CAJ | 학술논문

目的：探讨宫腔镜手术患者的临床特点及宫腔镜手术的相关临床热点问题。方法回顾性分析2014年7月至12月在北京协和医院妇产科行宫腔镜手术的315例患者资料，总结其临床及病理特点，并对宫腔镜手术相关临床热点问题包括PALM-COEIN病因分类，子宫内膜息肉的超声诊断，以及特殊病例子宫腺肌瘤样息肉、乳腺癌辅助内分泌治疗后宫腔占位、子宫瘢痕憩室的特点进行分析。结果315例宫腔镜手术患者中，有异常子宫出血（abnormaluterinebleeding， AUB）症状者172例，无症状者143例， AUB患者恶性病变的检出率明显高于无症状者（15.7％比2.1％， P＝0.000）。育龄期AUB患者128例，进行PALM-COEIN病因分类，最常见类型为子宫内膜息肉（AUB-P）（45.3％，58／128）。子宫内膜息肉患者160例，阴道超声用于诊断子宫内膜息肉的阳性预测值、阴性预测值、敏感性、特异性和准确性分别为80％、75％、71％、81％和76％。子宫腺肌瘤样息肉17例，其中非典型腺肌瘤样息肉3例；10例患者有乳腺癌手术史，9例辅助内分泌治疗，宫腔病理均为良性；剖宫产术后子宫瘢痕憩室患者5例，宫腔镜下均有特异表现。结论宫腔镜作为微创手术技术，对于诊断和治疗AUB和宫腔占位具有重要价值，对于子宫内膜息肉、乳腺癌术后的子宫内膜增厚、剖宫产术后的子宫瘢痕憩室等大多数良性病变，宫腔镜检查明确诊断的同时可以达到治疗目的。对宫腔镜诊治诸多热点问题的探讨有助于改善临床处理策略。
목적：탐토궁강경수술환자적림상특점급궁강경수술적상관림상열점문제。방법회고성분석2014년7월지12월재북경협화의원부산과행궁강경수술적315례환자자료，총결기림상급병리특점，병대궁강경수술상관림상열점문제포괄PALM-COEIN병인분류，자궁내막식육적초성진단，이급특수병례자궁선기류양식육、유선암보조내분비치료후궁강점위、자궁반흔게실적특점진행분석。결과315례궁강경수술환자중，유이상자궁출혈（abnormaluterinebleeding， AUB）증상자172례，무증상자143례， AUB환자악성병변적검출솔명현고우무증상자（15.7％비2.1％， P＝0.000）。육령기AUB환자128례，진행PALM-COEIN병인분류，최상견류형위자궁내막식육（AUB-P）（45.3％，58／128）。자궁내막식육환자160례，음도초성용우진단자궁내막식육적양성예측치、음성예측치、민감성、특이성화준학성분별위80％、75％、71％、81％화76％。자궁선기류양식육17례，기중비전형선기류양식육3례；10례환자유유선암수술사，9례보조내분비치료，궁강병리균위량성；부궁산술후자궁반흔게실환자5례，궁강경하균유특이표현。결론궁강경작위미창수술기술，대우진단화치료AUB화궁강점위구유중요개치，대우자궁내막식육、유선암술후적자궁내막증후、부궁산술후적자궁반흔게실등대다수량성병변，궁강경검사명학진단적동시가이체도치료목적。대궁강경진치제다열점문제적탐토유조우개선림상처리책략。
Objective To investigate the clinical characteristics of hysteroscopic patients and to discuss some inconclusive questions in hysteroscopy .Methods A total of 315 patients who underwent hysteroscopy in Peking Union Medical College Hospital from July to December , 2014 were included in this retrospective study . Clinical and pathological features of these patients were summarized .Clinically relevant inconclusive questions in-cluding PALM-COEIN classification , ultrasonic diagnosis of endometrial polyp , case characteristics of adenomyo-matous polyp , intrauterine space-occupying lesion induced by adjuvant endocrine therapy for breast cancer , and uterine scar diverticulum were analyzed based on the data of these patients .Results Among the 315 patients, 172 cases presented with abnormal uterine bleeding (AUB), and the other 143 were asymptomatic.Malignant lesions were more common in AUB patients compared with asymptomatic patients ( 15.7% vs.2.1%, P =0.000 ) .In the AUB patients , 128 were of reproductive age , in whom the most common condition was endometri-al polyps (58 cases, 45.3%) according to PALM-COEIN classification system .All together 160 cases of endom-etrial polyps were identified .The positive predictive value , negative predictive value , sensitivity , specificity , and accuracy of transvaginal ultrasound in diagnosing endometrial polyps were 80%, 75%, 71%, 81%, and 76%, respectively .Seventeen patients had adenomyomatous polyp , including 3 with atypical pathological features;10 patients had history of surgically treated breast cancer , 9 of whom received adjuvant endocrine therapy , and all had benign results of endometrial pathological examination;5 patients had scar diverticulum after cesarean section , all with specific hysteroscopic demonstrations .Conclusions As a minimally invasive technique , hysteroscopy plays an important role in diagnosis and treatment of AUB and intrauterine space-occupying lesion .For most benign lesions , such as endometrial polyps , endometrial hyperplasia following postoperative endocrine therapy of breast cancer , and cesarean scare diverticulum , hysteroscopy allows therapeutic operation while confirming diagnosis .Investigation into hot topics in diagnosis and treatment with hysteroscopy could help to optimize clinical strategies .