宫腔镜诊治宫内占位性疾病1065例临床分析

Clinical Analysis of 1 065 Endometrial Occupying by Hysteroscopy

目的:探讨宫腔镜检查与阴道彩色超声(TVB)对宫内占位性疾病的诊治价值。方法:回顾性分析因不孕、绝经后出血、阴道彩色超声提示宫腔占位等不同原因行宫腔镜检查的1 065例患者,根据宫腔镜检查结果,了解TVB诊断的准确率及宫腔占位性疾病的病理性质。结果:1 065例宫腔镜检查的患者术前TVB提示有宫内占位的为800例,经宫腔镜检查,术中见宫内占位900例,2种检查方法相比,差异无统计学意义(P>0.05)。术前TVB提示有宫内占位的800例患者中,经宫腔镜检查证实有宫内占位750例,TVB与宫腔镜检查的阳性符合率为93.8%(750/800),假阳性率为6.2%(50/800)。术前TVB未提示宫内占位的265例患者中,经宫腔镜检查存在宫内占位的有150例,TVB的假阴性率为10.8%(115/1 065)。宫腔镜术后病理诊断提示,宫腔内膜息肉670例,占62.9%(670/1 065),子宫黏膜下肌瘤121例,占11.4%(121/1065),内膜简单性增生153例,占14.4%(153/1 065),内膜功能性增生93例,占8.7%(93/1 065),复杂性增生9例,占0.8%(9/1 065),不典型增生8例,占0.8%(8/1 065),子宫内膜癌11例,占1.0%(11/1 065)。结论:准确诊断宫内占位性疾病性质,须在宫腔镜直视下检查并取材进行病理诊断,此是宫内占位性疾病的最终诊断结果。

Objective： To explore the value of diagnosis and treatment about trans-vaginal B ultrasound （TVB） examination, hysteroscopy and pathology diagnosis for intrauterine ＇Occupying. Methods： A total of 1 065 cases due to infertility, postmenopausal bleeding, uterine occupying by B ultrasound were retrospectively analyzed. According to the results after hysteroscopy, the accuracy rate of diagnosis and the pathological nature of uterine occupying were analyzed. Results： Among 1 065 cases with uterine occupying or endometrial thickening by ultrasound examination, 900 cases were confirmed intrauterine occupying, including 6 cases with uterine empyema, 5 cases with effusion and hemorrhage. The accuracy rate of B ultrasound was 93.8% （750/800）, false positive rate Was 6.2% （50/800）. Postoperative pathological examination confirmed 670 cases of uterine endometrial polypus, accounting for 62.9% （670/1 065）： One hundred and twenty-one cases had uterine submucous myoma, accounting for 11.4% （121/1 065）. One hundred and fifty-three cases had endometrial simple hyperplasia, accounting for 14.4% （153/1 065）. Ninety-three cases had endometrial function hyperplasia, accounting for 8.7% （93/1 065）. Nine cases had complex hyperplasia, accounting for 0.8% （9/1 065）. Eight cases had atypical hyperplasia, accounting for 0.8% （8/1 065）. Eleven cases had endometrial cancer, accounting for 1.0% （11/1 065）. Conclusion： In order to exactly diagnose the pathological nature of uterine occupying, examination and drawing materials under hysteroscopy are necessary. Pathology is the gold standard for diagnosis of uterine occupying.