CAJ | 학술논문

目的：探讨经阴道实时三维子宫输卵管超声造影(TVS RT-3D-HyCoSy)发生逆流的原因，为减少造影剂逆流提供科学依据。方法观察167例不孕症患者进行 TVS RT-3D-HyCoSy 检查时发生逆流的声像图特征，分析输卵管通畅性、不孕类型、子宫内膜厚度、月经干净天数、宫腔异常、宫腔手术史、盆腔手术史及宫外孕病史与逆流发生率的关系。结果 TVS RT-3D-HyCoSy 逆流发生率为41.3%。单侧输卵管通畅是双侧通畅发生逆流的4.929倍，双侧输卵管阻塞是双侧通畅发生逆流的9.215倍。继发不孕逆流发生率高于原发不孕，且两者差异有统计学意义(P <0.05)。Logistic 回归分析显示逆流与输卵管通畅性、子宫内膜厚度及宫腔手术史相关，与其他因素无关。结论 TVS RT-3D-HyCoSy 能更好地鉴别逆流图像，适时选择造影时间、尽量避免子宫内膜的损伤会减少逆流的发生。
목적：탐토경음도실시삼유자궁수란관초성조영(TVS RT-3D-HyCoSy)발생역류적원인，위감소조영제역류제공과학의거。방법관찰167례불잉증환자진행 TVS RT-3D-HyCoSy 검사시발생역류적성상도특정，분석수란관통창성、불잉류형、자궁내막후도、월경간정천수、궁강이상、궁강수술사、분강수술사급궁외잉병사여역류발생솔적관계。결과 TVS RT-3D-HyCoSy 역류발생솔위41.3%。단측수란관통창시쌍측통창발생역류적4.929배，쌍측수란관조새시쌍측통창발생역류적9.215배。계발불잉역류발생솔고우원발불잉，차량자차이유통계학의의(P <0.05)。Logistic 회귀분석현시역류여수란관통창성、자궁내막후도급궁강수술사상관，여기타인소무관。결론 TVS RT-3D-HyCoSy 능경호지감별역류도상，괄시선택조영시간、진량피면자궁내막적손상회감소역류적발생。
Objective To discuss the possible reasons of contrast agent reflux during transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy),and in order to provide scientific evidences for reducing the contrast agent reflux.Methods The sonographic features of contrast reflux were observed in the images of 167 infertile patients who underwent TVS RT-3D-HyCoSy, and the association of the incidence rate of the reflux with tubal patency,the types of infertility,endometrial thickness,menstrual clean days,abnormal uterine cavity,the history of intrauterine operations,pelvic operations and ectopic pregnancies were analyzed.Results The incidence rate of the reflux during TVS RT-3D-HyCoSy was 41 .3%.The incidence rates of reflux in unilateral patency and bilateral obstruction were 4.929 and 9.21 5 times of that of bilateral patency respectively.The incidence rate of reflux in the secondary infertility cases was significantly higher than that of primary ones(P <0.05).Logistic regression analysis demonstrated that the reflux is associated with the tubal patency,the endometrial thickness and the history of intrauterine operations,and none of the other factors.Conclusions TVS RT-3D-HyCoSy could differentiate the images of reflux better;the proper timing of the contrast examination and avoiding the damage of endometrium would reduce the incidence of the reflux.