宫腔镜诊断和处理78例宫腔内占位的临床分析

The diagnosis and treatment of 78 patients with uterine mass with hysteroscopy

目的 探讨B超诊断为宫腔内占位的妇科疾病类型和宫腔镜治疗的效果。 方法 回顾分析我院 2 0 0 0年 8月～ 2 0 0 1年 7月宫腔内占位 78例 ,在宫腔镜下检查和治疗后取下病变 ,并送病理。 结果 78例中有症状者 6 2例 (79 5 % )。其中异常阴道出血者 5 8例 (74 4 % ) ,腹痛或异常阴道排液 4例 (5 1% ) ;其余 16例 (2 0 5 % )无症状查体发现。术中无 1例出现明显并发症。术后病理结果 :子宫内膜息肉 4 0例 ,单纯性增生 16例 ,复合性增生 1例 ,子宫内膜或腺体非典增生 3例 ,子宫内膜癌 1例 ,子宫肌瘤或腺肌瘤 11例 ,不全流产 1例 ,正常子宫内膜 5例 ,分别占 5 1 3% ,2 0 5 % ,1 3% ,3 9% ,1 3% ,14 1% ,1 2 8% ,6 4 1%。绝经期宫腔内的异常占位 ,85 7% (30 / 35例 )都是良性病变。术后随访 2～ 12个月 ,随访率 88 5 % (6 9/ 78) ,总满意率为 94 2 % (6 5 / 6 9)。绝经的 35例中 4例失访 ,31例全部满意手术结果。 结论 B超诊断为宫腔内占位的患者 ,以良性病变为主 ,绝经期的宫腔内异常占位 ,更适于宫腔镜手术。

Objective To find out what kind of disease the uterine mass diagnosed by B-ultrasound is and discuss its outcome treated by hysteroscopy. Methods 78 cases of uterine mass were treated by hysteroscopy in our hospital from Auguest 2000 to July.2001, Masses were detected,cut out and sent for pathologic diagnosis. Results sixty-two cases (79.49%)(62/78)came to see their doctors with the symptoms,including abnormal bleeding (58) and abnormal discharge or abdominal pain(4).The other 16 cases were detected in regular physical examination without any complaint.No complication occurred during the operation.The results of pathology were as follows:endometrial polyp 51.3%(40/78),simplex hyperplasia 20.5%(16/78),complex hyperplasia 1.3%(1/78),atypical hyperplasia 2.6%(2/78),endometrial adenocarcinoma 1 3% (1/78),leiomyoma or adenomyoma 14.1%(11/78),incomplete abortion 1.3%(1/78),and no abnormolily 5 cases(6.4%).Thirty-five cases of mass were discovered in postmenopausal women and 85.7%(30/35)of cases were benign.Sixty-nine patients(88.5%)were followed up for (2～12)months after the operation.Sixty-five of them were satisfied with treatment.The satisfying rate was 94.2%.Especially with the postmenopausal women,all 31 cases were satisfied with the operation though 4 cases no longer contacted us. Conclusions Most of utering masses diagnosed by B ultrasound are benign.Hysteroscopy therapy is an appropriate method for the uterine mass in postmenopausal women.