宫腔镜在诊断绝经后子宫内膜病变中的应用价值  

Diagnostic Value of Hysteroscopy for Endometrial Lesions in Postmenopausal Women

作　　者：欧阳珊[1] 赵良平[1] 张淳[1] 张庆华[1] 

机构地区：[1]武汉市中心医院妇产科,武汉430014

出　　处：《华中科技大学学报（医学版）》2014年第3期356-358,363,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探讨宫腔镜在诊断绝经后子宫内膜病变中的应用价值。方法选择2012年3月～2013年11月在武汉市中心医院就诊的绝经后阴道出血或超声提示子宫内膜增厚或宫腔内异常回声的患者共160例。其中80例行宫腔镜检查及治疗，80例行诊刮术。对比分析两组子宫内膜病变的诊断结果差异。结果①与诊刮组相比，宫腔镜组具有更高的病变组织检出率，两组差异有显著性意义（Х^2=4．266，P=0．045）。②宫腔镜组在诊断子宫内膜息肉、子宫黏膜下肌瘤中与诊刮组相比有更高的检出率，差异有统计学意义（Х^2=20．364，P=0．000，Х^2=25．872，P=0．000）。③对于子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜增生、子宫内膜癌的诊断敏感度、特异度、阳性预测值、阴性预测值等指标，宫腔镜组也高于诊刮组。结论宫腔镜能直视官腔内病变，定点取材，诊断准确率高，是绝经后子宫内膜病变的首选诊断方法。Objective To examine the application of hysteroscopy in the diagnosis of endometrial lesion in postmenopausal women. Methods A total of 160 patients who were diagnosed with postmenopausal bleeding or had thickened endometrium （≥ 5 mm） or abnormal uterine images on ultrasound in Wuhan Central Hospital between March 2012 and November 2013 were en- rolled. Hysteroscopy and endometrial biopsy were performed in 80 patients, and the diagnostic curettage in another 80 patients. The diagnostic outcomes were compared between the two groups. Results ①The hysteroscopy ＆. biopsy had greater diagnostic accuracy than diagnostic curettage in terms of endometrial lesions （Х^2= 4. 266, P= 0. 045）. （2）Hysteroscopy biopsy was superior to diagnostic curettage in diagnosis of endometrial polyps and submucosal myoma and there was significant difference between the two groups （ Х^2 = 20. 364, P = 0. 000 ; Х^2 = 25. 872, P = 0. 000）. ③ The diagnostic sensitivity and specificity, positive predicative value and negative predicative value were higher in the hysteroscopy group than in diagnostic curettage group in terms of endometrial polyps,submucosal myoma,endometrial hyperplasia and endometrial cancer. Conclusion H yste- roscopy is the diagnostic tool of choice in the evaluation of the endometrial lesions in postmenopausal women as it can visualize the endometrial lesions and obtain a sample at a specific location,and it has a high diagnostic accuracy.

关 键 词：绝经后妇女 子宫内膜病变 宫腔镜检查 诊断 

分 类 号：R711[医药卫生—妇产科学]