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输卵管因素是导致不孕症的主要原因[1]。研究发现,子宫输卵管造影(hysterosalpingography,HSG)显示输卵管不通或通而不畅的不孕症患者需要行腹腔镜手术[2],但对HSG显示输卵管通畅的不孕症患者能否进行腹腔镜手术未见报道。本文应用99TcmO4-输卵管显像能更好地观察不孕患者输卵管功能受损情况,对指导腹腔镜手术有重要价值,尤其针对HSG显示输卵管通畅的不孕症患者能否进行腹腔镜手术具有重要意义。
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166例(332条输卵管)不孕症患者经99TcmO4-输卵管显像结果显示,输卵管功能正常(图 1)68条(20.5%),轻度受损(图 2)83条(25%),中度受损(图 3)56条(16.8%),重度受损76条(22.8%),无功能30条(9.0%),输卵管不通19条(5.7%)。若去掉不通的输卵管19条,99TcmO4-输卵管显像显示功能受损的输卵管245条,占78.3%(245/313)。
图 1 99TcmO4-输卵管显像正常图像(2 s/帧) 图中,A:子宫腔潴留液≤3 mL患者的正常显影;B:子宫腔潴留液>3 mL患者的正常显影。
Figure 1. Normal images of radionuclide tubal imaging with 99TcmO4- (2 s/frame)
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99TcmO4-输卵管功能检查及腹腔镜检查结果比较见表 1。由表 1可知,91条HSG检查正常的输卵管行99TcmO4-显像及腹腔镜检查结果比较,其差异有统计学意义(χ2=27.56,P<0.05)。当腹腔镜显示通畅时,99TcmO4-输卵管显像显示以输卵管功能正常及轻度受损为主;若腹腔镜显示通而不畅,99TcmO4-输卵管显像显示输卵管功能以中、重度受损及无功能为主。
腹腔镜检查 99TcmO4-输卵管显像 合计/条 正常 轻度受损 中度受损 重度受损 无功能 通畅 40 9 5 3 1 58 通而不畅 5 5 11 7 5 33 注:HSG:子宫输卵管造影。 表 1 HSG检查正常的91条输卵管行99TcmO4-显像及腹腔镜检查结果
Table 1. 99TcmO4- imaging and laparoscopy results in 91 the normal fallopian tube of hysterosalpingography check
99TcmO4-输卵管显像对不孕症患者腹腔镜手术的价值
Application of oviduct radionuclide imaging in laparoscopy with infertility
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摘要:
目的应用99TcmO4-输卵管显像研究不孕症患者X线子宫输卵管造影(HSG)显示机械性通畅输卵管的功能受损程度,进而研究99TcmO4-输卵管显像对腹腔镜手术的价值。 方法对HSG显示至少一侧输卵管通畅或通而不畅的不孕症女性患者166例(通畅输卵管91条,通而不畅输卵管222条,单侧不通输卵管19条)行99TcmO4-输卵管显像。并对HSG显示通畅的91条输卵管进行99TcmO4-输卵管显像及腹腔镜对比分析。采用SPSS 17.0软件对HSG检查通畅输卵管99TcmO4-显像的输卵管功能损伤程度与腹腔镜检查的输卵管通畅性进行比较并行χ2检验。 结果对HSG显示输卵管机械性通畅(包括通畅及通而不畅)的不孕症患者,99TcmO4-输卵管显像结果显示输卵管功能受损的阳性率为78.3%。对不孕症患者HSG检查显示通畅的输卵管,行99TcmO4-显像及腹腔镜结果比较,其差异有统计学意义(χ2=27.56,P < 0.05)。其中,若腹腔镜显示通畅,则放射性核素99TcmO4-输卵管显像显示输卵管功能以正常及轻度受损为主;若腹腔镜显示通而不畅,则放射性核素99TcmO4-输卵管显像显示输卵管功能以中、重度受损及无功能为主。 结论放射性核素99TcmO4-输卵管显像对输卵管功能受损程度及通畅性的判断具有重要价值,对临床腹腔镜手术选择具有重要指导价值,尤其对HSG显示输卵管通畅的不孕症患者能否进行腹腔镜手术价值更大。 Abstract:ObjectiveTo investigate the value of improved radionuclide imaging in the evaluation of fallopian patency by hysterosalpingography (HSG) and laparoscopy. MethodsA total of 166 cases showed at least one side of tubal patency in HSG were considered in this study. Of these cases, 19 were unilaterally obstructed fallopian tubes, 222 were obstructed fallopian tubes, and 91 were unobstructed fallopian tubes. Radionuclide imaging was conducted, and the results were compared with laparoscopy results. ResultsRadionuclide imaging showed a damage rate of 78.3% in patients with unobstructed tubes in HSG. In the unobstructed fallopian tube group, radionuclide imaging and laparoscopic examination differed significantly(χ2=27.56, P < 0.005). When the laparoscopic examination showed tubal patency, radionuclide oviduct imaging showed normal or mildly impaired fallopian tubes. When the laparoscopic examination showed poor tubal patency, radionuclide oviduct imaging showed moderately damaged, severely damaged, or nonfunctional tubes. ConclusionsRadionuclide imaging of the fallopian tubes with different degrees of damage has great clinical value in evaluating the patency and extent of damage of fallopian tubes and is an efficient guide to the choice of laparoscopy, especially in patients with tubal patency in HSG. -
Key words:
- Infertility, female /
- Fallopian tube /
- Radionuclide imaging /
- Laparoscopy /
- Hysterosalpingography
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表 1 HSG检查正常的91条输卵管行99TcmO4-显像及腹腔镜检查结果
Table 1. 99TcmO4- imaging and laparoscopy results in 91 the normal fallopian tube of hysterosalpingography check
腹腔镜检查 99TcmO4-输卵管显像 合计/条 正常 轻度受损 中度受损 重度受损 无功能 通畅 40 9 5 3 1 58 通而不畅 5 5 11 7 5 33 注:HSG:子宫输卵管造影。 -
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