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SUMMARY The tubai infertility usually results from the alteration due to the inflammation that affects the Fallopian tube and lor its relation in the way that will affect the transport of the egg, gametes or embryo, or alter the function of the tube at the site of fertilisation. In Cameroon 1 as in many other studies, the tubai factor is the first cause offeminine infertility 2,3,4. In the evaluation oftubai patency, the HSG these last years is count among the most propagated and the most efficient tubai investigations methods 5 , 6. His importance in the gynaecological practice cali for many talking points 7,8,9. By means of analytic, comparative and retrospective study, our principal objective is focused on the determination ofthe HSG value in the diagnosis ofthe tubai patency. Thus, we have enlisted 261 patients according to our inclusion conditions who had benefited a laparoscopy for infertility in obstetrical gynaecology service A of the YGH during the period from the first January 1994 to the 31 st December. 1998. These ones, in their pre-coelioscopical basic evaluation would have result from HSG. We have observed an age variation between 17 and 42 years with an average of 31 ± 5 years. The repartition considering the type of infertility has given 75 (28,7%) patients presenting a primary infertility and 186 (71,3%) a secondary infertility with p=0.005. The maximal duration of the infertility ofour patients is 24 years. The results ofHSG have been compared to those of laparoscopy considered as standard method. We have noticed for the determination of the HSG value in the tubai patency, the following parameters: proximal obstruction, distal obstruction, hydrosalpinx, pelvian adhesion and peri-tubai, endometriosis. For ail these parameters, we have calculated the sensibility, the specificity, the kappa value, and the positive and negative predictive values. We interested our self on the evaluation of the ideal date limit between the both exams. Our principal results are presenting as followed: In the case ofbilateral proximal tubai obstruction, we found: sensibility (Se) 62%, specificity (Sp) 95%, positive predictive value (PPV) 63 %, negative predictive value (NPV) 94%, Kappa value (K) 0.59(0.074). In the case of unilateral proximal tubai obstruction, we found: sensibility (Se) 26%, specificity (Sp) not determined, positive predictive value (PPV) 100 %, negative predictive value (NPV) not determined, Kappa value (K) not determined 17
In the case of bilateral distal tubaI obstruction, we fOllnd: sensibility (Se) 42%, specificity (Sp) 97%, positive predictive value (PPV) 85 0/0, negative predictive value (NPV) 79%, Kappa value (K) 0.45(0.06). In the case of unilateral distal tubaI obstruction, we found: sensibility (Se) 390/0, specificity (Sp) 87%, positive predictive value (PPV) 48 %, negative predictive value (NPV) 820/0, Kappa value (K) 0.28(0.069). In the case of bilateral hydrosalpinx, we found: sensibility (Se) 700/0, specificity (Sp) 890/0, positive predictive value (PPV) 77%, negative predictive value (NPV) 85%, Kappa value (K) 0.06(0.053). In the case of unilateral hydrosalpinx, we found: sensibility (Se) 59%, specificity (Sp) 88%, positive predictive value (PPV) 60%, negative predictive value (NPV) 88%, Kappa value (K) 0.47(0.064). In the case of adherence, we found: sensibility (Se) 29%, specificity (Sp) 68%, positive predictive value (PPV) 76 % , negative predictive value (NPV) 22%, Kappa value (K) -0.02(0.039). In the case of endometriosis, we found: sensibility (Se) 9%, specificity (Sp) 98%, positive predictive value (PPV) 140/0, negative predictive value (NPV) 96%, Kappa value (K) 0.08(0.104). HSG and laparoscopie findings in diagnosis oftubaI patency were concordant in 83.90/0. The most concordant findings were observed when the date-limit between the two methods was less or equals to 5 weeks. Finally, we notice that the HSG determinate considerably the llnpatency according to his high specificity in general. The bilateral hydrosalpinx diagnosed by HSG is not refutable. For bilateral proximal tubaI obstruction the diagnostic is dubitative. The HSG will be on a limit utility for the determination of parameters like the OTDB, the OTDU, and unilateral hydrosalpinx. The determination ofthe adhesions is nulle The HSG made in an ideal time (inferior or equals to 5 weeks, according to our study) before laparoscopy will more approached to the tubaI state. We suggest that: although HSG should be the method of choice as part of the basic evaluation, an infertile woman should undergo laparoscopy before the evaluation is considered complete or final. The best date-limit betweel1 HSG and laparoscopy should be respected. 17
Page 4 and 5: Staffof the Faculty of Medicine and
Page 9 and 10: 20. NGOWE NGOWE Marcelin 21. NJAMNS
Page 11 and 12: TABLE DES MATIERES
Page 13 and 14: VII CONCLUSION ET RECOMMANDATIONS 7
Page 15 and 16: TABLE DES ILLUSTRATIONS Figure V-1
Page 17 and 18: RESUME - SUMMARY
Page 19: Dans le cas de obstruction tubaire
Page 23 and 24: 1 INTRODUCTION Du fait de leur fonc
Page 25 and 26: II OBJECTIFS
Page 27 and 28: III REVUE DE LA LITTERATURE
Page 29 and 30: L'ampoule constitue la portion la p
Page 31 and 32: définitives de l'endomètre et des
Page 33 and 34: Actuelle (leucorrhée, glaire purul
Page 35 and 36: Les clichés sont exécutés au sé
Page 37 and 38: C'est celui qui expose le mieux la
Page 39 and 40: 111.4.2.2 Organes vus à la coelios
Page 41 and 42: • LA PREPARATION DIGESTIVE L'obje
Page 43 and 44: débit d'emblée d'un litre par min
Page 45 and 46: opératoires en cœliochirurgie et
Page 47 and 48: 111.4.3 L'ECHOGRAPHIE 66 111.4.3.1
Page 49: IV MATERIEL ET METHODE
Page 52: Cœlioscopie HSG Oui NON TOTAL OUI
Page 56: Moyenne ± écart-type = 31 ± 5 Qu
Page 59: Concernant la répartition suivant
Page 63 and 64: Tableau V-4 : Antécédents gynéco
Page 66 and 67: Tableau V-8 : Résultats de l'HSG p
Page 69 and 70: Tableau V-IO : Concordance du diagn
Page 71 and 72:
Tableau V-Il : Concordance du diagn
Page 73 and 74:
Tableau V-12 : Concordance du diagn
Page 75 and 76:
VI DISCUSSION
Page 77:
supposons qu'il existerait un rappo
Page 81:
VII CONCLUSION ET RECOMMANDATIONS A
Page 85 and 86:
Utilisation de stérilet :__ (1 ==O
Page 87 and 88:
4- Procédures diagnostiques étudi
Page 89 and 90:
PID S.auréus S.B S. epidermitis S.
Page 91 and 92:
IX RENVOI BIBLIOGRAPHIQUE 1 Nasah B
Page 93 and 94:
30 Op. Cit. 25 31 Op. Cit. 6 32 Op.
Page 95 and 96:
70 Fleiss JL. Statistical methods f
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