经阴道超声及宫腔镜诊断子宫内膜病变

Transvaginal sonography and hysteroscopy in diagnosis of uterus endometrial lesions

目的探讨经阴道超声(TVS)及宫腔镜(HS)诊断子宫内膜病变的临床价值。方法回顾性分析2008年8月—2011年5月接受TVS、HS和病理检查的疑似子宫内膜病变患者192例,与病理结果对照,评价两种方法诊断子宫内膜病变的敏感度、特异度、阳性预测值、阴性预测值及诊断符合率,并进行统计学比较。结果 TVS诊断子宫内膜异常的敏感度、特异度、阳性预测值、阴性预测值分别为93.60%(161/172)、55.00%(11/20)、94.71%(161/170)、50.00%(11/22);HS诊断子宫内膜异常的敏感度、特异度、阳性预测值、阴性预测值分别为97.67%(168/172)、90.00%(18/20)、98.82%(168/170)、81.82%(18/22)。HS的诊断敏感度、特异度、阳性预测值、阴性预测值均高于TVS;HS及TVS对子宫内膜增生、内膜息肉、黏膜下肌瘤、内膜癌、内膜萎缩的诊断符合率差异均无统计学意义(P均>0.05),慢性非特异性子宫内膜炎、未见异常者的诊断符合率差异有统计学意义(P均<0.05)。结论 TVS可作为子宫内膜病变的首选检查方法,为HS提供导向;TVS与HS相结合,有望成为诊断子宫内膜病变的最佳方法。

Objective To investigate the diagnostic value of transvaginal sonography （TVS） and hysteroscopy （HS） for uterus endometrial lesions. Methods From August 2008 to May 2011, data of 192 patients suspected for uterus endometri- al lesions who underwent TVS, HS and biopsy were analyzed retrospectively. The results obtained with TVS or HS were compared, taking the finally pathological results as standards. The sensitivity, specificity, positive, negative predictive val- ues and diagnostic accordance rate of TVS and HS for endometrial lesions were analyzed and compared statistically. Results The sensitivity, specificity, positive and negative predictive value of TVS in diagnosis of endometrial lesions was 93.60% （161/172）, 55.00~ （11/20）, 94.71% （161/170） and 50.00% （11/22）, while of HS was 97.67% （168/172）, 90.00~ （18/20）, 98.82% （168/170） and 81.82% （18/22）. The sensitivity, specificity, positive and negative predictive value of HS were higher than those of TVS. There was no statistical difference for the diagnosis of endometrial hyperplasia, endo- metrialpolyps, submucous myoma, endometrial carcinoma, endometrial atrophy and endometrial lesions between TVS and HS （all P〈0.05）, but there was statistical difference for nonspecific and chronic endornetritis （both P〈0.05）. Conclusion TVS may be used as the preferred way in diagnosis of endometrial lesions and guiding HS. TVS combined with TVS may be the best inspection method for uterus endometrial lesions.