宫腔镜与诊断性刮宫在绝经后无症状子宫内膜增厚诊断价值中的比较  

Comparison of diagnostic value of hysteroscopy and diagnostic curettage in postmenopausal asymptomatic endometrial thickening

作　　者：李菁[1] 冯炜炜 龙雯晴[1] 陈慧[1] 沈育红[1] LI Jing;FENG Weiwei;LONG Wenqing;CHEN Hui;SHEN Yuhong(Department of Obstetrics and Gynecology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院妇产科,上海200025

出　　处：《中国医药科学》2020年第14期30-35,共6页China Medicine And Pharmacy

摘　　要：目的 本研究旨在回顾性分析相关临床病理资料,比较宫腔镜与诊断性刮宫在绝经后无症状子宫内膜增厚的诊断价值.方法 对2012年10月-2018年3月在上海交通大学医学院附属瑞金医院妇科就治的因体检发现子宫内膜增厚(经阴道超声检查子宫内膜厚度>5mm),无症状的364例绝经后妇女进行回顾性分析.将364例患者分为宫腔镜组229例与诊断性刮宫组135例,分析两组的病理检出率、临床意义和手术并发症等.结果 比较宫腔镜组和诊刮组的良性及恶性病变的病理检出率,宫腔镜组明显高于诊刮组(93.0%vs.13.3%,P<0.05).此外,32例先行诊刮,后行宫腔镜检查,提示诊刮对于子宫内膜癌/不典型增生的诊断误诊率为6.3%,漏诊率为3.1%.两组超声提示有或无宫腔占位者,病理类型分布显示差异无统计学意义(P>0.05).子宫穿孔的发生为3例(3/364),宫腔镜与诊断性刮宫的并发症发生率无统计学差异(0.7%vs.0.7%,P>0.05).诊刮细胞学阴性患者随访过程中,1例因术后半年出现绝经后出血、子宫内膜厚度增加,行子宫切除病理提示为子宫内膜腺癌.结论 绝经后无症状子宫内膜增厚患者,无论良性或恶性病变,宫腔镜下病理检查准确率均高于诊断性刮宫.超声影像学提示宫腔占位与否,与病理类型无关.诊刮细胞学阴性患者仍需严密随访.宫腔镜在诊断绝经后无症状子宫内膜增厚的价值高,诊断性刮宫无法取代.Objective To retrospectively analyze the relevant clinicopathological datato compare the diagnostic value of hysteroscopy and diagnostic curettage in postmenopausal asymptomatic endometrial thickening. Methods 364 asymptomatic postmenopausal women who were found to be with endometrial thickening(endometrial thickness > 5 mm by transvaginal ultrasound) by physical examination and treated in the gynecology departmentin Ruijin Hospital,Shanghai Jiaotong University School of Medicine from October 2012 to March 2018 were retrospectively analyzed and were divided into the hysteroscopy group(n=229) and the diagnostic curettage group(n=135). The pathological detection rate, clinical significance and surgical complications of the two groups were analyzed. Results The pathological detection rates for benign and malignant lesions in the hysteroscope group(93.0%) were higher than that in the diagnostic curettage group(13.3%)(P < 0.05). In addition, it was suggested by 32 cases treated with diagnostic curettage first and then with hysteroscopy that the misdiagnosis rate and omission diagnostic rate of diagnostic curettage for endometrial cancer/atypical hyperplasia were 6.3% and 3.1%, respectively. And it was suggested by ultrasound results of the two groups that the difference in the pathological type distribution with or without occupation disease in uterine cavity was statistically insignificant(P > 0.05). There were 3 cases withuterine perforation(3/364), and there was no significant difference in the complications incidence rate between the hysteroscopy group and the diagnostic curettage group(0.7% vs 0.7%, P > 0.05). During the follow-up of patients with negative curettagecytology, 1 case was performed hysterectomy due to postmenopausal hemorrhage and increased endometrial thickness half a year after operation, and was pathologically diagnosed as endometrial adenocarcinoma. Conclusion The accuracy rate of pathological examination under hysteroscope is higher than that of diagnostic curettage for benign or malignant lesi

关 键 词：绝经后 无症状 子宫内膜增厚 宫腔镜 诊断性刮宫 

分 类 号：R711.74[医药卫生—妇产科学]