宫腔镜检查对绝经后子宫出血的诊断价值

The Diagnostic Value of Hysteroscopy on Postmenopausal Bleeding

为探讨绝经后子宫出血的原因和评价宫腔镜对绝经后子宫出血的诊断价值，作者采用宫腔镜与病理组织学检查相结合的方法，对２３４ 例绝经后子宫出血患者的出血原因进行了分析。结果显示：子宫内膜萎缩是引起绝经后子宫出血的主要原因，其次为子宫内膜增生、子宫内膜癌及癌前病变、子宫内膜息肉及子宫粘膜下肌瘤。本组病例宫腔镜诊断与病理组织学检查的符合率为７４．６１％ ，其中良性病变７６ 例，子宫内膜癌及癌前病变２７ 例，其年龄及绝经年限分布比较均有显著性差异（Ｐ＜ ０．０１）。本研究结果表明，采用宫腔镜检查技术，结合病理组织学检查，对发现绝经后子宫出血的原因，尽早确诊子宫内膜癌及癌前病变，预防宫内膜癌的发生具有积极作用。宫腔镜检查是一种操作方便、安全有效，使用价值较高的方法。

The objectives of this study were to investigate the causes of postmenopausal bleeding and evaluate the diagnostic value of hysterscopy. Using the diagnostic technique of hysteroscopy and directed biopsies, the authors analysed the causes of postmenopausal bleeding of 234 patients undergoing hysteroscopy. The results showed that atrophic endometrium was the most common cause of postmenopausal bleeding and that endometrial hyperplasia, endometrial carcinoma/precancerous lesion, and submucous leiomyoma/endometrial polyp were also common in the patients with postmenopausal bleeding. The agreement rate between hysteroscopy and directed biopsies was 74.61%. In 234 cases of postmenopausal bleeding, the benign and malignant pathological changes were found in 76 and 27 cases respectively. In terms of age and menopause time, there were significant differences (χ 2=3.36, P <0.01; χ 2=3.92, P <0.01 respectively)between the patients with postmenopausal bleeding in the benign changes group and those in the malignant changes group. So the combined use of hysteroscopical technique and directed biospies is of great significance in finding out the causes of postmenopausal bleeding, making a definite diagnosis of endometrial carcinoma and precancerous lesion, and further preventing the occurrence of endometrial carcinoma. The examination of hysteroscopy is an effective and valuable method for diagnosing postmenopausal bleeding.