宫腔镜、宫腔声学造影与阴道超声对绝经后子宫出血诊断价值的比较

Comparison of Diagnostic Value of Hysteroscopy vs Sonohysterography vs Transvaginal Sonogra-phy in Postmenopausal Bleeding

【目的】评价和比较宫腔镜、宫腔声学造影与阴道超声对绝经后子宫出血的诊断价值。【方法】2010年5月至2011年1月诊治绝经后子宫出血患者158例，平均年龄62岁，对137例资料完整患者其子宫内膜宫腔镜、宫腔声学造影与阴道超声检查结果进行分析比较。【结果】137例患者所有异常病变，宫腔镜、宫腔声学造影、阴道超声的诊断灵敏度分别为92．3％、89．6％、70．0％，特异度分别为80．7％、77．3％、50．0％，阳性预测值分别为96．2％、95．3％、80．9％，阴性预测值分别65．3％、58．3％、35．4％。【结论】宫腔镜是一种优于宫腔声学造影和阴道超声诊断绝经后子宫出血的方法，宫腔声学造影具有方面、安全、诊断精确性优于阴道超声并接近于宫腔镜等优点，可作为绝经后子宫出血的优选检查方法。

[Objective]To evaluate and compare the diagnostic value of hysteroscopy（HS） vs sonohyster- ography（SIS） vs transvaginal sonography（TVS） in postmenopausal bleeding. [Methods] Totally 158 patients with postmenopausal bleeding from May 2010 to Jan. 2011 were enrolled in this study. The average age o{ all patients was 62 years old. The results o{ TVS, SIS and TVS were compared. [Results] The results of 137 pa- tients were analyzed. For all abnormal lesions, the diagnostic sensitivity o{ HS, SIS and TVS were 92.30//00, 89.6~/~0, and 70.0%0, respectively, while the specificity of HS, SIS and TVS were 80.7~//0, 77. 3% and 50. 0%, respectively. The positive predictive values o{ HS, SIS and TVS were 96.2~, 95.3o/00 and 80.9%, re- spectively, while negative predictive values were 65.3%, 58.3//oo and 35.4~, respectively. ~Conclusion] HS {or the diagnosis to postmenopausal bleeding is superior to SIS and TVS. The convenience, safety and diagnos- tic accuracy o{ SIS are better than TVS, but are close to HS. Therefore SIS can be taken as the optimizing ex- amination method of postmenopausal bleeding.