Letterie G S, Haggerty M F, Fellows D W
Reproductive Endocrinology Service, Virginia Mason Clinic, Seattle, WA 98111.
Arch Gynecol Obstet. 1992;251(4):175-80. doi: 10.1007/BF02718383.
Hysterosalpingography (HSG) to assess tubal patency in the postoperative evaluation of the infertile patient has been well described. However, the sensitivity and specificity of HSG after tubal surgery has not been reported. We correlated HSG and laparoscopic findings in 25 patients who had tubal surgery (microsurgical tubal reanastomoses [11] and distal salpingostomies [14]). HSG provided a more reliable means of assessing tubal patency (sensitivity and specificity of 96% and 61% respectively) than in detecting pelvic adhesive disease (PAD) (sensitivity and specificity of 12% and 75% respectively) regardless of tubal surgical procedure. HSG was associated with a high false negative rate (60%) due primarily to the inability to detect PAD. Complete agreement between HSG and laparoscopy was noted in only 15% of cases. These data suggest that HSG is a sensitive means to determine tubal patency, but was not sufficiently sensitive or specific to detect PAD after tubal surgery. These limitations should be noted in the interpretation of HSG in any infertile patient with a history of tubal surgery, and severely limits the application of HSG to the management of the post-operative infertile patient.
子宫输卵管造影术（HSG）在不孕患者术后评估中用于评估输卵管通畅性已有详细描述。然而，输卵管手术后HSG的敏感性和特异性尚未见报道。我们对25例接受输卵管手术（显微外科输卵管再吻合术[11例]和输卵管远端造口术[14例]）的患者的HSG和腹腔镜检查结果进行了相关性分析。无论输卵管手术方式如何，HSG在评估输卵管通畅性方面（敏感性和特异性分别为96%和61%）比检测盆腔粘连性疾病（PAD）（敏感性和特异性分别为12%和75%）提供了更可靠的方法。HSG主要由于无法检测到PAD而具有较高的假阴性率（60%）。HSG与腹腔镜检查完全一致的情况仅在15%的病例中出现。这些数据表明，HSG是确定输卵管通畅性的一种敏感方法，但在检测输卵管手术后的PAD方面不够敏感或特异。在对任何有输卵管手术史的不孕患者进行HSG解读时应注意这些局限性，这严重限制了HSG在术后不孕患者管理中的应用。
