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目的分析子宫输卵管造影(HSG)与腹腔镜检查(L S C)在不孕症中对输卵管通畅性检查的意义。方法回顾性分析1 3 4例不孕症患者先后行HSG和LSC的检查资料。结果无粘连组H S G与LSC均诊断输卵管通畅的阳性符合率(敏感度)为9 4.1%,均诊断不通的阴性符合率(特异度)为45.5%。有粘连组HSG与LSC均诊断输卵管通畅的阳性符合率(敏感度)为8 1.8%,均诊断不通的阴性符合率(特异度)为7 1.3%。无盆腔粘连者阳性符合率高,有盆腔粘连者阴性符合率高。LSC检查发现盆腔病变者9 8例,以盆腔炎及子宫内膜异位症居多,其中盆腔炎占47.8%,继发不孕患者当中,有盆腔炎病史者明显高于原发不孕患者,两者比较差异有统计学意义(χ2=1 6.46,P<0.0 5);子宫内膜异位症其次,占26.9%,原发不孕患者子宫内膜异位症发生率高于继发不孕者(χ2=9.0 4,P<0.0 5),而正常盆腔者原发不孕与继发不孕发生率差异无统计学意义。结论 HSG对于有盆腔粘连和无盆腔粘连患者检查的特异度和敏感度不同,有粘连者,敏感度低,特异度高,无粘连者敏感度高,特异度低;LSC能发现具体的盆腔病变,并能予以相应治疗,去除可能导致不孕因素。继发不孕患者当中,盆腔炎病史明显高于原发不孕者,对于不孕患者,HSG及LSC均是很好的检查方法,二者可以互补,应视情况采用。对于盆腔粘连者,应积极行LSC检查。
Objective To analyze the significance of HSG and LSC in the examination of tubal patency in infertility. Methods The data of HSG and LSC in 134 infertility patients were retrospectively analyzed. Results The positive coincidence rate (sensitivity) of tubal patency between HSG and LSC without adhesions was 9 4.1%, and the negative coincidence rate (specificity) was 45.5%. The positive coincidence rate (sensitivity) of tubal patency in HSG and LSC with adhesion group was 8 1.8%, and the negative coincidence rate (specificity) of diagnosing tubal adhesions was 71.3%. No pelvic adhesions positive coincidence rate, pelvic adhesions negative coincidence rate. LSC examination found that pelvic lesions in 98 cases, mostly pelvic inflammatory disease and endometriosis, pelvic inflammatory disease accounted for 47.8% of secondary infertility patients, history of pelvic inflammatory disease was significantly higher than the primary infertility patients, The difference was statistically significant (χ2 = 1 6.46, P <0.0 5), followed by endometriosis 26.9%, the incidence of endometriosis in primary infertility was higher than that of secondary infertility Pregnant women (χ2 = 9.04, P <0.05), while there was no significant difference in the incidence of primary infertility and secondary infertility in normal pelvis. Conclusions HSG has different specificity and sensitivity in examining patients with pelvic adhesions and pelvic adhesions with adhesion, low sensitivity, high specificity, high sensitivity and low specificity without adhesions; LSC can detect specific pelvic lesions , And can be treated accordingly to remove possible causes of infertility. Secondary infertility patients, pelvic inflammatory disease was significantly higher than the history of primary infertility, infertility patients, HSG and LSC are good methods of inspection, the two can complement each other, as appropriate. For pelvic adhesions, LSC should be actively checked line.