阴道超声联合宫腔镜诊断绝经期妇女子宫内膜增厚的临床价值

Value of transvaginal sonography combined with hysteroscopy in diagnosis of endometrial thickening in menopausal women

目的探讨阴道超声(TVS)联合宫腔镜诊断绝经期妇女子宫内膜增厚的临床价值。方法回顾性分析TVS提示子宫内膜增厚≥5 mm的住院绝经期妇女170例的临床资料。其中的69例伴随阴道流血等症状。145例患者施行了宫腔镜及内膜病理学检查(宫腔镜组),25例患者施行了诊断性刮宫及内膜病理学检查(诊刮组)。比较TVS联合宫腔镜检查与TVS联合诊断性刮宫对绝经期子宫内膜增厚的诊断价值。结果宫腔镜组对于子宫内膜萎缩(90.9%vs.50.0%)、子宫内膜增生(87.5%vs.57.1%)、子宫内膜息肉(80.6%vs.66.7%)的诊断灵敏度均优于诊刮组(P<0.05),两组子宫内膜癌诊断率相仿(75.0%vs.80.0%)(P>0.05)。结论 TVS发现绝经期子宫内膜增厚≥5 mm的女性,无论是否伴有阴道流血的症状,都应尽早行相关检查,明确内膜病变性质。TVS联合宫腔镜诊治具有安全性好、准确性高和微创的优点,可作为明确子宫内膜病变的首选。

Objective To investigate the value of transvaginal sonography(TVS) combined with hysteroscopy in the diagnosis of endometrial thickening in menopausal women.Methods Clinical data of 170 menopausal women with endometrial thickening ≥ 5 mm indicated by TVS were retrospectively analyzed,of whom 69 cases were with clinical symptoms of vaginal bleeding.Hysteroscopy and endometrial pathology were performed in 145 cases(group A) and curettage and endometrial pathology were performed in 25 cases(group B).The value of hysteroscopy combined with TVS and curettage combined with TVS in the diagnosis of endometrial thickening in menopausal women was compared.Results Compared to group B,the sensibility in the diagnosis of atrophy of endometrium(90.9% vs.50.0%),hyperplasia endometrii(87.5% vs.57.1%) and endometrial polyps(80.6% vs.66.7%) was higher in group A(P<0.05).In the diagnosis of endometrial carcinoma,the sensibility of groups of A and B was similar(75.0% vs.80.0%)(P>0.05).Conclusion Early examination should be performed to determine the nature of intimal lesions in the women with endometrial thickening ≥ 5 mm indicated by TVS whether with or without symptoms of vaginal bleeding.TVS combined with hysteroscopy has the advantages of good safety,high accuracy and minimally invasive,which may be taken as the first choice for determining the nature of endometrial lesions.