子宫内膜吸取活检与宫腔镜下诊刮的对照研究

A comparative study between endometrial aspiration biopsy and hysteroscopic curettage

目的探讨应用宫腔组织吸引管行子宫内膜活检筛查子宫内膜癌及癌前病变的临床价值。方法选取2017年9月-2018年5月行宫腔镜下诊断性刮宫(诊刮)排除子宫内膜病变的患者90例,采用手动式一次性官腔组织吸引管吸取活检子宫内膜,随后行宫腔镜下诊刮,并以宫腔镜下诊刮病理为金标准,比较2种取材方式下患者的疼痛程度、出血量、手术时间、扩张宫颈率、取材满意率的差异及病理诊断符合率。结果采用吸引管吸取活检的患者疼痛程度较轻或基本无痛,几乎不需扩张宫颈,手术时间短,术中出血少,与宫腔镜下诊刮比较,差异有统计学意义(P<0.05)。吸取活检与宫腔镜下诊刮取材满意率分别为95.55%(86/90)、98.88%(89/90),差异无统计学意义(P>0.05)。吸取活检病理诊断符合率为81.40%(70/86),诊断子宫内膜良性病变的灵敏度95.00%,特异度87.88%,准确率89.53%;诊断子宫内膜不典型增生、内膜癌的灵敏度75.00%,特异度100%,准确率98.84%。结论应用宫腔吸引管行子宫内膜吸取活检与宫腔镜下诊刮诊断子宫内膜病变一致性较好,且手术时间短、出血量少、几乎无需扩张宫颈、疼痛感轻,可以广泛用于子宫内膜疾病筛查。

Objective To explore the clinical value of endometrial aspiration biopsy with uterine tissue aspiration tube in screening endometrial cancer and precancerous lesions.Methods From September 2017 to May 2018,90 patients who underwent diagnostic curettage under hysteroscopy and endometrial lesions were excluded were selected for this study.Endometrial biopsy was performed by manual disposable uterine tissue suction tube,followed by hysteroscopy and curettage.With the curettage pathology under hysteroscopy as gold standard,the degree of.pain,bleeding volume,opera- tion time,cervical dilatation rate,satisfaction rate and pathological diagnosis coincidence rate between the two methods were compared.Results The patients who underwent endometrial aspiration biopsy had less pain,much lower cervical dilatation rate,shorter operation time and less bleeding during operation compared with hysteroscopic curettage (P < 0.05 ).The satisfaction rates of aspiration biopsy and hysteroscopic curettage were 95.55%(86/90)and 98.88 %(89/ 90),respectively,with no significant difference (P >0.05).The pathological diagnosis coincidence rate of aspiration biopsy was 81.40%(70/86).The sensitivity,specificity and accuracy for the diagnosis of benign endometrial lesions by endometrial aspiration biopsy were 95.00%,87.88%and 89.53%,respectively,and the sensitivity,specificity and accuracy for the diagnosis of atypical endometrial hyperplasia and endometrial cancer by endometrial aspiration biopsy were 75.00%,100% and 98.84%,respectively.Conclusions Endometrial aspiration biopsy with intrauterine suction tube has a good consistency with curettage pathology under hysteroscopy in the diagnosis of endometrial lesions.It can be widely used in endometrial disease screening because of its short operation time,less bleeding,almost no need to dilate the cervix and less pain.