单纯阴道超声、宫腔镜和联合诊断子宫异常出血原因的临床价值比较

Comparison of the clinical value of simple transvaginal ultrasonography,hysteroscopy and their combination in the diagnosis of abnormal uterine bleeding

目的:比较单纯阴道超声诊断、宫腔镜诊断和联合诊断子宫异常出血的临床价值。方法:选取2014年12月至2016年12月佛山市南海区第三人民医院收治的子宫异常出血患者300例为研究对象,患者接受单纯阴道超声、宫腔镜检查或宫腔镜联合阴道超声检查(以下简称联合诊断),以病理检查结果为准,对比3种诊断方法符合率、漏诊率、误诊率,比较不同诊断方法对各种病理类型的诊断符合率,分析单纯阴道超声诊断、宫腔镜诊断和联合诊断子宫异常出血的效能。结果:300例患者临床诊断显示AUB阳性280例、阴性20例。其中,阴道超声诊断、宫腔镜诊断、联合诊断与病理结果符合率分别为70.67%、83.67%、91.67%,3种方法诊断符合率比较差异均有统计学意义(均P<0.05);联合诊断、宫腔镜诊断的漏诊率、误诊率明显低于阴道超声诊断,其差异均有统计学意义(均P<0.05);单纯宫腔镜诊断、联合诊断对子宫内膜癌、子宫黏膜下肌瘤、子宫内膜息肉的诊断符合率均高于单纯阴道超声诊断,且差异均有统计学意义(均P<0.05);联合诊断子宫异常出血的灵敏度91.43%、特异度95.00%、准确度91.67%高于单纯阴道超声诊断(71.43%、60.00%、70.67%)或宫腔镜诊断(85.71%、55.00%、83.67%);宫腔镜诊断灵敏度、准确度高于阴道超声诊断,其差异具有统计学意义(P<0.05)。结论:对于异常子宫出血患者,采用联合诊断可以提高单纯阴道超声诊断/宫腔镜诊断的灵敏度、特异度、准确度,尤其对子宫内膜息肉、黏膜下肌瘤、子宫内膜癌检出率高,值得在临床推广应用。

Objective： To compare the clinical value of simple transvaginal ultrasonography,hysteroscopy and their combination in the diagnosis of abnormal uterine bleeding（ AUB）. Methods： 300 patients with AUB treated in the hospital from December 2014 to December 2016 were enrolled in the study. All patients were examined with simple transvaginal ultrasonography,hysteroscopy and hysteroscopy combined with transvaginal ultrasonography（ combined diagnosis）. With pathological results as the standard,the diagnostic coincidence rate,missed diagnosis rate and misdiagnosis rate of the three kinds of diagnosis methods were compared. Results： Among the 300 patients,there were 280 ones AUB positive and 20 ones negative. The coincidence rate of transvaginal ultrasonography,hysteroscopy and combined diagnosis with pathological diagnosis were 70. 67%,83. 67% and 91. 67% respectively,with statistically significant differences between groups（ P〈0. 05）. The missed diagnosis rates and misdiagnosis rates of combined diagnosis and hysteroscopy were obviously lower than those of transvaginal ultrasonography which were 22. 00% and 7. 33% respectively（ P〈0. 05）. The coincidence rates of hysteroscopy and combined diagnosis in the diagnosis of endometrial carcinoma,submucous myoma and endometrial polyp were higher than those of transvaginal ultrasonography（ P〈0. 05）. The sensitivity,specificity and accuracy of combined diagnosis（ 91. 43%,95. 00%,91. 67%） in the diagnosis of AUB were higher than those of transvaginal ultrasonography（ 71. 43%,60. 00%,70. 67%） and hysteroscopy（ 85. 71%,55. 00%,83. 67%）. The diagnostic sensitivity and accuracy of hysteroscopy were higher than those of transvaginal ultrasonography（ P〈0. 05）. Conclusions： For patients with AUB,the combined diagnosis of transvaginal ultrasonography and hysteroscopy can improve the diagnosticsensitivity,specificity and accuracy,especially for endometrial polyps,submucous myoma and endometrial carcinoma,thusly worthy of clinical promotion.