Tubal faktör tanısında histerosalpingografi sonuçlarının laparoskopi sonuçları ile karşılaştırılması

Comparisons of hysterosalpingography and laparoscopy results in the diagnosis of tubal occlusion

Ümit GÖKTOLGA, Berfu DEMİR, Müberra KOÇAK, Yasemin TAŞÇI, Rafet DURAKER, Özgür AKKURT, Berna DİLBAZ

Özet

Amaç: Tubal faktör olgularında histerosalpingografi (HSG) ve laparoskopinin (L/S) uyumu ve infertilite etyolojisinde önemli yer tutan endometriozis hastalığının bulunma sıklığı araştırıldı. Gereç ve Yöntem: İnfertilite Kliniğinde 2006-2009 yılları arasında, HSG’de tubal faktör ön tanısı alan ve takiben L/S’ye alınan 139 hasta dahil edildi. HSG ve laparoskopi bulguları karşılaştırıldı. Ayrıca L/S’de endometriozis saptanan olguların tubal faktör varlığına göre dağılımı incelendi. Bulgular: Olguların ortalama yaşı 31.8±5.7, gravida 0 (0-5), infertilite süresi 30.7±3.7 ay, BMI 24.6±4.6 kg/m2 olarak bulundu. HSG’de unilateral tubal oklüzyon saptanan olguların % 38.8’de (n=38), bilateral tubal faktör saptanan olguların % 58.8’da (n=20) L/S’de tubal oklüzyon saptandı. HSG’de unilateral tubal oklüzyon saptanan olgularda tubal faktör bulunmama oranı bilateral tubal oklüzyon saptanan olgulara kıyasla anlamlı olarak fazla bulundu [(sırasıyla, % 61.2, % 51.2) (p: 0.001)]. L/S de tubal patoloji saptanmayan olgularda % 28.4 oranında endometriozis saptanırken, bu oran unilateral tubal faktör saptanan olgularda % 13.9, bilateral tubal faktör saptanan olgularda % 22.7 olarak bulundu. Gruplar arasında endometriozis insidansı bakımından fark bulunmadı (p=0.24). Sonuç: HSG infertil kadının değerlendirilmesinde ilk basamak tekniktir. Fakat, laparoskopi daha invaziv bir teknik olmasına rağmen, tubal tıkanıklıkları değerlendirmede gold standarttır.

Abstract

Objective: The compliance rate between the hysterosalpingography (HSG) and laparoscopy (L/S) results in patients who diagnosed tubal occlusion on the HSG was investigated. Also, the incidence of endometriosis was evaluated in the study population. Material and Methods: Medical records of 139 women who were underwent L/S for the investigation of the tubal occlusion were reviewed retrospectively. The concordance rate between the HSG and L/S was investigated. The incidence of endometriosis in patients with no tubal pathology was compared with patients with unilaterally and bilaterally tubal occlusion. Results: Mean age of the women was 31.8±5.7years, mean BMI was measured as 24.6±4.6 kg/m2, and gravida 0 (0-5), mean infertility period was 30.7±3.7 months. Tubal occlusion was confirmed after the L/S in 38.8% of the patients (n=38) who has unilaterally tubal occlusion on the HSG. However, 58.8% (n=20) of the patients who were diagnosed as bilaterally tubal occlusion on the HSG was confirmed with the L/S. The misdiagnosis rate of the HSG was significantly high in women with unilaterally tubal occlusions compared with bilaterally tubal occlusions [(respectively, 61.2%, 51.2%) (p: 0.001)]. Endometriosis was observed in 28.4% of the patients who had patent tubes and in 13.9% of the patients in the unilaterally tubal occlusion group and and in 22.7% of the patients in the bilaterally tubal occlusion group. But the difference was not statistically significant when groups were compared according to the rate of endometriosis (p=0.24). Conclusion: HSG is the first step diagnostic test for the assessment of the fallopian tubes. Although L/S is more invasive technique than HSG, L/S with chromopertubation is the gold standard test for identifying periadnexal adhesive disease and endometriosis.