宫腔镜及超声检查在子宫内膜病变诊断中的价值

The value of hysteroscopy and ultrasonography in the diagnosis of endometrial lesions

目的:探究阴道超声检查(TVS)和宫腔镜检查(HS)在子宫内膜病变诊断中的价值。方法:回顾性分析医院收治的314例疑似子宫内膜病变患者资料,分别使用TVS和HS进行诊断检查,经术后病理学确认,或使用HS下进行组织活检,详细记录检查结果。比较子宫内膜病变中TVS和HS诊断的阳性预测值、阴性预测值、敏感度、准确率及符合率。结果:314例疑似子宫内膜病变患者术后病理检查结果无病变32例,子宫内膜病变282例;两种检查方法的子宫内膜炎、内膜癌、黏膜下肌瘤及内膜息肉诊断准确率比较,差异有统计学意义(x^2=30.721,x^2=6.252,x^2=11.109,x^2=5.710;P<0.05)。两种方法诊断灵敏度和阳性预测值比较,差异无统计学意义(x^2=2.646,x^2=0.848;P>0.05);HS检查的特异度、阴性预测值优于TVS检查,其差异有统计学意义(x^2=10.835,x^2=28.571;P<0.05)。结论:病理检查是子宫内膜病变诊断金标准,HS诊断具有较高的阴性预测值和特异性,而TVS则具有操作简单、诊断有效等优点。将TVS与HS两种诊断方法联合应用,可为子宫内膜病变诊断提供科学依据。

Objective: To investigate and compare the diagnostic values of transvaginal ultrasonography (TVS) and hysteroscopy (HS) in endometrial lesions. Methods: A total of 314 patients with suspected endometrial lesions admitted to our hospital were enrolled in this retrospective analysis. And TVS and HS were respectively adopted to implement diagnostic examination for them. And these results were further confirmed by postoperative pathology, or they were implemented tissue biopsy under HS, and the inspection results were carefully recorded. And then, the diagnostic positive predictive rate, negative predictive rate, sensitivity, accuracy rate and coincidence rate of TVS and HS in endometrial lesions were compared. Results: The results of postoperative pathological examination of 314 patients with suspected endometrial lesions showed that there were 32 cases without lesions and 282 cases with endometrial lesions. The differences of diagnostic accuracies of endometritis, endometrial carcinoma, submucosal myoma of uterus and endometrial polyps between the two methods were significant (x^2=30.721, x^2=6.252, x^2=11.109, x^2=5.710, P<0.05). While the differences of diagnostic sensitivity and positive predictive value between the two methods were no significant (x^2=2.646, x^2=0.848, P>0.05). Besides, the specificity and negative predictive value of HS were significantly superior than those of TVS (x^2=10.835, x2=28.571, P<0.05). Conclusion: Pathological examination is the gold standard for the diagnosis of endometrial diseases. HS diagnosis has higher negative predictive value and specificity, while TVS has the advantages of simple operation and effective diagnosis. Therefore, the combination of TVS and HS that is used in clinical practice can provide a scientific basis for the diagnosis of endometrial lesions.