阴道超声和宫腔镜在诊断绝经后子宫出血中的应用  

Clinical use of transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding

作　　者：刘崇东[1] 张震宇[1] 郭淑丽[1] 王淑珍[1] 李琳[1] 

机构地区：[1]首都医科大学附属北京朝阳医院妇产科,北京100020

出　　处：《中国实验诊断学》2004年第4期425-428,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的　比较阴道超声和宫腔镜检查在诊断绝经后子宫出血中的应用。方法　回顾性分析 2 0 0 0年 1月至2 0 0 3年 12月来我院行阴道超声和宫腔镜检查的绝经后阴道出血妇女 6 3例。全部在宫腔镜检查后刮取子宫内膜送病理检查。结果　组织取样不足 2例 (3 1% ) ;萎缩子宫内膜 18例 (2 8 5 7% ) ;正常子宫内膜 4例 (14 2 9% ) ;子宫内膜炎1例 (1 5 9% ) ;子宫内膜息肉 11例 (17 4 6 % ) ;子宫粘膜下肌瘤 9例 (14 2 9% ) ;子宫内膜单纯增生 3例 (4 76 % ) ;子宫内膜非典型增生 2例 (3 17% ) ;子宫内膜癌 13例 (2 0 6 3% )。阴道超声诊断子宫内膜癌的敏感性为 6 9 2 3% ,特异性为88% ,阳性预测值为 6 0 % ,阴性预测值为 91 6 7% ;宫腔镜诊断子宫内膜癌的敏感性为 76 92 % ,特异性为 98% ,阳性预测值为 90 91% ,阴性预测值为 94 2 3% ;二者联合诊断子宫内膜癌的敏感性为 10 0 % ,特异性为 89 7% ,阳性预测值为92 3% ,阴性预测值为 10 0 %。阴道超声诊断子宫内膜病变的敏感性为 94 2 9% ,特异性为 39 2 8% ,阳性预测值为6 6 % ,阴性预测值为 84 6 2 % ;宫腔镜诊断子宫内膜病变的敏感性为 94 2 9% ,特异性为 92 86 % ,阳性预测值为94 2 9% ,阴性预测值为 92 86 % ;二者联合诊断子宫内膜病变的敏感性?Objective To determine(compare) the diagnostic value of transvaginal ultrasonography and hysteroscopy in patients with postmenopausal bleeding. Methods Between January, 2000 and December, 2003, 63 women with postmenopausal bleeding were enrolled in a retrospective study. They underwent transvaginal ultrasonography and hysteroscopy, and were submitted to biopsy after hysteroscopy. Results Among 63 women enrolled, the histological findings were scanty material in 2(3 17%), atrophy in 18(28 57%), normal endometrium in 4(6 35%), endometritis in 1(1 59%), polyps in 11(17 46%), leiomyoma in 9(14 29%), non atypical hyperplasia in 3(4 76%), atypical hyperplasia in 2(3 17%), and endometrial carcinoma in 13 cases(20 76%). For the assessment of endometrial carcinoma, vaginal ultrasonography revealed sensitivity 69 23%, specificity 88%, positive predictive value 60%, negative predictive value 91 67%; and hysteroscopy revealed sensitivity 76 92%, specificity 98%, positive predictive value 90 91%, negative predictive value 94 23; and the combination of transvaginal ultrasonography and hysteroscopy revealed sensitivity 100%, specificity 89 7%, positive predictive value 92 3%, negative predictive value 100%. Conclusion Transvaginal ultrasonography was useful screening tests for postmenopausal bleeding women. The combination of transvaginal ultrasonography and hysteroscopy was a superior diagnostive procedure for the women with endometrial thickness equal of more than 4 mm.

关 键 词：阴道超声 宫腔镜 绝经后子宫出血 

分 类 号：R711[医药卫生—妇产科学]