Chan Carina C W, Ng Ernest H Y, Tang Oi-Shan, Chan Karen K L, Ho Pak-Chung
Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
Acta Obstet Gynecol Scand. 2005 Sep;84(9):909-13. doi: 10.1111/j.0001-6349.2005.00797.x.
Two-dimensional hysterosalpingo-contrast-sonography, as a screening test for tubal patency for subfertile patients, is limited by the difficulty in visualizing the entire Fallopian tube owing to its tortuosity. This major disadvantage can be overcome by means of the three-dimensional hysterosalpingo-contrast-sonography (3D-HyCoSy). The current study compared the efficacy of 3D-HyCoSy with diagnostic laparoscopy and its feasibility as a screening test for tubal patency.
Twenty-one consecutive patients scheduled to have laparoscopy were recruited to undergo the 3D-HyCoSy 2 days before the scheduled laparoscopy. Echovist (Schering AG, Berlin, Germany), the ultrasound contrast medium, was injected into the uterine cavity via a Foley's catheter. The flow of the medium in the Fallopian tube was captured by using three-dimensional power Doppler mode and was stored for later analysis. The person analyzing the images, the surgeon performing the laparoscopy, and the patients were blinded to the patients' identity and the sonography findings. The sonography and the laparoscopy findings were compared. The duration for the ultrasound examination, pain score, and patient acceptability were assessed.
Thirty-four of 42 (81%) Fallopian tubes were assessed. The sensitivity of 3D-HyCoSy for detecting tubal patency was 100% with a specificity of 67%. The positive and negative predictive values were 89 and 100%, respectively; the concordance rate was 91%. The mean duration (+/- SD) for the 3D-HyCoSy was 13.4 +/- 5.5 min. Fifteen patients (71%) regarded the sonography examination as at least acceptable.
This study confirmed the feasibility of using 3D-HyCoSy as an initial investigation for tubal patency.
二维子宫输卵管超声造影作为对不育患者输卵管通畅性的筛查试验，由于输卵管迂曲，在可视化整个输卵管方面存在困难，其应用受到限制。三维子宫输卵管超声造影（3D-HyCoSy）可以克服这一主要缺点。本研究比较了3D-HyCoSy与诊断性腹腔镜检查的有效性及其作为输卵管通畅性筛查试验的可行性。
连续招募21例计划进行腹腔镜检查的患者，在预定腹腔镜检查前2天接受3D-HyCoSy检查。通过Foley导管将超声造影剂Echovist（德国柏林先灵公司）注入宫腔。使用三维能量多普勒模式采集造影剂在输卵管内的流动情况并储存以供后续分析。分析图像的人员、进行腹腔镜检查的外科医生以及患者均对患者身份和超声检查结果不知情。比较超声检查和腹腔镜检查结果。评估超声检查的持续时间、疼痛评分和患者接受度。
42条输卵管中的34条（81%）得到评估。3D-HyCoSy检测输卵管通畅性的敏感性为100%，特异性为67%。阳性和阴性预测值分别为89%和100%；符合率为91%。3D-HyCoSy的平均持续时间（±标准差）为13.4±5.5分钟。15例患者（71%）认为超声检查至少可以接受。
本研究证实了使用3D-HyCoSy作为输卵管通畅性初步检查的可行性。
