生育期异常子宫出血患者诊断方法的探讨

Research of the Diagnostic Value of Transvaginal Sonography, Hysteroscopy and Pathology on Abnormal Endometrorrhagia in Child-bearing Period

目的 探讨经阴道超声检查（TVS）、宫腔镜及病理联合检查对生育期异常子宫内膜出血患者的临床诊断价值.方法 228例生育期异常子宫内膜出血患者排除内科、妊娠及节育器因素、子宫肌瘤及与妊娠有关疾病后 ,依次行 TVS、官腔镜和子宫内膜病理检查,比较其诊断的准确率、敏感度、特异度,阳性预测值、阴性预测值.结果 在228例患者中,临床诊断与病理诊断符合为67例（29.39%）.经阴道彩超检查符合134例（58.77%）,经阴道彩超联合宫腔镜检查符合为202例（88.59%）,阴道超声、宫腔镜检查对子宫内膜病变诊断的敏感度 58.77%,88.59%,特异度 78.72%,85.10%,阳性预测值58.77%,88.59%,阴预测测值 91.49%,100%.经统计学处理,临床诊断与阴道彩超及联合宫腔镜检查符合情况比较,有显著性差异（P〈0.05）,阴道彩超检查与阴道彩超联合宫腔镜检查情况的各项指标比较,经统计学处理,有显著性差异（P〈0.05）.阴道彩超联合宫腔镜及病理检查对于诊断生育期子宫内膜异常出血有较高的诊断价值.结论 经阴道彩超是筛选子宫内膜病变的方便、简捷、有效与经济的方法,三者结合明显提高了生育期子宫内膜异常出血疾病的诊断准确率.

Objective To investigate the diagnostic values of transvaginal sonography（TVS） ,hysteroscopy and pathology on abnormal endometrurrhagia. Methods 228 patients in child-bearing period with abnormal endometrorrhagia （ excluding diseases of pregnancy and endometrorrhagia induced by intrauterine contraceptive,physicians,uterine myoma） ,were detected. With TVS hysteroscope pathology on abnormal endometrorrhagia, compare the accuracy, hysteroscopy, thespecificities, the positively predictive valur the Negative predictive value. Results In 228 patients, coincidence rate of clinical diagnosis, TVS and TVS with hysteroscopy was 29. 39% （67 patients） , 57.46% （ 131 patients） and 88.6% （ 202 patients） respectively. The diagnostic sensitivities of TVS and hysteroscopy to endometrium diseases were 58.77% and 88.59% respectively. The specificities were 78.72% and 85.10%. The positive predictive values were 58.77 and 88.59. The difference was statistical significance between clinical diagnosis and TVS with hysteroscopy [ P 〈 0.05 ）. The difference was also statistical significance between TVS and TVS with hysteroscopy（ P 〈 0.05 ）. TVS with hysteroscopy was more valuable to the diagnosis of hemorrhagic diseases of en- dometrium in child-bearing period women. Conclusion TVS is a convenient,quick,effective and economic method in screening the disease of endometrium, and hysteroscope is a reliable method,but the gold standard is pathology. The combination of these three medhods can raise obviously the diagnostic accuracy rate in in hemorrhagic disease of endometrium and it deserves to be recommended.