宫腔镜联合诊断性刮宫对绝经过渡期和绝经后子宫出血诊断价值的探讨

Exploration on diagnostic value of hysteroscope combined with diagnostic curettage in menopausal transition and postmenopausal uterine bleeding

目的探讨宫腔镜联合诊断性刮宫对绝经过渡期和绝经后子宫出血诊断的价值。方法采用宫腔镜联合诊断性刮宫的方法为139例绝经过渡期和绝经后子宫出血的患者进行检查,结合病理诊断出病因。结果绝经过渡期和绝经后异常子宫出血的原因主要是萎缩性子宫内膜炎、子宫黏膜下肌瘤、子宫内膜息肉、子宫内膜增生过长、宫内节育器伴子宫出血、子宫内膜癌。宫腔镜诊断准确率92.1%优于诊断性刮宫63.3%,差异有统计学意义(P<0.01)。两种检查共发现子宫恶性病变6例,占4.3%,5例为子宫内膜癌,1例为宫颈癌,与手术后标本病理检查结果相符。诊断性刮宫发现4例恶性病变,有1例因病灶范围<0.5 cm诊刮时漏诊,经宫腔镜下活检确诊为子宫内膜癌;另有1例本次术前曾多次诊刮提示子宫内膜增生过长,后经宫腔镜活检确诊子宫内膜癌。1例宫腔镜检查提示子宫内膜增生过长,经诊刮提示为子宫内膜癌。结论宫腔镜联合诊断性刮宫对绝经过渡期和绝经后子宫出血诊断中有着重要的临床价值,可以提高诊断的准确率,早期诊断和发现肿瘤,是目前最佳诊断手段之一。

Objective To explore the diagnostic value of hysteroscope combined with diagnostic curettage in menopausal transition and postmenopausal uterine bleeding. Methods A total of 139 patients with menopausal transition and postmenopausal uterine bleeding all examined by hysteroscope combined with diagnostic curettage, and combined with pathology to diagnose the cause. Results The reasons of menopausal transition and postmenopausal uterine bleeding were mainly for atrophic endometritis, uterine submucous myoma, endometrial polyps, endometrial hyperplasia, intrauterine device with uterine bleeding, endometrial cancer. Hysteroscope had better accuracy rate of diagnosis as 92.1% than 63.3% by diagnostic curettage, and the difference had statistical significance（P〈0.01）. These two examination measures showed totally 6 cases with malignant uterine lesions, accounting for 4.3%. Among them, there were 5 cases with endometrial cancer and 1 case with cervical cancer, which were corresponding with postoperative pathological examination of samples. Diagnostic curettage showed 4 cases with malignant uterine lesions. There was 1 missed diagnosed case due to lesion range 0.5 cm, which was diagnosed as endometrial cancer by hysteroscopic biopsy, 1 case showed as endometrial hyperplasia by multiple diagnostic curettage, which was diagnosed as endometrial cancer by hysteroscopic biopsy, and 1 case showed as endometrial hyperplasia by hysteroscope, which was diagnosed as endometrial cancer by diagnostic curettage. Conclusion Combination of hysteroscope and diagnostic curettage shows important clinical value in diagnosis of menopausal transition and postmenopausal uterine bleeding, and it can improve the accuracy rate of diagnosis for early diagnosis and detection of tumors. It is one of the best means of diagnosis.