目的：采用经阴道四维子宫输卵管超声造影（transvaginal four-dimensional hysterosalpingo-contrast sonography,TVS 4D-HyCoSy）检查不孕症患者的输卵管通畅性,观察TVS 4D-HyCoSy的诊断效能,并进行误诊分析。方法：对52例女性不孕症患者共97条输卵管行TVS 4D-HyCoSy检查,评价输卵管通畅性,并按照结果分将其分为阻塞组和非阻塞组（包含通畅和通而不畅）,以美蓝通液术结果为金标准进行对照分析。结果：97条输卵管行TVS 4D-HyCoSy检查显示34条通畅,28条通而不畅,35条阻塞,与美蓝通液术结果比较,83条符合,14条不符合,其中导致假阳性结果的主要原因为盆腔术后（3/3）、伴盆腔子宫内膜异位及输卵管痉挛等;导致假阴性结果的原因包括对侧输卵管通畅对比剂弥散至患侧、输卵管远端积水、膨大被误认为对比剂弥散及对比剂逆流。TVS 4D-HyCoSy检查诊断输卵管通畅性的灵敏度为78.4%（29/37）,特异度为90.0%（54/60）,阳性预测值为82.9%（29/35）,阴性预测值87.1%为（54/62）。结论：TVS 4D-HyCoSy检查是评价输卵管通畅性的有效方法,而对于有盆腔手术史的患者,尤其应该注意可能出现的假阳性结果,必要时需要进行第二次造影。
Objective: To assess the diagnostic efficiency of transvaginal ultrasound four-dimensional contrast hysterosalpingography (TVS 4D-HyCoSy) in evaluation of fallopian tube patency and analyze the misdiagnosed cases. Methods: Fifty two infertile patients (97 fallopian tubes) underwent TVS 4D-HyCoSy and fallopian tube patency was assessed. The results were divided into obstructed and unobstructed groups (consisting of fully unobstructed and partially obstructed). The results of laparoscopic methylene blue test were used as the golden standard. The results were compared and contrasted with that of laparoscopic methyl blue test. Results: Among the 97 fallopian tubes, TVS 4D-HyCoSy showed 34 unobstructed tubes, 28 partially obstructed tubes, 35 obstructed tubes, resulting in a consistency of 83 tubes and inconsistency of 14 tubes with the findings of laparoscopic methylene blue test. The factors in false positive results included pelvic surgery, endometriosis of pelvis and tubal spasm, and for false negative results included the contrast agent in the unobstructed fallopian tubes diffusing into the diseased side, distal fallopian hydrops and expansion being mistaken for contrast agent diffusion and contrast agent reflux. The sensitivity, specificity, positive predictive value and negative predictive value of TVS 4D-HyCoSy were 78.4%(29/37), 90.0%(54/60), 82.9%（29/35）, 87.1%（54/62）, respectively. Conclusions: TVS 4D-HyCoSy is an effective method for evaluating the fallopian tube patency. If the above-mentioned factors in misdiagnosed cases occur, objective analysis should be conducted to distinguish the false positive and false negative ones. False positive result should be aware of when there is a history of pelvic surgery. Second time contrast imaging could be done if needed.
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