宫腔镜检查对异常子宫出血患者的诊断价值

Diagnostic value of hysteroscopy in patients with abnormal uterine bleeding

目的探讨宫腔镜检查在异常子宫出血患者中的诊断价值。方法回顾性分析接受宫腔镜检查的547例异常子宫出血患者的临床资料，患者宫腔镜检查结束后进行诊断性刮宫，所得标本进行组织病理学检查，比较分析宫腔镜检查与组织病理学的检查结果。结果宫腔镜诊断子宫腔内异常病变的敏感性为95．83％（161／168），特异性为97．63％（370／379），假阳性率为2．37％（9／379），假阴性率为4．17％（7／168），阳性预测值为94．71％（161／170），阴性预测值为98．14％（370／377），约登指数为0．934。宫腔镜诊出子宫内膜息肉54例，病理诊断符合率79．63％（43／54）；单纯性增生93例，病理诊断符合率90．32％（84／93）；非典型增生16例，病理诊断符合率87．50％（14／16）；分化子宫内膜腺癌4例，病理诊断符合率100．00％（4／4）；浆乳癌2例，病理诊断符合率100．00％（2／2）；子宫内膜移行细胞癌1例，病理诊断符合率100．00％（1／1）。结论宫腔镜能够直观的对宫颈管与子宫腔内的形态结构进行观察，同时对子宫内膜息肉、单纯性增生、非典型增生和子宫内膜痛的诊出率较高．故对异常子宫出血的诊断具有荤要的临床价值。

Objective To investigate the diagnostic value of hysteroscopy in patients with abnormal uterine bleeding. Methods The clinical data of 547 cases of abnormal uterine bleeding were analyzed retrospectively. The diagnostic curettage was conducted after hysteroscopy, the specimens were examined by histopathology, the detection result of hysteroscopy and histopathologieal were compared. Results The sensitivity Of hysteroscopy in diagnosed abnormal uterine cavity lesions was 95.83% （ 161/168 ）, the specificity was 97.63% （ 370/379 ）, the false positive rate was 2.37% （9/379）,the false negative rate was 4.17% （7/168）,the positive predictive value was 94.71% （161/170）, the negative predictive value was 98. 14% （370/377）, the Jorden index was 0. 934. Hysteroscopy diagnosis showed that the endometrial polyps was 54 cases, the pathological diagnosis coincidence rate was 79.63% （ 43/54 ） ;93 cases of simple hyperplasia, the pathological diagnosis coincidence rate was 90.32% （ 84/93 ） ; 16 cases of atypical hyperplasia, the pathological diagnosis coincidence rate was 87.50% （14/16）;4 cases of differentiated endometrial adenocarcinoma,the pathological diagnosis coincidence rate was 100.00% （4/4）;2 cases of uterine papillary serous carcinoma, the pathological diagnosis coincidence rate was 100.00% （2/2）;I case of transitional cell carcinoma of endometrium, the pathological diagnosis coincidence rate was 100. 00% （1/1）. Conclusion Hysteroscopy can visually observe the morphology of cervical canal and uterine cavity, the diagnostic rate of endometrial polyps,simple hyperplasia, atypical hyperplasia and endometrial carcinoma are higher, so it has important clinical value in the diagnosis of abnormal uterine bleeding.