经阴道超声 超声宫腔水造影及宫腔镜对子宫异常出血女性子宫内膜病变的诊断效能分析  

The diagnostic efficacy of transvaginal ultrasound,hydrohysterography and hysteroscopy in women with abnormal endometrial bleeding

作　　者：周可荷 何颖韬[1] 赵燕 张茜 陈方红[1] ZHOU Ke-he;HE Ying-tao;ZHAO Yan;ZHANG Qian;CHEN Fang-hong(Department of Ultrasound Medicined,Lishui Central Hospital,Lishui,Zhejiang 323000,China;不详)

机构地区：[1]丽水市中心医院超声医学科,浙江丽水323000 [2]丽水市中心医院妇产科

出　　处：《中国妇幼保健》2023年第21期4268-4271,共4页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2021ZH064)。

摘　　要：目的 探讨经阴道超声(TVS)、超声宫腔水造影(SIS)及宫腔镜对子宫异常出血(AUB)女性子宫内膜病变的诊断效能。方法 回顾性分析2018年5月—2020年8月在丽水市中心医院收治的80例AUB患者,并记录AUB的病因,所有参与者均接受TVS、SIS及宫腔镜诊断评估并记录检测结果,使用统计和数据科学软件(STATA)对数据进行了分析,并使用ROC曲线评估TVS和SIS相对于诊断性宫腔镜的灵敏度。结果 患者平均年龄(38.1±8.8)岁,范围为25~71岁,平均病程(6.37±0.75)月,70例(87.5%)患者处于绝经前年龄,59例有生育史,75.0%患者为农村居住人口,56例(70.0%)患者有经期出血,10例(12.5%)患者月经过少,7例(8.75%)闭经,4例(5.0%)月经大量出血,3例(3.75%)经前出血;TVS、SIS及宫腔镜诊断黏膜下肌瘤的发生率分别为17.5%、37.5%及40.0%,TVS、SIS及宫腔镜诊断子宫内膜息肉的发生率分别为15.0%、17.5%及17.5%。SIS的整体灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及诊断准确性分别为92.1%、83.3%、96.9%、62.5%及90.0%,而TVS分别为38.2%、100.0%、100.0%、22.2%及47.5%,SIS的灵敏度、NPV及准确性高于TVS,但TVS的特异度和PPV比SIS高;此外,TVS诊断子宫内膜息肉的灵敏度、特异度、PPV及NPV分别为75.0%、100.0%、100.0%及94.1%,SIS诊断子宫内膜息肉的灵敏度、特异度、PPV及NPV为100.0%、100.0%、100.0%及100.0%时表现更好。相较于TVS检测(38.2%、33.3%及75.0%),SIS对于患者子宫内膜正常、黏膜下肌瘤及子宫内膜息肉检测具有更高的灵敏度(94.1%、90.5%及100.0%),此外,虽然TVS在检测这3种病理学方面的特异度(100.0%)与SIS(100.0%)相当,但SIS的准确性更高。结论 SIS的诊断准确性高于TVS,并且显示出与宫腔镜检查相当的诊断准确性,用于资源贫乏地区的AUB妇女的临床诊断。Objective To explore the diagnostic efficacy of transvaginal ultrasound(TVS),saline infusion sonohysterography(SIS),and hysteroscopy in the evaluation of endometrial lesions in women with abnormal uterine bleeding(AUB).Methods A retrospective analysis was conducted on 80 AUB patients admitted to the Central Hospital of Lishui City from May 2018 to August 2020.The etiology of AUB was recorded,and all participants underwent TVS,SIS,and hysteroscopy for diagnostic evaluation.The results were recorded and analyzed using statistical and data science software(STATA).The sensitivity of TVS and SIS relative to diagnostic hysteroscopy was evaluated using ROC curves.Results The average age of the patients was(38.1±8.8) years old,ranging from 25 to 71 years.The average duration of the disease was(6.37±0.75) months.Seventy patients(87.5%) were premenopausal,and 59 patients had a history of childbirth.Seventy-five percent of the patients resided in rural areas.Fifty-six patients(70.0%) experienced menstrual bleeding,10 patients(12.5%) had hypomenorrhea,7 patients(8.75%) had amenorrhea,4 patients(5.0%) had menorrhagia,and 3 patients(3.75%) had premenstrual bleeding.The incidence of submucosal fibroids diagnosed by TVS,SIS,and hysteroscopy was 17.5%,37.5%,and 40.0%,respectively.The incidence of endometrial polyps diagnosed by TVS,SIS,and hysteroscopy was 15.0%,17.5%,and 17.5%,respectively.The overall sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and diagnostic accuracy of SIS were 92.1%,83.3%,96.9%,62.5%,and 90.0%,respectively,while those of TVS were 38.2%,100.0%,100.0%,22.2%,and 47.5%,respectively.SIS had higher sensitivity,NPV,and accuracy than TVS,but TVS had higher specificity and PPV than SIS.Furthermore,the sensitivity,specificity,PPV,and NPV of TVS in diagnosing endometrial polyps were 75.0%,100.0%,100.0%,and 94.1%,respectively,while those of SIS were 100.0%,100.0%,100.0%,and 100.0%,showing better performance.Compared to TVS(38.2%,33.3%,and 75.0%),SIS had higher sensitivity(94.1%

关 键 词：经阴道超声 超声宫腔水造影 宫腔镜 子宫内膜出血 子宫内膜病变 

分 类 号：R711.74[医药卫生—妇产科学]