绝经后阴道流血的宫腔镜诊断与激光治疗

探讨宫腔镜对绝经后阴道流血的病因诊断和激光治疗的安全性和有效性。方法:对139例绝经后阴道流血患者作宫腔镜检查,根据镜下诊断结果分别行诊断性刮宫和宫腔镜直视下Nd:YAG激光治疗。结果:以病理标准为金标准,则宫腔镜诊断子宫内膜癌及子宫肉瘤的敏感性为100％,特异性为100％。诊断子宫内膜息肉的敏感性为97.1％,特异性为100％。诊断粘膜下肌瘤的敏感性为100％,特异性为100％。诊断萎缩性子宫内膜炎的敏感性为100％,特异性为100％。宫腔镜诊断与病理学诊断具有高度的一致性。所有手术均顺利进行,平均手术时间3.0±10.2分钟(3～30分钟),患者对宫腔镜检查的耐受性较好,术中术后未发生严重并发症,术后B超随访1～3月宫腔内赘生物均消失。结论:宫腔镜检查对绝经后阴道流血的病因具有较高的诊断价值,宫腔镜下激光治疗宫腔内良性病变如子宫内膜息肉和子宫粘膜下肌瘤安全可行。

Objective: To study diagnosis value of Hysteroscopic examination for patients with behind menopause vaginal bleeding and safety of Nd: YAG laser ablation of endometrial polyps and submucous leiomyoma. Methods: A total of 139 patients with behind menopause vaginal bleeding were included in this group, recruited from the outpatient department of Obstetrics and Gynecology Hospital of Shanghai Fu Dan University during the period from April 1996 to October 2001. According to diagnostic outcome of hysteoscopic Nd: YAG laser ablation, respectively proceed dilation and curettage and hyste-roscopic Nd:YAG laser ablation. There is a contrast analysis between hysteroscopic examination and pathological diagnosis. Results: There were 100% sensitivity and particularly in diagnosis of endometrial carcinoma -uterine sarcoma-.submucous leiomyoma and atrophic endometritis by Hysteroscopic examination, sensitivity of endometrial polyps under Hysteroscopy examination was 97.1% , particularity was 100%. Hysteroscopic examination was highly in accordance with pathologic diagnosis. All surgical operations were completed successfully. The average uterine depth was 6. 8cm(6 -9) and the average operative time was 3. 0 ± 10.2 minutes, patients with behind menopause vaginal bleeding were able to endure hysteroscopic examination. No serious complications occurred during or after operation. The intrauterine neoplasms disappeared in 83 cases a follow - up period of 1 - 3 month. Conclusion: Hysteroscopic examination is of great significance for cause of disease behind menopause vaginal bleeding. For patients having diagnosed endometrial polyps and submucous leiomyma, hysteroscopic Nd; YAG laser ablation is an effective and safe approach of treatment