老年女性子宫内膜病变特点及宫腔镜检查的诊断价值

Clinical characteristics of endometrium in elder women and the diagnostic value of hysteroscopy

目的探讨官腔镜检查对异常子宫出血和无症状子宫内膜增厚的老年女性的诊断价值。方法回顾性病例分析，对131例异常子宫出血（53例，40．5％）和无症状子宫内膜增厚（78例，59．5％）的老年女性进行宫腔镜检查及诊断性刮宫术，将宫腔镜诊断结果与术后病理结果进行分析比较。结果131例患者中内膜正常39例（29．8％）、子宫内膜息肉65例（49．6％）、黏膜下肌瘤6例（4．6％）、子宫内膜增生8例（6．1％）、子宫内膜癌13例（9．9％）。绝经后异常子宫出血患者53例中子宫内膜癌8例（15．1％）；绝经后无症状子宫内膜增厚患者78例中子宫内膜癌8例（6．4％）。宫腔镜检查对异常子宫出血患者正常子宫内膜诊断的敏感性、特异性、阳性预测值和阴性预测值分别为88％、97％、94％和95％，无症状子宫内膜增厚患者分别为82％、95％、86％、93％；诊断子宫内膜息肉分别为100％、79％、74％、100%与98％、88％、92％、97%；子宫内膜癌分别为75%、100%、100％、96％与80％、100％、100％和99％。结论宫腔镜检查能较准确的诊断子宫内膜病变，对宫腔镜诊断的子宫内膜良性病变需结合其临床特点，进行必要的病理活检以排除恶性病变。

Objective To evaluate the value of hysteroscopy in elder women with abnormal uterine bleeding （AUB） and asymptomatic postmenopausal women with a thickened endometriurrL Methods Fifty- three cases in the AUB group and seventy-eight cases in the endometrial hyperplasia group underwent hysteroseopy examination and hystemseopy-guided biopsy, then the hysteroscopic and histopathological results were compared between the two groups. Results Of the 131 cases, the normal endometrium accounted for 29. 8% （n=39）, endometrial polyp for 49. 6% （n= 65）, submucous myornas for 4. 6% （n= 6）, hyperplasia endometrii for 6. 1%（n=8） and endometrial carcinoma for 9. 9% （n= 13）. Both the AUB group and the endometrial hyperplasia group had 8 cases of endometrial carcinoma （15. 1%, 6.4%, respectively）. For the diagnosis o{ normal endometrium with hysteroscopy, the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） were 88%, 97%, 94% and 95%, respectively, in the AUB group, versus 82 %, 95 %, 86 % and 93 %, respectively, in the endometrial hyperplasia group. For the endometrial polyps, hystemseopy showed a sensitivity, specificity, PPV and NPV of 100%, 79%, 74%, 100%, respectively, in the AUB group and 98%, 88%, 92%, 97%, respectively, in the endometrial hyperplasia group. For the endometrial cancer, hysteroscopy had a sensitivity, specificity, PPV and NPV of 75%, 100%, 100% and 96%, respectively, in the AUB group; while in the endometrial hyperplasia group, the sensitivity was 80%, the specificity and PPV were 100%, and the NPV was 99%. Conelusions In elder females, hysteroscopy allows for an accurate diagnosis in endometrial disease, and hysteroscopically directed sampling is mandatory, even if the uterine cavity appears normal at hysteroscopy, to rule out endometrial neoplasms.