宫腔镜在绝经期子宫内膜增厚诊疗中的价值

Value of Hysteroscopy in the Diagnosis and Treatment of Endometrial Hyperplasia in Postmenopausal Women

目的探讨宫腔镜在绝经期子宫内膜增厚(内膜>5 mm)的诊疗意义。方法 2004年10月～2008年10月我院389例绝经期子宫内膜增厚(超声发现内膜增厚(5mm),先行诊断性刮宫,然后行宫腔镜内膜切除术,比较2种方法诊断结果及对子宫内膜癌的阳性预测值。结果 29例诊刮时无组织刮出或仅有极少量组织刮出难以送病检,无法明确病因,行TCRE病理诊断证实子宫黏膜下肌瘤5例,子宫内膜息肉14例,增生期子宫内膜9例,子宫内膜癌1例。10例因宫腔镜扩张宫口未达10 mm,或子宫穿孔未继续行宫腔镜检,TCRE取材失败,仅行诊刮,病理诊断:子宫内膜癌1例,子宫内膜炎6例,子宫内膜息肉3例。TCRE和分段诊刮对于子宫内膜癌的阳性预测值分别为100.0%(102/102)和50.0%(51/102),差异有显著性(P=0.000)。结论绝经期子宫内膜增厚,常规行宫腔镜检查,可提高诊断的准确率,早期发现子宫内膜癌,良性病变能同时获得治疗。

Objective To evaluate the value of hysteroscopy in the management of postmenopausal women with sonographically thickened endometrium （ 〉 5 mm）. Methods From October 2004 to October 2008, we treated totally 389 postmenopausal women, who were detected with thickened endometrium by B ultrasonography. Diagnostic curettage and then hysteroscopic transcervical resection of the endometrium （TCRE, continuous flow hysteroscopy, Storz hysteroscope） were performed on the patients. After the treatment, we compared the positive predictive values of diagnostic curettage and hysteroscopy. Results Among the patients, diagnostic curettage was failed in 29 cases, and then TCRE showed submucosal myoma in 5 of them, endometrial polyp in 14, proliferative endometrium in 9, and endometrial cancer in 1. Hysteroscopic examination was failed in 10 patients, because of insufficiently opened cervical orifice （ 〈 10 ram） or uterine perforation, and thus only diagnostic curettage was done. In these 10 patients, 1 was confirmed with endometrial cancer by pathological examination, 6 were endometritis, and 3 were endometrial polyp. Positive predictive value of TCRE and diagnostic curettage for endometrial cancer was 100.0% （102/102） and 50.0% （51/102） respectively （ P = 0. 000）. Conclusions For menopausal patient with proliferative endometrium, hysteroscopic examination is useful to increase accuracy of diagnosis, and thus endometrial cancer is more likely to be discovered in early stage, and benign diseases can be treated in time.