宫腔镜检查与诊断性刮宫在绝经后阴道出血病因诊断中的应用价值

Comparison of the application value of hysteroscopy and diagnostic curettage in etiological diagnosis of postmenopausal bleeding

目的比较宫腔镜检查与诊断性刮宫在绝经后阴道出血(PMB)病因诊断中的临床应用价值。方法回顾性选取2018年5月至2020年6月在首都医科大学附属北京康复医院妇科行宫腔镜检查及诊断性刮宫的PMB患者各120例,比较宫腔镜检查与诊断性刮宫对PMB病因诊断的价值。结果宫腔镜检查19例未见宫腔异常,101例见宫腔病变,包括27例子宫内膜息肉(EP)、20例子宫内膜增殖症(EH)、12例宫腔粘连(IUA)、10例子宫内膜癌(EC)、12例宫腔感染、20例子宫黏膜下肌瘤(SUM)。诊断性刮宫21例未见宫腔异常,99例见宫腔病变,包括30例EP、20例EH、15例IUA、6例EC、13例宫腔感染、15例SUM。以术后病理学诊断结果作为金标准,宫腔镜检查的确诊率为92.50%,误诊率为5.83%,漏诊率为1.67%;诊断性刮宫的确诊率为91.67%,误诊率为5.83%,漏诊率为2.50%。宫腔镜检查诊断PMB患者宫腔病变的敏感度为97.92%,特异度为70.83%,准确率为92.50%,诊断性刮宫诊断PMB患者宫腔病变的敏感度为96.84%,特异度为72.00%,准确率为91.67%,二者的敏感度、特异度及准确率比较差异均无统计学意义(P>0.05)。结论宫腔镜检查与诊断性刮宫在PMB病因诊断中均有一定的应用价值,有助于进一步指导临床治疗。

Objective To compare the clinical application value of hysteroscopy and diagnostic curettage in etiological diagnosis of postmenopausal bleeding(PMB).Method A retrospective study was conducted.120 patients with PMB who underwent hysteroscopy and 120 patients with PMB who underwent diagnostic curettage at the Department of Gynecology,Beijing Rehabilitation Hospital Affiliated to Capital Medical University from May 2018 to June 2020 were enrolled in the study.The value of hysteroscopy and diagnostic curettage in etiological diagnosis of PMB was compared.Result Hysteroscopy found that there were 19 cases without intrauterine abnormalities and 101 cases with intrauterine lesions,including 27 cases with endometrial polyps(EP),20 cases with endometrial hyperplasia(EH),12 cases with intrauterine adhesion(IUA),10 cases with endometrial carcinoma(EC),12 cases with intrauterine infection and 20 cases with submucous uterine myoma(SUM).Diagnostic curettage found that there were 21 cases without intrauterine abnormalities and 99 cases with intrauterine lesions,including 30 cases with EP,20 cases with EH,15 cases with IUA,6 cases with EC,13 cases with intrauterine infection and 15 cases with SUM.With postoperative pathological results as the gold standard,the diagnosis rate,misdiagnosis rate and missed diagnosis rate of hysteroscopy were 92.50%,5.83%and 1.67%,which of diagnostic curettage were 91.67%,5.83%and 2.50%.The sensitivity,specificity and accuracy of hysteroscopy for diagnosing intrauterine lesions in patients with PMB were 97.92%,70.83%and 92.50%,which of diagnostic curettage were 96.84%,72.00%and 91.67%,without statistical difference(P>0.05).Conclusion Hysteroscopy and diagnostic curettage both have certain value in etiological diagnosis of PMB,and can assist in clinical treatment.