| Objectives:In order to make hysterosalpingography (HSG) safer and more standard, provide new scientific evidence for clinical diagnosis and treatment, we compare the usage of improved gradually pressurized HSG with traditionary hand pushing HSG in the diagnosis and treatment of infertility caused by fallopian tubal occlusion, want to prove the superiority and feasibility of automatic high pressure syringe. Meanwhile, we compare and analyze the image date of two methods anatomically.Methods: 1 Research objects A total of 200 cases were collected from No.2 Baoding central hospital, and time period was from January 2005 to December 2013. These cases were all females infertility caused by fallopian tubal occlusion, their ages were 20 to 44 years old, and their average age was 29.3 years old. These patients were divided into two groups according to the method of retrospective study. The experimental group had 100 patients whom was treated by gradually pressurized HSG. The contral group had 100 patients whom was treated with traditionary hand pushing HSG. Those cases with congenital aplasia of uterus or surgical exairesis of uterine tube were ruled out from both two groups. All patients had signed the informed consent document. 2 Research facilities and methods The patients of two groups were inlayed a double cavity balloon catheter via vagina into uterine cavity by doctors from department of gynaecology during 3 to 7 days after menstruation, when their menstruation were finished. After that, HSG were performed in our radiology department with SIEMENS R200 digital gastrointestinal machine under X-ray. Iohexol were injected into the uterine cavity of the patients in experimental group with Zentith-1710 automatic high pressure syringe, with velocity of 0.2 ml/s and the pressure of 200 PSI. If unilateral or bilateral uterine tubes were obstructed, the injected pressure were increased to 300PSI. The operator took photos, recorded the dosage of contrast agent and X-ray exposure time at the same time. In order to prevent tubal rupture during HSG, the operator should pay attention to the reaction of the patients. Iohexol were injected into the uterine cavity of the patients in control group with 10 ml injector by hand. The pressure could be increased slightly when met higher resistance, but must under the limitation of patients who can endured. The operator took photos, recorded the dosage of contrast agent and X-ray exposure time at the same time. After the inspection, the operator extracted the air in the balloon with a 5 ml syringe, pulled out the catheter, and observed the diffusion of contrast agent in pelvic cavity.3 Analytical method HSG performance can be divided into normal fallopian tube and abnormal uterine tube. The normal uterine tube is completely unobstructed, the abnormal uterine tube include complete obstruction, partial unobstructed, and peritubal adhesions. Complete obstruction can be divided into proximal segment obstruction and distal segment obstruction. The number of normal and abnormal uterine tube of each group was recorded and compared. The contrast agent dosage, X-ray exposure time and contrast medium reflux were also compared between two methods.According to the image data, the length and inner diameter of the proximal segment and distal segment of the unobstructed uterine tube is measured, and compared to the records of normal human bodys. The above data were compared between the two groups, too. Anatomical analysis was made to the image date of experimental group before and after the pressure increase.All results using SPSS software to establish a database and statistical analysis. Measurement data were denoted as mean±standard deviation (x±s), t test was used to compare the difference between two groups. Numeration data were compared by χ2 test. P<0.05 indicating that the difference was statistically significant.Results:General conditions, such as infertility patient’s age, history of infertility, number of pregnancies, etc. was no significant difference between the two groups. The HSG results of two groups were comparable.(1) Comparison of clinical results between two groups:Both groups have 200 uterine tube. The number of unobstructed tube in the experimental group (138) was higher than the control group (116) with statistical significance. The number of complete obstruction of the uterine tube in the experimental group was 43, the control group was 70. The percentage of complete obstruction of experimental group was significantly lower than the control group. The number of partial obstruction of the uterine tube in the experimental group was 9, the control group was 8. The number of peritubal adhesions in the experimental group was 10, the control group was 6. The comparison of the latter two items have no significant difference.(2) Comparison of dosage, adverse reactions and exposure time between two groups:The dosage of iohexol in the experimental group was higher than that in control group. The adverse reactions of two groups have no obvious difference. Both groups did not cause serious adverse reactions. Exposure time in the experimental group is lower than the control group, which can shorten the exposure time and reduce the patients X-ray radiation.(3) Anatomical analysis of two sets of image data:Normal performance of HSG showed the linear tube is connected to the uterine horns and gradually thicken from the proximal to the distal. Since the contrast agent flow out from the uterine tube umbrella to the abdominal cavity, the contrast agent was strip sheet or strip dispersed around and smeared on the ovaries or around the bowel. With time extending, the contrast agent gradually fades. The imaging performance of complete obstruction is at least one side of the uterine tube does not visible completely, or partially visible and no distal diffusion. Complete obstruction can be further distinguished. Proximal obstruction is within the isthmus and proximal segment, distal obstruction is beyond the ampullary part to the umbrella part, the distal end of the tube. The imaging performance of partial obstruction is at least one side of the uterine tube is passable, but shape of the uterine tube was irregular, rough, enlarged or uneven thickness, which may be accompanied with/or without adhesion around the uterine tubes. Imaging performance of peritubal adhesions is the contrast agent gathered into clumps around umbrella, no diffusion or poor diffusion.The length of the proximal segment of unobstructed tubal is 43.83± 7.53mm,41.60±4.93mm in experimental groups and control groups respectively; distal segment were 38.29±8.58mm,39.89±6.25mm, respectively. The inner diameter of proximal segment were 0.63±0.10mm, 0.66±0.12m; distal segment were 3.99±0.88mm,3.90±0.71mm, respectively. There was no significant difference between two groups in length and inner diameter of the two segments. The length of the proximal segment were greater than the records of normal human bodys, the inner diameter of the proximal segment were slightly lower than the records of normal human bodys. The length of the distal segment were slightly lower than the records of normal human bodys, the inner diameter of the distal segment were similar to the records of normal human bodys. Those indicate that both two HSG methods have stretched the length of the proximal segment of the uterine tube, but haven’t maken significant changes on the form of the uterine tubes. According to the result that HSG can stretch the lenth of proximal tube, we can distinguish the position of obstruction by measuring the length of the visible uterine tubes.Increase the pressure can promote the recanalization of isthmus in some proximal obstruction patients, but not effective in distal obstruction cases. The reasons perhaps due to the significantly increased adverse events when the pressure increases. Increasing pressure method can improve the recanalization rate of proximal obstruction, but the imaging amelioration to partial obstruction and peritubal adhesions is not obvious.Conclusions:(1)Gradually pressurized HSG is superior to the conventional method in the diagnosis and treatment of uterine tube obstructive infertility. The method is simple in operation and reduce the X-ray radiation, can obtain satisfactory image results.(2) High pressure method of HSG can significantly improve the recanalization rate of tubal obstruction, and for the proximal obstruction better than the distal obstruction. (3) High pressure method of HSG can improve the partial obstruction of uterine tube and peritubal adhesions. |
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