宫腔镜及B超联合诊治绝经后出血的临床价值

Clinical value of hysteroscopy and ultrasonography in women with postmenopausal bleeding

目的：探讨宫腔镜及B超联合诊治技术对于绝经后出血患者的临床价值。方法：对我科2000年2月-2005年8月收治的167例绝经后出血患者进行了宫腔镜及B超联合诊治。所有患者均先进行B超检查，之后行宫腔镜诊治，必要时辅以B超引导监护。结果：167例中84例内膜厚度〈5mm，5—10mm者64例，〉10mm者19例；同时提示宫腔内病变者12例。出血的病因依次为子宫内膜炎54例（32．3％）、子宫粘膜下肌瘤38例（22．8％）、子宫内膜息肉32例（19．2％）、子宫内膜癌22例（13．2％）、子宫内膜增生11例（6．6％）、宫颈息肉6例（3．6％），其它4例（2．3％）。保守治疗11例，化疗1例，31例同时进行了宫腔镜下治疗，99例实施宫腔镜电切手术，25例开腹手术，病理学诊断总的符合率为80．8％。结论：宫腔镜检查联合B超应作为绝经后出血患者的首选，内膜厚度〈5mm者应慎行刮宫术。宫腔镜联合B超进行宫腔内病变治疗及电切手术对于老年宫腔内良性疾患的治疗具有重要临床价值。

Objective： To evaluate the clinical value of hysteroscopy and ultrasonography on patients with postmenopausal bleeding. Methods：One hundred and sixty-seven patients with postmenopausal bleeding from Feb 2000 to Aug 2005 were examined by ultrasonography first, followed examined and treated by hysteroscopy under the ultrasonographic monitoring. Results： Of the one hundred and sixty-seven cases, eighty four had an endometrial thickness 〈 5mm,sixty four had between 5mm and 10mm,nineteen had 〉 10mm.Only twelve were revealed as ut fine cavity lesion simultaneously.The results showed that endometrial inflammation （54 cases,32.3% ） was the most common cause of postmenopausal bleeding and others were submucous myoma in 38 （ 22.8 % ）, endometrial polyp in 32 （ 19.2% ）, endometrial carcinoma in 22（13.2%） ,endometrial hyperplasia in ll（6.6%）,cervical polyp in 6（3.6%）,scamy cases in 4（2.3%） respectively.These findings were continued pathologically in 135（80.8% ） out of 167 cases. Thirty-one patients were treated simultaneously under hysteroscopy. Ninty-nine patients were operated with surgical hysteroscopy. Twenty-five patients were operated with regulan surgery. Conclusion： Combination with ultrasonography, hysteroscopy was an effective method for outpatients of posunenopausal bleeding. For those who had endometrial thickness 〈 5mm,the invasive procedures may be avoided.Surgical hysteroscopy and ultrasonography are also significant to the most patients as the first choice in its clinical value.