宫腔镜联合阴道超声检查在绝经后妇女子宫内膜息肉诊断中的价值

The value of hysteroscopy combined with transvaginal ultrasound examination for diagnosing endometrial polyps of postmenopausal women

目的:探讨阴道超声联合宫腔镜诊断绝经后妇女子宫内膜息肉价值。方法:选取2017年6月—2019年3月因异常子宫出血或阴道超声提示子宫内膜增厚而行宫腔镜检查的绝经后妇女673例。年龄61.3±9.3岁,绝经时间10.7±2.7年。以病理结果为最终诊断,统计阴道超声联合宫腔镜诊断子宫内膜息肉效能。结果:阴道超声诊断子宫内膜息肉256例,漏诊377例,误诊11例;灵敏度40.4%,特异度72.5%,阳性似然比1.47,阴性似然比0.82,约登指数是0.13;阴道超声联合宫腔镜诊断子宫内膜息肉550例,漏诊83例,误诊4例;灵敏度86.9%,特异度90.0%,阳性似然比8.69,阴性似然比0.15,约登指数0.77。阴道超声联合宫腔镜提高了诊断子宫内膜息肉的灵敏度、特异度、阳性似然比和越等指数,降低了阴性似然比。结论:阴道超声联合宫腔镜对子宫内膜息肉诊断较单纯使用阴道超声更准确,漏诊率降低。

Objective:To investigate the value of hysteroscopy combined with transvaginal ultrasound examination for diagnosing endometrial polyps of postmenopausal women.Methods:From June 2017 to March 2019,673 postmenopausal women who underwent hysteroscopy because of abnormal uterine bleeding or endometrial thickening indicated by transvaginal ultrasound were included this study.The average age of these included women was 61.3±9.3 years old,and their average durational of menopause was 10.7±2.7 years.The efficacy of transvaginal ultrasound examination combined with hysteroscopy for diagnosing endometrial polyps was calculated based on the final pathological results as diagnosis gold standard.Results:256 women with endometrial polyps were diagnosed by transvaginal ultrasound,377 women with missed diagnosis,and 11 women were misdiagnosed.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and Yoden index of diagnosis by transvaginal ultrasound were 40.4%,72.5%,1.47,0.82,and 0.13,respectively.550 women with endometrial polyps were diagnosed by hysteroscopy combined with transvaginal ultrasound examination,83 women with missed diagnosis,and 4 women were misdiagnosed.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and Yoden index of diagnosis by hysteroscopy combined with transvaginal ultrasound were 86.9%,90.0%,8.69,0.15,and 0.77,respectively.Hysteroscopy combined with transvaginal ultrasound examination had increased the sensitivity,specificity,positive likelihood ratio,and yoden index,while had decreased negative likelihood ratio.Conclusion:Vaginal ultrasound examination combined with hysteroscopy for diagnosing endometrial polyps of postmenopausal women has more accurate and lower of missed diagnosis rate.