恶性风险模型和经阴道彩色多普勒超声预测绝经后阴道流血子宫内膜癌的价值  

The risk assessment of endometrial cancer in postmenopausal women presenting with aginal bleeding by transvaginal color doppler ultrasound and the malignant risk model

作　　者：陈铃[1] 梁齐桁[2] 孙鹏涛[3] 赵娴[3] 

机构地区：[1]广东省中医院,超声诊断科,广东广州510120 [2]广东省中医院妇科,广东广州510120 [3]广东省中医院超声诊断科,广东广州510120

出　　处：《中国实用妇科与产科杂志》2014年第4期285-288,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨恶性风险模型及经阴道彩色多普勒超声(transvaginal color doppler ultrasound,TVCDU)预测绝经后阴道流血患者子宫内膜良恶性病变的临床价值。方法以2010年3月至2012年2月在广东省中医院因绝经后阴道流血而入院的112例患者为研究对象,其中恶性病变33例,良性病变79例。以糖尿病、经阴道超声测量的子宫内膜厚度、反复阴道出血、年龄和体重指数5种高危因素建立恶性风险模型;同时行TVCDU检查。结果子宫内膜癌与子宫内膜良性病变组内膜厚度比较差异有统计学意义(t=6.0,P<0.0001)。TVCDU预测子宫内膜癌的敏感性为74.4%,特异性为94.5%。经阴道彩超提示子宫内膜癌肌层浸润82.8%(24/29),肌层浸润深度70.8%(17/24)。以恶性风险模型评分≥4分为界值,恶性风险模型预测子宫内膜恶性病变的敏感性为84.9%,特异性为80.0%。恶性风险模型联合TVCDU对子宫内膜癌的诊断率为100%。结论恶性风险模型是预测子宫内膜恶性病变的良好临床指标;TVCDU是术前诊断子宫内膜癌、判断子宫内膜癌肌层浸润深度及决策预后的重要检查方法;联合两者有助于避免对绝经后阴道出血患者的过度手术和治疗。Objective To evaluate the prediction value of endometrial benign and malignant lesions in postmenopausal women presenting with aginal bleeding by clinical prediction model based on patients＇characteristics and transvaginal color doppler ultrasound. Methods 112 cases of postmenopausal vaginal bleeding women admitted to Guangdong Hospital of Traditional Chinese Medicine as the research object between March 2010 and February 2012,33 cases were malignant, 79 cases were benign. The malignant risk model was based on diabetes, endometrial thickness measurement on transvaginal ultrasound, frequency vaginal bleeding, age and body mass index. At the same time the vaginal color doppler ultrasound was observed. Results The endometrial thickness of endometrial carcinoma and endometrial benign lesions has signifi- cant difference （t = 6. 0,P 〈 0. 0001 ）. The sensitiity, specifitciy of transnational color doppler ultrasound in the predic- tion of endometrial cancer 74. 4% ,94. 5%. The diagnostic accuracy of TVCDU in evaluation of the myometrial infiltration and the depth of myometrial infiltration were 82. 8% （24/29）and 70. 8% （17/24）, respectively. For the malignant risk model cut-off score equal to or greater than 4, the sensitivity, specificity in the prediction of endometrial malignant were 84. 9% , 80. 0%. 29 cases predicting the high risk in endometrial cancer by the malignant risk model, the diagnostic ac- curacy of endometrial cancer was 100% combined color doppler ultrasonography. Conclusion The malignant risk model is the good clinical indicator to predict the endometrium malignant lesions. Transnational color doppler uhrasonography is important method in preoperative diagnosis of endometrial cancer, the prediction for the myometrial infiltration and the depth of myometrial invasion of the endometrial carcinoma, and prognosis. Combined the two methods helps to avoid ex- cessive surgery and treatment in postmenopausal women presenting with aginal bleeding.

关 键 词：绝经后阴道出血 恶性风险模型 经阴道彩色多普勒超声 子宫内膜癌 

分 类 号：R737.3[医药卫生—肿瘤]