宫腔镜诊治772例宫腔内疾病的临床分析

Clinical Value of Hysteroscopy in Diagnosis and Management of Intrauterine Diseases:A Review of 772 Cases

目的探讨宫腔镜对宫腔内疾病的临床诊治价值。方法采用回顾性分析法选取2007年9月至2008年8月在四川大学华西第二医院门诊就诊并接受宫腔镜检查患者772例的临床病历资料为研究对象,并对相关检查结果进行统计学分析(本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准,得到该委员会批准)。结果①772例接受宫腔镜检查患者中,10例(1.30%)未完成检查,均为绝经前患者。本组宫腔镜检查的成功率为98.70%(762/772)。772例患者的宫腔镜检查结果主要为:子宫内膜息肉222例(28.76%),为导致宫腔内疾病的最主要病因,宫腔粘连113例(14.64%)、节育环异常58例(7.51%)、子宫内膜增生50例(6.48%)等。②同时接受宫腔镜与组织病理学检查的423例患者的组织诊断结果吻合率为80.14%(339/423)。宫腔镜诊断对子宫内膜息肉、子宫内膜单纯增生、子宫黏膜下肌瘤的灵敏度分别为90.99%,53.06%及94.44%;特异度分别为86.07%,98.93%及98.02%;阳性预测值(PPV)分别为87.83%,86.67%及65.38%;对子宫内膜癌诊断的灵敏度为83.33%,PPV为100.00%。③615例(79.66%)宫腔内疾病患者中,经宫腔镜确诊为537例,符合率为87.32%;超声确诊为402例,符合率为65.37%。宫腔镜与超声对宫腔内疾病的检出率比较,差异有统计学意义(P<0.01),且宫腔镜优于超声。401例(51.94%)宫腔占位病变中,经宫腔镜检出为339例,检出率为84.54%,经超声检出为303例,检出率为75.56%,二者检出率比较,差异有统计学意义(P<0.05),且宫腔镜检查优于超声。④410例(65.92%)宫腔镜检查的同时行宫腔镜治疗患者中,子宫内膜息肉为86.49%(192/222),节育环异常为100.00%(58/58),粘连为90.14%(128/142)。结论宫腔镜诊治宫腔内疾病是一项安全、有效、可靠的微创方法,优于超声,可明显提高诊断准确率,并可在检查的同时对疾病进行治疗。采取宫腔镜检查结合组织病理学诊断,是确诊宫腔内病变的最佳选择。

Objective To investigate the clinical value of hy steroscopy in diagnosis and management of intrauterine diseases. Methods A total of 772 out-patient cases who underwent hysteroscopical examin at ions from September 2007 to August 2008 were enrolled in this retrospective stud y. Clinical data were made statistical analysis. The study protocol was approve d by the Ethical Review Board of Investigation in Human Being of West China Sec ond University Hospital,Sichuan University. Informed consent was obtained from all participants. Results ① A total of 772 wo men were recruited in the study, and hysteroscopical examinations were successfu lly conducted in 98.70%（762/772） of them. Ten cases failed the hysteroscopy exam ina tion, all of them were premenopause cases. The detection rate of intrauterin e diseas es were 28.76% for endometrial polyps,14.64% for intrauterine adhesion, 7.51% f or intrau t erine devices abnormalities and 6.48% for endometrial hyperplasia and so on. ②B iopsies were taken in 423 women, in which hysteroscopical diagnosis of 339 women w ere confirmed, the coincidence rate was 80.14%（339/423） between two methods. The sensitivity of hysteroscopy for endometrial polyps, simple endometrial hyperplasia and submucous fibroids were 90.99%, 53.06% and 94.44%, respectively, and the specificity were 86.07%, 98.0 3% and 98.02%, respectively. The positive predictive value （PPV） were 87.83%,86.67% and 65.38%, respectively. The sensitivity and PPV of hysteroscopy for endometrial carcinoma were 83.33% and 100.00%, respectively. ③Intrauterine diseases wer e identified in 615 patients （79.66%）, among whom 537 by hysteroscopy with an ac cordance of 87.3 2% （537/615） and 402 by ultrasonography with an accordance of 65.37% （402/615）. Hysteroscopy was better than ultrasonography in the diagnosis of intrauterine di seases （P0.05）. Occupation diseases in uterine cavity were reported in 401 cases. Of those 339 women were reported in hysteroscopy with the accordance of 8 4.54%, and 303 women were reported in ultrasonography with the accordance of 75 .56% （P0.05）. ④Therapy had been conducted simultaneously in 65.49% of 772 women, with endometrial polpys of 86.49%（192/222）, intrauterine devices a bnormalities of 100.00%（58/58） and adhesions of 90.14%（128/142）. Conclusions Hysteroscopy is a safe, effective and minimally invasive approach in diagnosis and management of intrauterine diseases. It could improve the diagnositic accurary than ultrasonography, also therapy can be c onducted simultaneously as well. Hysteroscopy combined with endometrial biopsies might be an optimal choice in diagnosis of intrauterine diseases.