宫腔镜在诊断绝经后出血中的应用价值

The diagnostic value of hysteroscopy on postmenopausal bleeding

目的:探讨绝经后出血的原因及宫腔镜在诊断绝经后出血中的应用价值。方法:130例绝经后出血患者行宫腔镜检查,术中行诊刮或直接活检,将宫腔镜诊断与病理结果结合并参考术前B超结果作出联合诊断。分别将宫腔镜诊断、诊刮及B超诊断与联合诊断进行比较。结果:130例中萎缩性宫内膜48例,内膜息肉29例,内膜癌20例,子宫内膜增殖症16例,粘膜下肌瘤8例,其他9例。宫腔镜的灵敏度、特异度、阳性及阴性预测值分别为95.12%、95.83%、97.50%、92.09%,宫腔镜的灵敏度及阴性预测值高于诊刮(75.61%、71.64%,P<0.005),宫腔镜的特异度及阳性、阴性预测值高于B超(50.00%、71.76%、80.00%,P<0.05)。结论:萎缩性宫内膜是绝经后出血的主要原因,宫腔镜在诊断绝经后出血方面具有较高的准确性,联合诊刮可高效准确地诊断绝经后出血。

Objective： To investigate the causes of postmenopausal bleeding and evaluate the diagnostic value of hysteroscopy. Methods： Using the diagnostic technique of hysteroscopy 130 patients with postmenopausal bleeding were examed and the hysteroscopical diagnosis was made. During the hysteroscopical examination the dilatation and curettage or directed biopsies were performed. The combined diagnosis were made associated with hysteroscopical diagnosis, histologic finding and ultrasonography finding .Then the hysteroscopical diagnosis, histologic finding, ultrasonography finding were compared with the combined diagnosis respectively. Results： The combined diagnoses were atrophy endometrium in 48,polyps in 29, endometrial carcinoma in 20, endometrial hyperplasia in 16, submucous myoma in 8 and others in 9 cases. The sensitivity, specificity, positive and negative predictive value for hysteroscopy were 95.12%,95.83%,97.50%,92.09%. The sensitivity and negative predictive value for hysteroscopy were higher than dilatation and curettage （75.61%,71.64%,P〈0.005）, the specificity and positive and negative predictive value for hysteroscopy were higher than ultrasonography （50.00% ,71.76% ,80.00%, P〈0.05）. Conclusion： The main causes of postmenopausal bleeding were atrophy endometrium and benign lesions. The examination of hysteroscopy has high accuracy in diagnosing postmenopausal bleeding, combined with dilatation and curettage were effective and valuable methods for diagnosing postmenopausal bleeding.