探讨实时三维子宫输卵管超声造影术(3D-HyCoSy)对不孕症患者不孕因素分析的临床价值。

选择2016年8月至2018年11月，于延安大学附属医院超声医学科接受实时3D-HyCoSy检查的249例女性不孕症患者为研究对象。其中，被临床诊断为原发性及继发性不孕症患者分别为121例与128例，分别纳入原发组(n＝121)与继发组(n＝128)。对22例患者(2例因为异位妊娠接受单侧输卵管切除术，共计40条输卵管)于实时3D-HyCoSy后1个月内，进行X射线下子宫输卵管碘油造影术(HSG)检查。采取回顾性分析法，对所有受试者的实时3D-HyCoSy结果进行分析。对于导致2组受试者不孕因素发生率，如输卵管通畅性构成比，宫腔、盆腔、卵巢病变发生率比较，采用χ²检验。计算实时3D-HyCoSy与HSG对于不孕症患者输卵管通畅性判断的总体符合率及Kappa值。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。2组不孕症患者的年龄、人体质量指数(BMI)、月经周期及不孕年限等一般临床资料比较，差异均无统计学意义(P>0.05)。

①继发组患者子宫腔病变发生率为30.5%(39/128)，显著高于原发组的16.5%(20/121)，并且差异有统计学意义(χ²＝6.685，P＝0.010)。2组不孕症患者输卵管通畅、通而不畅、阻塞构成比，以及盆腔病变、卵巢病变发生率分别比较，差异均无统计学意义(P>0.05)。②实时3D-HyCoSy与HSG检查，对不孕症患者输卵管通畅性判断的总体符合率为87.5%(35/40)，Kappa值为0.695(Z＝5.308，P<0.001)，判断一致性较高。

采取实时3D-HyCoSy对于原发性与继发性不孕症患者的不孕因素分析，有助于临床评价不孕症患者的不孕因素。由于本研究纳入样本量相对较小，实时3D-HyCoSy对不孕症患者不孕因素分析的临床价值，尚有待大样本、多中心临床研究进一步证实。

To investigate the effects of real-time three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) for analysis of factors leading to female infertility.

A total of 249 female infertility patients who received real-time 3D-HyCoSy examination in Department of Ultrasound, Yan′an University Affiliated Hospital from August 2016 to November 2018 were selected as research subjects. Among them, 121 cases were primary infertility females and 128 cases were secondary infertility females, and they were enrolled into primary group (n=121) and secondary group (n=128), respectively. Twenty-two female infertility patients (2 cases with a history of unilateral salpingectomy due to ectopic pregnancy, with a total of 40 fallopian tubes) underwent X-ray hysterosalpingography (HSG) examination within 1 month after real-time 3D-HyCoSy. Results of real-time 3D-HyCoSy of all subjects were retrospectively analyzed. Incidences of factors leading to female infertility, such as the constituent ratio of fallopian tube patency, incidences of uterine cavity, pelvic cavity and ovarian lesions in two groups were compared by chi-square test. The overall coincidence rate and Kappa value of real-time 3D-HyCoSy and HSG in evaluation of fallopian tube patency in female infertility patients were calculated. The procedures in this study were in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013. There were no statistical differences between two groups in the age, body mass index (BMI), menstrual cycle and duration of infertility (P>0.05).

①Incidence of uterine cavity lesions in secondary group was 30.5% (39/128), which was statistically higher than that in primary group 16.5% (20/121), and the difference was statistically significant (χ²=6.685, P=0.010). There were no statistical differences between two groups in constituent ratio of unobstructed, partially passable and obstructed fallopian tubes, and incidences of pelvic cavity and ovarian lesions (P>0.05). ②The overall coincidence rate of real-time 3D-HyCoSy and HSG in evaluation of fallopian tube patency in female infertility patients was 87.5% (35/40), and the Kappa value was 0.695 (Z=5.308, P<0.001), the consistency of these two methods was high.

Real-time 3D-HyCoSy has certain clinical values for analysis of factors leading to female infertility between primary and secondary infertility, and it is helpful for clinical evaluation of factors leading to female infertility. Due to the relatively small sample size included in this study, the clinical values of real-time 3D-HyCoSy for analysis of factors leading to female infertility remain to be confirmed by large-sample and multi-center clinical studies.