经阴道超声在绝经后阴道出血患者诊疗中的价值

Trans-vaginal ultrasound: A preferable means for the diagnosis of postmenopausal bleeding

目的:探讨经阴道超声(阴超)在绝经后阴道出血患者诊疗中的价值。方法:对2004年1月到2005年3月中384例因有绝经后不规则阴道出血而来我院就诊的绝经后妇女进行阴超检查。内膜厚度(5 mm的一组行宫腔镜检查。内膜厚度≤5mm的一组随访6个月及1年时分别进行阴超检查,其中阴超有特殊表现、有再次阴道流血或内膜较前增厚的行宫腔镜检查。结果:在内膜厚度≤5 mm的195例中,21例阴超有特殊表现的患者,宫腔镜检查结果16例为内膜息肉,1例为内膜癌;因再次出血而行宫腔镜的8例中,2例为内膜简单性增生过长,1例为内膜癌;而因内膜增厚而行宫腔镜的6例中,1例为内膜简单性增生过长,1例为内膜息肉,其余均为正常内膜或内膜炎性表现。内膜(5mm的189例中,123例为正常内膜或内膜炎性表现,内膜厚度为(6.9±1.1)mm;42例为内膜良性病变,内膜厚度为(9.4±3.2)mm;24例为内膜癌,内膜厚度为(15.6±5.1)mm。任意两组间内膜厚度差异均有显著性(P<0.05)。结论:经阴道超声可作为筛查绝经后内膜疾病的首选方法。内膜厚度≤5 mm的首次绝经后阴道出血患者可以随访。将内膜厚度15mm作为阴超判断子宫内膜病变良恶性的临界值比较适宜。

Objective： To investigate the value of trans-vaginal ultrasound （TVS） in the diagnosis of postmenopausal bleeding. Methods： Trans-vaginal ultrasound was performed for 384 women referred to the hospital because of postmenopausal bleeding from January 2004 to March 2005. Those with endometrial thickness 〉 5 mm underwent hysteroscopy and ≤5 mm reexamined by TVS after 6 and 12 months. Hysteroscopy was done for those with recurrent bleeding, increased endometrial thickness or special TVS features. Results： Among the 195 women with endometrial thickness≤5 mm, 21 had special TVS features, 16 endometrial polyp and 1 endometrial cancer. Of the 8 women who underwent hysteroscopy for recurrent bleeding, 2 had endometrial hyperplasia and 1 endometrial cancer. And in the 6 women with increased endometrial thickness, 1 had hyperplasia and another polyp. Of the 189 women with endometrial thickness 〉 5 mm, 123 had normal or inflammatory endometria with thickness of （6.9 -±1.1 ） mm, 42 benign lesion in the endometrium with thickness of （9.4± 3.2） mm, and 24 endometrial cancer with endometrial thickness of （ 15.6 ± 5.1 ） mm. There was significant difference in endometrial thickness between any two groups （ P 〈 0.05 ）. Conclusion ： TVS can be used as the first preference for the diagnosis of endometrial lesions. Follow-up should be conducted for those with the first postmenopausal vaginal bleeding and endometrial thickness≤5 mm. Endometrial thickness of 15 mm could be the threshold for the differentiation of benign from malignant endometrial lesions.