经阴道超声测量子宫内膜厚度诊断绝经后妇女疾病的价值

Diagnosis of endometrial pathology in postmenopausal women by transvaginal ultrasonographic endometric thickness

目的 根据内膜病理组织学结果评价经阴道超声测量子宫内膜厚度对绝经后妇女子宫内膜疾病诊断的价值。方法 将 63例病人分为 4组 ,第 1组为无既往内膜病史及服用他莫昔芬和雌激素者 ;第 2组为服用他莫昔芬组 ;第 3组为服用雌激素组 ;第 4组为既往有内膜疾病史者。对 4组病人进行超声测量子宫内膜厚度 ,以内膜厚度 >5mm为临界值 ,跟踪其病理诊断结果。结果 在四组中以内膜厚度≤ 5mm为指标是除外内膜疾病的良好指标 ;组 1和组 4中 ,内膜厚度 >5mm阳性预测值为 90 %和 63 %。在组 2和组 3中 ,内膜厚度 >5mm诊断疾病准确性差 ,阳性预测值均为 17%。结论 单纯超声子宫内膜厚度测量是早期发现子宫内膜疾病的敏感方法 ,但仅局限于无用药史的病例 ,随着患者用药复杂程度增加 。

Objective To compare transvaginal sonographic evaluation of the endometrium with histology obtained by endometrial biopsy in menopausal women to determine whether endometric thickness might be useful in the evaluation of postmenopausal women. Methods The study included 63 unselected postmenopausal women who had endometrial biopsy in final. They were cut into 4 groups. Group 1: No previous history of endometrial disease and no tamoxifen and estrogen taken history. Group 2: Having Tamoxifen taken history. Group 3: Having estrogen taken history. Group 4: Having previous history of endometrial disease. All the patients were evaluated by transvaginal sonographic endometrium thickness, performed immediately before endometrial biopsy. Results Using the endometrial thickness ≤5 mm cut off level were of good quality to predict no risk of endometrial disease in all 4 groups. In Group 1 and Group 4, cut off value >5mm performed well in predicting high risk of endometrial diseases with positive predicting value of 90% and 63%. In group 2 and Group 3, >5 mm could not be used as a accurate rule, the positive predicting value were 17% and 17%. Conclusion Endometrial thickness was useful in menopausal women with no drugs taken history and previous diseases. But under a more confused and fast changing environment, this criteria should be changed accordingly.