阴道超声与宫腔镜对围绝经期异常子宫出血诊断效能比较  

Comparison of efficacy of transvaginal ultrasound and hysteroscopy for diagnosing perimenopausal abnormal uterine bleeding

作　　者：袁焙烽 项越芬 YUAN Beifeng;XIANG Yuefen(Wenling Dongfang Hospital,Zhejiang Province,317525)

机构地区：[1]温岭东方医院,317525

出　　处：《中国计划生育学杂志》2022年第4期882-886,共5页Chinese Journal of Family Planning

摘　　要：目的:评价阴道超声与宫腔镜对围绝经期异常子宫出血的诊断价值。方法:回顾性选取本院2018年1月-2020年1月收治的围绝经期异常子宫出血患者175例,均行阴道超声与宫腔镜检测,具备明确病理诊断结果。采用配对设计方式,运用McNemar检验分析两种检测与病理诊断差异性,Kappa检验检测一致性;计算两种检测诊断效能。结果:对围绝经期异常子宫出血诊断阴道超声检测与病理诊断有差异(P<0.05),Kappa值为0.409,一致性较差;宫腔镜与病理诊断无差异(P>0.05),Kappa值为0.844,具一定诊断一致性;阴道超声联合宫腔镜诊断Kappa值为0.931,检验效能提升。阴道超声对围绝经期异常子宫出血检测的灵敏度和阳性预测值分别为84.6%和93.3%;特异度与阴性预测值分别为65.4%和42.5%;宫腔镜灵敏度与阳性预测值>98%,特异性与阴性预测值>85%;联合诊断效能提升,灵敏度、特异度、阳性预测值和阴性预测值分别为98.7%、92.3%、99.3%和96.0%。检测病因符合率,宫腔镜在对子宫内膜恶变与不典型增生、无排卵性宫血、子宫内膜局部异常及其它因素引起的诊断效能高于阴道超声(P<0.05)。子宫内膜厚度<4mm时,两种检测对子宫内膜病变病因检出力无差异,>4mm时宫腔镜对子宫内膜局部异常和子宫内膜生理性改变的检测力优势体现。结论:阴道超声对围绝经期异常子宫出血有一定诊断价值,尤其对子宫形态大小的检测具优势;但与金标准相比仍存在差异,一致性较差,特异度与阴性预测值偏低。宫腔镜检测价值相对较高,与病理诊断一致性较好,尤其对子宫内膜恶变与不典型增生等病因诊断符合率高于阴道超声,对子宫内膜厚度>4mm的内膜局部异常和生理性改变检出率更高;联合诊断可提高检测准确性,提示临床可根据患者病情等因素,酌情增加阴道超声或宫腔镜检测。Objective:To evaluate the values of transvaginal ultrasound and hysteroscopy for diagnosing perimenopausal abnormal uterine bleeding.Methods:A retrospective survey was conducted in 175patients with perimenopausal abnormal uterine bleeding from January 2018to January 2020.These patients were all given examinations by transvaginal ultrasound and hysteroscopy,and all these patients had the pathological diagnosis results.Paired design and McNemar test were used to analyze the difference between the examinations by transvaginal ultrasound and hysteroscopy and the pathological diagnosis results.Kappa test was performed to analyze the detection consistency of pathogenesis.The diagnostic efficacies of transvaginal ultrasound and hysteroscopy were calculated.Results:There was significant difference in diagnosing the abnormal perimenopausal uterine bleeding between vaginal ultrasonography and pathological diagnosis(P<0.05),which Kappa value was 0.409,with poor diagnostic consistency.There was no significant difference in diagnosing the abnormal perimenopausal uterine bleeding between hysteroscopy diagnosis and pathological diagnosis(P<0.05),which Kappa value was 0.844,with certain diagnostic poor consistency.The Kappa value of vaginal ultrasound combined with hysteroscopy for diagnosing the abnormal perimenopausal uterine bleeding was 0.931,and which efficiency had increased significantly.The sensitivity,the positive predictive value,the specificity,and the negative predictive value of transvaginal ultrasound for detecting abnormal perimenopausal uterine bleeding were 84.6%,93.3%,65.4%,and 42.5%,respectively.The sensitivity and the positive predictive value of hysteroscopic for detecting abnormal perimenopausal uterine bleeding were over 98%,and the specificity and the negative predictive value of which were over 85%.The sensitivity,the specificity,the positive predictive value,and the negative predictive value of transvaginal ultrasound combined with hysteroscopic for detecting abnormal perimenopausal uterine bleeding wer

关 键 词：围绝经期子宫异常出血 阴道超声 宫腔镜 病理 病因 内膜厚度 诊断价值 

分 类 号：R711.52[医药卫生—妇产科学] R711.75[医药卫生—临床医学]