原发不孕症患者超液化碘油子宫输卵管造影不同时间行延迟片拍摄后结果的比较分析OA

Objective To evaluate the clinical value of delayed radiography at different time points after hysterosalpingography(HSG)using lipiodol ultra-fluide in patients with primary infertility.Methods A total of 200 patients with infertility admitted to Guangzhou Women and Children's Medical Center Liuzhou Hospital from July 2023 to February 2025 were included.The research team clearly informed the patients of the advantages and disadvantages of the two contrast agents.Patients voluntarily chose the type of contrast agent based on informed consent,adhering to the principle of voluntary selection.According to the contrast agent type,patients were divided into a control group and an experimental group,with 100 cases in each group.The experimental group underwent HSG with lipiodol ultra-fluide,while the control group received a water-soluble contrast agent(iopromide 320).In the experimental group,delayed radiography was performed at 4h,6h,and 24h post-procedure.Gwet's ACI was used to assess the agreement between the diagnostic results of tubal patency and uterine cavity morphology at 4h and 6h compared with the 24h reference.Linearized analysis was used to compare the differences in agreement coefficients between the two time points.Receiver operating characteristic(ROC)curves were applied to evaluate the diagnostic performance of delayed radiography at 4h and 6h for tubal patency and pelvic adhesions.In the control group,pelvic review radiographs were taken 15-30 minutes post-procedure.Adverse reactions were recorded in both groups.Results In the experimental group,the 24h post-procedure diagnosis identified 17 cases with tubal patency grade 0,20 cases with grade 1,28 cases with grade 2A,and 35 cases with grade 2B.The diagnostic consistency between the 4h and 24h delayed radiography for tubal patency demonstrated high agreement(Gwet's ACI=0.71,P<0.001)with good diagnostic performance[area under the curve(AUC):0.790-0.870].The 6h delayed radiography showed even higher agreement with the 24h results(Gwet's ACI=0.77,P<0.001)and excellent diagnostic performance(AUC:0.951-0.986).Regarding uterine cavity morphology,the 24h post-procedure diagnosis in the experimental group identified 75 cases with uterine cavity adhesion grade 0,11 cases with grade 1,6 cases with grade 2,and 8 cases with grade 3.Agreement between the 4h and 24h results was poor(Gwet's ACI=0.58,P<0.001)with limited diagnostic ability(AUC:0.614-0.800),while the 6h delayed radiography showed high agreement(Gwet's ACI=0.89,P<0.001)and good diagnostic performance(AUC:0.812-0.953).Visual analogue scale(VAS)scores during the procedure and at 0.5h post-procedure were significantly lower in the experimental group compared with the control group(t=-24.688 and-65.280,respectively,P<0.05).There was no statistically significant difference in the incidence of vaginal bleeding at 0.5 hours post-procedure between the two groups(P>0.05).Conclusion Delayed radiography performed 6h after HSG with lipiodol ultra-fluide shows strong agreement with 24h findings in evaluating tubal patency and uterine cavity morphology.Combined with lower pain scores and favorable safety,this approach demonstrates good clinical feasibility.