CAJ | 학술논문

目的探讨阴道超声及宫腔镜检查对绝经后子宫出血的临床诊断价值.方法选取146例因绝经后子宫出血就诊的患者作为研究对象,入院后先行阴道超声检查,然后行宫腔镜检查并且取异常子宫内膜做病理检查,以病理检查结果为最终诊断,比较阴道超声检查及宫腔镜检查诊断绝经后子宫出血的敏感性及阳性预测值.结果(1)病理检查结果显示:146例中子宫内膜非特异性病变有74例(50.69%),其中阴道超声检出57例,宫腔镜检出70例;子宫内膜息肉有20例(13.70%),其中阴道超声检出13例,宫腔镜检出18例;子宫内膜增殖症28例(19.18%),其中阴道超声检出11例,宫腔镜检出26例;子宫粘膜下肌瘤16例(10.96%),其中阴道超声检出14例,宫腔镜检出11例;子宫内膜癌8例(5.48%),其中阴道超声检出4例,宫腔镜检出6例.(2)在子宫内膜非特异性病变、子宫内膜增殖症诊断方面,宫腔镜检查敏感性(分别为94.59%,92.86%)明显高于阴道超声(分别为77.03%,39.29%)(P<0.05);在子宫内膜非特异性病变、子宫内膜息肉、子宫粘膜下肌瘤、子宫内膜癌诊断方面,宫腔镜检查阳性预测值(分别为93.33%,81.82%,92.86%,100.00%)明显高于阴道超声(分别为75.00%,54.17%,63.64%,44.44%)(P<0.05).结论阴道超声检查在绝经后子宫出血时可以作为初步筛查方法,宫腔镜检查相对灵敏度及阳性预测值更高一些,并且同时能取子宫内膜进行病理检查,因此可以作为进一步检查的重要手段.
목적탐토음도초성급궁강경검사대절경후자궁출혈적림상진단개치.방법선취146례인절경후자궁출혈취진적환자작위연구대상,입원후선행음도초성검사,연후행궁강경검사병차취이상자궁내막주병리검사,이병리검사결과위최종진단,비교음도초성검사급궁강경검사진단절경후자궁출혈적민감성급양성예측치.결과(1)병리검사결과현시:146례중자궁내막비특이성병변유74례(50.69%),기중음도초성검출57례,궁강경검출70례;자궁내막식육유20례(13.70%),기중음도초성검출13례,궁강경검출18례;자궁내막증식증28례(19.18%),기중음도초성검출11례,궁강경검출26례;자궁점막하기류16례(10.96%),기중음도초성검출14례,궁강경검출11례;자궁내막암8례(5.48%),기중음도초성검출4례,궁강경검출6례.(2)재자궁내막비특이성병변、자궁내막증식증진단방면,궁강경검사민감성(분별위94.59%,92.86%)명현고우음도초성(분별위77.03%,39.29%)(P<0.05);재자궁내막비특이성병변、자궁내막식육、자궁점막하기류、자궁내막암진단방면,궁강경검사양성예측치(분별위93.33%,81.82%,92.86%,100.00%)명현고우음도초성(분별위75.00%,54.17%,63.64%,44.44%)(P<0.05).결론음도초성검사재절경후자궁출혈시가이작위초보사사방법,궁강경검사상대령민도급양성예측치경고일사,병차동시능취자궁내막진행병리검사,인차가이작위진일보검사적중요수단.
Objective To investigate the clinical effect and value of transvaginal sonography and hysteroscopy in the diagnosis of uterine bleeding after menopause.Methods 146 cases with postmenopausal bleeding were studied. All patients were examined by vaginal ultrasound and hysteroscopy after admission. The histopathology provides the final diagnosis. The sensitivity and the positive predictive value of the two methods were compared. Results (1) In all patients, pathologic diagnosis of endometrial nonspecific lesions 74 cases (50.69%), with ultrasound diagnosis of 57 cases and hysteroscopy diagnosis of 70 cases; pathologic diagnosis of endometrial polyps 20 cases(13.70%), with ultrasound diagnosis of 13 cases and hysteroscopy diagnosis of 18 cases;pathologic diagnosis of endometrial hyperplasia 28 cases(19.18%), with ultrasound diagnosis of 11 cases and hysteroscopy diagnosis of 26 cases;pathologic diagnosis of submucous myoma 16 cases (10.96%), with ultrasound diagnosis of 14 cases and hysteroscopy diagnosis of 11 cases;pathologic diagnosis of endometrial cancer 8 cases(5.48%), with ultrasound diagnosis of 4 cases and hysteroscopy diagnosis of 6 cases. (2) The sensitivities of hysteroscopy on the diagnosis of endometrial nonspecific lesions(94.59%) and endometrial hyperplasia(92.86%) were significantly higher than that of vaginal ultrasound(77.03% and 39.29%)(P<0.05);The positive predictive values of hysteroscopy on the diagnosis of endometrial nonspecific lesions(93.33%), endometrial polyps(81.82%), submucous myoma(92.86%), endometrial cancer(100.00%) were significantly higher than that of vaginal ultrasound(75.00%,54.17%,63.64%,44.44%)(P<0.05). Conclusion Vaginal ultrasound examination is a preliminary screening method for patients of postmenopausal uterus bleeding. And hysteroscopy with biopsy can be used as a further check method, for its high sensitivity and positive predictive value compared to transvaginal ultrasonography.