宫腔声学造影、阴道超声与宫腔镜诊断子宫内膜病变的比较研究

Comparison of diagnostic accuracy of saline infusion sonohysterography,transvaginal sonography and hysteroscopy in endometrial pathology

目的比较宫腔声学造影、阴道超声与宫腔镜对子宫内膜病变的诊断价值。方法 2006年6月～2008年3月诊治月经过多、绝经后出血和不孕患者112例,对其子宫内膜宫腔声学造影、阴道超声与宫腔镜检查结果进行分析比较。结果 74.5%的病例经病理确诊为子宫异常改变。对于子宫内膜疾病和腔内肿块的诊断,宫腔镜的诊断灵敏度和特异度最高,其次是宫腔声学造影和阴道超声。对于子宫腔内肿块(肌瘤和息肉)的诊断,宫腔声学造影优于阴道超声。对于子宫内膜疾病(子宫内膜增生和子宫癌)的诊断,阴道超声优于宫腔声学造影。结论宫腔镜是一种优于宫腔声学造影和阴道超声诊断子宫内膜病变的方法。

[Objective] The purpose of the study was to compare the effectiveness of saline infusion sonohysterography （SIS）, transvaginal sonography （TVS） and hysteroscopy （HS） in the diagnosis of endometrial pathology in symptomatic women. [Methods] From June 2006 to March 2008, the present study was conducted on 112 women, with symptoms of menorrhagia, postmenopausal bleeding and infertility. Sensitivity, specificity, and positive and negative likelihood ratios were calculated to compare the diagnostic accuracy of TVS, SIS and HS. [Results] We observed endometrial pathology in 74.5% of cases. In the diagnosis of en- dometrial diseases and intraeavitary mass, HS was the most accurate diagnostic technique, followed by SIS and TVS. SIS was found to be statistically significantly more accurate than TVS for the diagnosis of intracavitary masses. TVS was statistically significantly more accurate for the diagnosis of endometrial diseases （hyperplasia or endometrial cancer） compared with SIS. [Conclusion] Hysteroscopy seems to be more valuable than saline infusion sonohysterography and ultrasound in the diagnosis of endometrial pathology.