态观察输卵管通畅情况,应用安全性也比较好,但是也存在假阳性与假阴性情况,合并糖尿病、产次、初潮年龄为导致四维子宫输卵管超声造影假阳性与假阴性的主要原因。

Analysis of the Causes of False Positives and False Negatives in Four-dimensional Uterine Fallopian Tube

ABSTRACT Objective: To investigate and analyze the causes of false-positive and false-negative contrast-enhanced ultrasound in four-dimensional uterine fallopian tubes. Methods: 125 patients who were initially diagnosed with tubal infertility in our obstetrics and gynecology clinic from June 2015 to August 2019 were selected. All patients were given X-ray hysterosalpingography (HSG) and four-dimensional uterus contrast-enhanced fallopian tube ultrasonography, recorded the diagnostic effect, adverse reactions, and judging the causes of false positives and false negatives. Results: In the 125 patients, HSG diagnosed 33 cases of unobstructed fallopian tube, 72 cases of unobstructed, and 20 cases of obstruction; 4four-dimensional contrast-enhanced ultrasound showed 33 cases of unobstructed fallopian tube, 74 cases of unobstructed, and 18 cases of blocked. Used the HSG as the gold standard, the accuracy rate of fallopian tube obstruction by four-dimensional contrast-enhanced ultrasound were 93.6 %, Kappa value=0.929 (P<0.05), and there were 8 cases of false positive and false negative occurred. The incidence of adverse reactions such as small vaginal bleeding, contrast agent hypersensitivity, nausea and vomiting, and abdominal pain during four-dimensional contrast-enhanced ultrasound examination were 2.4 %, which were significantly lower than 13.6 % of HSG examination (P<0.05). The univariate analysis results showed that the false positives and false negatives of combined diabetic, parity, age of menarche, pregnancy, and four-dimensional uterine fallopian tube ultrasound contrast were significantly correlated (P<0.05). The results of multivariate logistic regression analysis showed that combined diabetes, parity, and menarche Age were the main cause of false positives and false negatives of four-dimensional uterine fallopian tube ultrasonography (P<0.05). Conclusion: Four-dimensional uterine fallopian tube ultrasound can dynamically observe tubal patency in real time, and there application safety is also good, but there are also false positives and false negatives. Combining diabetes, parity, and menarche age are the main cause of false-positive and false-negative of four-dimensional uterine fallopian tube ultrasonography.