宫腔镜在子宫腺肌病合并不孕妇女子宫内膜病变诊断中的价值  

Value of Hysteroscopy in Diagnosis of Endometrial Lesions in Women with Adenomyosis and Infertility

作　　者：潘宁宁[1] 马彩虹[1] 宋雪凌[1] 杜晓果[1] 杨艳[1] 庞天舒[1] 

机构地区：[1]北京大学第三医院生殖医学中心,北京100083

出　　处：《中国微创外科杂志》2017年第5期385-387,392,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：国家科技支撑计划(2014BAI05B03)

摘　　要：目的探讨宫腔镜在筛查子宫腺肌病合并不孕妇女子宫内膜病变中的价值。方法 2013年1月~2015年12月因子宫腺肌病合并不孕行宫腔镜检查的573例患者为子宫腺肌病组,因输卵管因素不孕行宫腔镜检查的856例患者为对照组。回顾性分析2组临床资料和宫腔镜检查结果。结果子宫腺肌病组宫腔镜检查发现子宫内膜或宫腔异常的占44.7%(256/573,包括子宫内膜息肉141例,慢性子宫内膜炎77例,宫腔粘连38例),对照组为33.6%(288/856,包括子宫内膜息肉135例,慢性子宫内膜炎96例,宫腔粘连57例),2组间差异有统计学意义(χ~2=11.719,P=0.000)。子宫腺肌病组中子宫内膜息肉患者显著多于对照组[24.6%(141/573)vs.15.8%(135/856),χ~2=17.197,P=0.000]。子宫腺肌病组术前超声检查未发现子宫内膜异常者中39.2%(175/446)宫腔镜检查有异常发现,其中子宫内膜息肉20.2%(90/446)。子宫腺肌病组术前曾行子宫内膜活检病理检查未见异常而胚胎移植失败者中26.3%(26/99)宫腔镜检查发现存在子宫内膜病变。结论子宫腺肌病合并不孕妇女需重视子宫内膜的异常,尤其是子宫内膜息肉。宫腔镜直观、准确,并同时可进行治疗。Objective To investigate the value of hysteroscopy in screening of endometrial lesions in women with adenomyosis and infertility. Methods We selected 573 patients with adenomyosis and infertility undergoing hysteroscopy from January 2013 to December 2015 as adenomyosis group. And another group of 856 patients with fubal infertility undergoing hysteroscopy were enrolled as control group. Then we analyzed the clinical data and the results of hysteroscopy of the patients retrospectively. Results Endometrial or intrauterine lesions were found in 44. 7% of the cases （256/573） under hysteroscopy in the adenomyosis group （ including 141 cases of endometrial polyps, 77 cases of chronic endometritis and 38 cases of intrauterine adhesion） , as well as 33.6% of the cases （288/856） in the control group （ including 135 cases of endometrial polyps, 96 cases of chronic endometritis and 57 cases of intrauterine adhesion） , with statistically significant difference （X2 = 11. 719, P = 0. 000）. In the adenomyosis group, the positive rate of endometrial polyps was significantly higher than that in the control group [24.6% （141/573） vs. 15.8% （135/856） , X2 = 17. 197, P =0.000]. Endometrial or intrauterian lesions were found in 39.2% （175/446） of the cases in the adenomyosis group under hysteroscopy, whose ultrasonic examination did not find abnormal endometrial echo and lesions. And endometrial polyps accounted for 20.2% （90/446） in the group. In the cases of patients who failed to detect an abnormal endometrial biopsy prior to embryo transfer, 26. 3% （26/99） had endometrial lesions diagnosed by hystertoscopy after undergoing embryo transfer failure. Conclusions Endometrial lesions, especially endometrial polyps, need to be noticed in patients with adenomyosis and infertility. Hysteroscopy is intuitive and accurate, and can be utilized to deal with the lesions at the same time.

关 键 词：子宫腺肌病 不孕症 宫腔镜 子宫内膜息肉 

分 类 号：R711.6[医药卫生—妇产科学] R711.71[医药卫生—临床医学]