慢性子宫内膜炎的宫腔镜诊断

Hysteroscopic Diagnosis of Chronic Endometritis

慢性子宫内膜炎因症状的非特异性而被临床忽视,但因其对女性生殖预后以及异常子宫出血的影响而渐被关注。慢性子宫内膜炎的宫腔镜下特征:局灶或弥漫性腺体周围充血;子宫内膜间质水肿,与月经周期不符的子宫内膜增厚、泛白、表面不规则;子宫内膜微小息肉(小于1 mm),带蒂并伴有基质水肿、局灶或弥漫性的腺体周围充血的息肉。宫腔镜诊断慢性子宫内膜炎的准确性受膨宫介质以及检查者经验的影响,其与组织病理学诊断的符合率差异很大。宫腔镜评价慢性子宫内膜炎的价值已得到认可,但能否独立作为慢性子宫内膜炎的诊断标准仍有争议。宫腔镜检查提示慢性子宫内膜炎的女性需要进一步明确组织病理学诊断,减少因漏诊导致慢性子宫内膜炎的持续存在对女性生殖预后的影响。

Chronic endometritis was often overlooked because of its nonspecific symptoms. However, it has drawn more and more attention recently because of its influence on female reproductive prognosis, and abnormal uterine bleeding. Clinical features of chronic endometritis under hysteroscopy were as follows：①focal or diffuse periglandular hyperemia;② endometrial stromal edema, increased thickness of the endometrium, with whitish color and irregular surface, and out of phase;③ pedunculated micropolyps （less that 1 mm）, stromal edema, or micropolyps with focal or diffuse periglandular hyperemia. The accuracy of hysteroscopic diagnosis of chronic endometritis is affected by the media and doctorr s experience. There is a great difference between the hysteroscopic diagnosis and the pathological diagnosis. The value of hysteroscopy in the evaluation of chronic endometritis has been recognized, but it is still controversial whether hysteroscopy can be used as an independent diagnostic criteria for chronic endometritis. The histopathological diagnosis should be advised if chronic endometritis is clinically suspected under hysteroscopy, so as to reduce the influence of the persistent chronic endometritis on female reproductive prognosis.