宫腔镜诊断绝经后子宫出血或超声检查示宫腔异常的临床价值

Hysteroscopy in the diagnosis of uterine bleeding or abnormal ultrasonographic findings in menopause women

目的探讨宫腔镜检查诊断绝经后妇女子宫内膜良恶性病变的临床价值。方法回顾性分析上海交通大学附属第一人民医院分院2008年12月—2012年1月间因绝经后子宫出血或超声检查提示宫腔异常行宫腔镜检查及病理诊断的177例患者的临床资料。结果 177例宫腔镜检查中,146例(82.5%)有宫腔异常表现,31例(17.5%)宫腔形态未见异常。146例有宫腔异常表现的患者中,良性病变132例(90.4%),包括子宫内膜息肉62例(42.5%)、宫颈管息肉16例(11.0%)、萎缩性子宫内膜炎10例(6.8%)、宫颈息肉合并子宫内膜息肉12例(8.2%)、宫腔粘连8例(5.5%)、子宫内膜不典型增生4例(2.7%)、子宫内膜增生期改变15例(10.3%)、黏膜下肌瘤3例(2.1%)、宫颈肌瘤1例(0.7%)、复杂性子宫内膜增生过长1例(0.7%);恶性病变14例(9.6%),均为子宫内膜腺癌。宫腔镜检查诊断的敏感度为96.6%(141/146),特异度为83.9%(26/31),准确性为94.4%(167/177)。宫腔镜检查的特异度和准确性均显著高于超声检查(P值均<0.01),而宫腔镜检查的敏感度虽较超声检查有升高趋势,但差异无统计学意义(P>0.05)。结论宫腔镜检查克服了诊断性刮宫的盲目性,减少了过度治疗和漏诊,使治疗更趋于合理,能早期发现子宫内膜病变,特别是无临床表现的子宫内膜早期恶变。

Objective To explore the diagnostic value of hysteroscopy for endometrial benign and malignant lesions in elderly women. Methods From December 2008 to January 2012, 177 elderly women took hysteroscopy and pathologic diagnosis because of postmenopausal bleeding or intrauterine abnormalities of ultrasound scan. Their clinical data were retrospectively analyzed in this study. Results In the 177 patients with hysteroscopy, there were 146 （82.5%） abnormal uterine cavities and 31 （17.5%） normal ones. In the 146 intrauterine abnormalities, there were 132 （90.4%） benign lesions and 14 （9.6%） endometrial adencarcinoma. The benign lesions included 62 endometrial polyps （42. 5%）, 16 cervical polyps （11. 0%）, 10 atrophic endometritis （6.8%）, 12 cervical polyps combined with endometrial polyps （8.2%）, 8 intrauterine adhesions （5.5%）, 4 atypical endometrial hyperplasia （2.7%）, 15 changes of endometrial proliferative phase （ 10.3% ）, 3 submucous myoma （2.1%）, 1 cervical fibroids （0.7%）, and 1 complicated endometrial hyperplasia （0.7%）. For the hysteroscopy, diagnostic sensitivity was 96.6 % （ 141 / 146）, the specificity was 83.9 % （26/31 ）, and the accuracy was 94.4% （167/177）. The specificity and accuracy of hysteroscopy were significantly higher than ultrasound （P〈0.01）. The sensitivity of hysteroscopy was higher than ultrasound, but there was no significant difference （P〉0.05）. Conclusion Hysteroscopy can avoid aimless diagnostic curettage, reduce excessive treatment and missed diagnosis, and make treatment more rational. The early detection of endometrial lesions, especially early malignant change without clinical manifestations, can be achieved by hysteroscopy. （Shanghai Med J, 2012, 35= 322-325）