摘要目的 探讨经阴道实时三维子宫输卵管超声造影(transvaginal ultrasound real-time three-dimensional hysterosalpingo-contrast sonography,TVS RT-3D-HyCoSy)在不孕症中的临床应用.方法 对诊断为不孕症的202例患者,共385条输卵管,在超声实时三维(4D)模式下,进行经阴道子宫输卵管超声造影,连续观察造影液在宫腔及输卵管显影情况.在拔双腔导管前宫腔注入生理盐水二维超声(2D)观察宫腔,导管拔出后三维容积成像(3D)评估宫腔形态.结果 202例385条输卵管,超声造影显示输卵管298条通畅,32条通而不畅,55条阻塞.子宫内膜息肉3例,宫腔粘连4例,宫腔形态异常4例,肌层逆流和/或静脉逆流共26例.结论 经阴道实时三维子宫输卵管超声造影可实时观察造影液在宫腔及输卵管的显影情况,可较准确地判断输卵管通畅性;3D及2D补充观察对判断宫腔形态及宫腔病变有重要价值.

abstractsObjective To investigate the clinical application of transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy) in infertility.Methods In 202 women with infertility,385 fallopian tubes were examined by transvaginal hysterosalpingography under real-time three-dimensional (4D) mode of ultrasound,and the development of the liquid in uterine cavity and fallopian tube was observed continuously.Normal saline was injected into the uterine cavity before pulling out the double lumen catheter to observe uterine cavity lesions by two-dimensional ultrasound (2D);and the shape of the uterine cavity was evaluated by three-dimensional volumetric imaging (3D) after the catheter was pulled out.Results Among the 385 fallopian tubes in the 202 women,298 fallopian tubes were diagnosed with patency by contrast-enhanced ultrasonography,32 incompletely obstructed,and 55 completely obstructed.There were 3 cases of endometrial polyp,4 cases of intrauterine adhesion,4 cases of abnormal uterine cavity morphology,and 26 cases of myometrium countercurrent and/or venous countercurrent.Conclusion Transvaginal real-time three-dimensional hysterosalpingo-contrast sonography can observe the development of the liquid in uterine cavity and fallopian tube in real time,and accurately judge the patency of fallopian tube.Three-dimensional ultrasound and two-dimensional ultrasound supplementary observation have important values in judging uterine cavity morphology and uterine cavity pathological changes.