探讨阴道超声与宫腔镜对绝经后子宫出血的诊断价值  

作　　者：贺芝英[1] 

机构地区：[1]广东省东莞市厚街医院妇产科,511711

出　　处：《当代医学》2013年第8期34-35,共2页Contemporary Medicine

摘　　要：目的探讨阴道超声及宫腔镜检查对绝经后子宫出血的临床诊断价值。方法选取146例因绝经后子宫出血就诊的患者作为研究对象,入院后先行阴道超声检查,然后行宫腔镜检查并且取异常子宫内膜做病理检查,以病理检查结果为最终诊断,比较阴道超声检查及宫腔镜检查诊断绝经后子宫出血的敏感性及阳性预测值。结果 (1)病理检查结果显示:146例中子宫内膜非特异性病变有74例(50.69%),其中阴道超声检出57例,宫腔镜检出70例;子宫内膜息肉有20例(13.70%),其中阴道超声检出13例,宫腔镜检出18例;子宫内膜增殖症28例(19.18%),其中阴道超声检出11例,宫腔镜检出26例;子宫粘膜下肌瘤16例(10.96%),其中阴道超声检出14例,宫腔镜检出11例;子宫内膜癌8例(5.48%),其中阴道超声检出4例,宫腔镜检出6例。(2)在子宫内膜非特异性病变、子宫内膜增殖症诊断方面,宫腔镜检查敏感性(分别为94.59%,92.86%)明显高于阴道超声(分别为77.03%,39.29%)(P<0.05);在子宫内膜非特异性病变、子宫内膜息肉、子宫粘膜下肌瘤、子宫内膜癌诊断方面,宫腔镜检查阳性预测值(分别为93.33%,81.82%,92.86%,100.00%)明显高于阴道超声(分别为75.00%,54.17%,63.64%,44.44%()P<0.05)。结论阴道超声检查在绝经后子宫出血时可以作为初步筛查方法,宫腔镜检查相对灵敏度及阳性预测值更高一些,并且同时能取子宫内膜进行病理检查,因此可以作为进一步检查的重要手段。Objective To investigate the clinical effect and value of transvaginal sonography and hysteroscopy in the diagnosis of uterine bleeding after menopause.Methods 146 cases with postmenopausal bleeding were studied. All patients were examined by vaginal ultrasound and hysteroscopy after admission. The histopathology provides the final diagnosis. The sensitivity and the positive predictive value of the two methods were compared. Results （1） In all patients, pathologic diagnosis of endometrial nonspecific lesions 74 cases （50.69%）, with ultrasound diagnosis of 57 cases and hysteroscopy diagnosis of 70 cases; pathologic diagnosis of endometrial polyps 20 cases（13.70%）, with ultrasound diagnosis of 13 cases and hysteroscopy diagnosis of 18 cases; pathologic diagnosis of endometrial hyperplasia 28 cases（19.18%）, with ultrasound diagnosis of 11 cases and hysteroscopy diagnosis of 26 cases;pathologic diagnosis of submucous myoma 16 cases （10.96%）, with ultrasound diagnosis of 14 cases and hysteroscopy diagnosis of 11 cases; pathologic diagnosis of endometrial cancer 8 cases（5.48%）, with ultrasound diagnosis of 4 cases and hysteroscopy diagnosis of 6 cases. （2） The sensitivities of hysteroscopy on the diagnosis of endometrial nonspecific lesions（94.59%） and endometrial hyperplasia（92.86%） were significantly higher than that of vaginal ultrasound（77.03% and 39.29%）（P0.05）; The positive predictive values of hysteroscopy on the diagnosis of endometrial nonspecific lesions（93.33%）, endometrial polyps（81.82%）, submucous myoma（92.86%）, endometrial cancer（100.00%） were significantly higher than that of vaginal ultrasound（75.00%,54.17%,63.64%,44.44%）（P0.05）. Conclusion Vaginal ultrasound examination is a preliminary screening method for patients of postmenopausal uterus bleeding. And hysteroscopy with biopsy can be used as a further check method, for its high sensitivity and positive predictive value compared to transvaginal ultrasonography.

关 键 词：子宫出血 阴道超声 宫腔镜 绝经 

分 类 号：R711.75[医药卫生—妇产科学]