功能失调性子宫出血宫腔镜检查结果分析

目的：应用宫腔镜检查功能失调性子宫出血，以探明该项技术临床应用的价值和成果。方法：将我科收治的子宫疾病998例进行宫腔镜检查，逐一登记、分类、整理、计算并进行统计学处理。结果：宫腔镜检查的子宫疾病，按其构成比，居首位的是功能失调性子宫出血，依次是黏膜下子宫肌瘤、子宫内膜息肉、带环出血及子宫颈息肉。以上5种共占受检人数的90．2％。且比临床诊断更直观、快捷、准确。结论：通过临床应用表明宫腔镜技术是现代诊断和治疗功能性子宫出血的金标准和首选的外科微创治疗方法。     

宫腔镜检查良性子宫出血性疾病的临床价值

目的:比较宫腔镜检查与诊刮术诊治良性子宫出血性疾病的临床价值。方法:应用宫腔镜检查良性子宫出血性疾病患者68例,镜下直视定位取材或定位诊刮;对照组65例行传统诊刮术。所取组织全部送检。结果:宫腔镜诊断后镜下直接取材与治疗的治愈率为98.53%(67/68),无误诊或漏诊。传统诊刮术后采取对因治疗的治愈率为89.23%(58/65),漏诊子宫内膜息肉13例,粘膜下肌瘤3例,子宫内膜增殖症4例。结论:宫腔镜检查良性子宫出血性疾病,可提高子宫内膜息肉、粘膜下肌瘤的诊断率,并可观察到更详细的形态学变化,并可在直视下定位取材与治疗。     

B超、宫腔镜联合检查对放置宫内节育器后子宫异常出血的诊断价值

目的探讨B超联合宫腔镜检查对放置宫内节育器(IUD)后子宫异常出血(AUB)的诊断价值。方法回顾性分析218例放置IUD后子宫异常出血病例进行B超及宫腔镜检查的临床资料。结果218例检查中,确诊IUD形态异常13例,占5.96%;位置异常37例,占16.97%;子宫腔异常63例,占28.90%;子宫内膜病变113例,占51.83%。B超、宫腔镜、病理检查总符合率分别为49.61%、69.88%、91.56%(P<0.005)。结论放置IUD后子宫异常出血的原因与IUD形态、大小、位置、宫腔形态及内膜变化有关。对放置IUD后子宫异常出血的病例进行B超及宫腔镜检查是一种具有直观、创伤少、准确的最佳检查方法。     

Case report of malignant endometrial polyps

The aims of this retrospective review were to determine the frequency of malignant endometrial polyps diagnosed with ambulatory hysteroscopy in the Obstetrics/ Gynaecology Department of HDE, Lisbon, between January 2001 and December 2005 and to characterize these cases according to risk factors, sonographic and endoscopic findings tumoral histology, and tumor stage. We found seven cases of malignant endometrial polyps in a total of 1333 polyps initially diagnosed: an incidence rate of 0. 53%. These seven patients had a mean age of 68 years (55–82 years), and all were postmenopausal, with five having one risk factor each for endometrial cancer. Metrorrhagia was present in six of the seven patients (85.7%). Ultrasonography was abnormal in all seven patients, with a mean endometrial thickness of 26 mm (range: 12–44 mm). The hysteroscopy images suggested malignancy in all cases. All except one patient had a single polyp. The polyps had volumes between 1.5 and 3 cm; two were removed completely and five were biopsed. The histological subtype was: mixed endometrioid/serous papillary or clear cell (2), adenocarcinoma with squamous differentiation (2), carcinosarcoma (2), and clear cell carcinoma (1). Malignancy inside polyps is rare, but diagnostic hysteroscopy with visual guided biopsies can identify these cases in the earlier stages. The risk factors are not different from those of other endometrial carcinomas, but the histological subtype seems to point to more aggressive cancers.     

Three-dimensional hysterosonography versus hysteroscopy for the detection of intracavitary uterine abnormalities.

OBJECTIVE: To compare 3-dimentional hysterosonography (3-DHS) and diagnostic hysteroscopy for the evaluation of intrauterine lesions. METHODS: In this prospective study 124 women with suspected intrauterine abnormality on 2-D ultrasonography or on hysterosalpingography were scheduled to undergo hysteroscopy, 3-DHS, and 3-D power Doppler (3-DPD) examination. However, 3-DHS could not be performed in 3 of the women because of cervical stenosis. The sensitivity and specificity of 3-DHS and 3-DPD were compared with those of hysteroscopy. RESULTS: Of the 121 women found to have an intracavitary abnormality, 20 had polyps, 11 had myomas, 2 had Müllerian duct anomalies, and 6 had synechiae on hysteroscopy. There was agreement between hysteroscopy and 3-DHS in 19 of the polyp cases, 11 of the myoma cases, 2 of the Müllerian anomaly cases, and 4 of the synechiae cases. Examination with 3-DHS and 3-DPD reached a sensitivity of 91.9% and specificity of 98.8%, with a positive predictive value of 97.1% and a negative predictive value of 96.5%, respectively. CONCLUSIONS: Examination with 3-DHS and 3-DPD both allows for accurate assessment of intrauterine abnormalities.     

宫-腹腔镜联合在不孕症诊治中的应用

目的:应用宫-腹腔镜技术,探讨宫-腹腔镜在女性不孕症诊治中的价值。方法:回顾性分析3年间宫-腹腔镜诊治女性不孕症61例临床资料,结果:61例中盆腔粘连16例,输卵管炎12例,宫腔粘连8例,子宫内膜异位症6例,子宫内膜息肉5例,子宫内膜炎5例,多囊卵巢综合症4例,子宫纵隔1例,子宫粘膜下瘤1例,术后妊娠率分别为56.25%,50%,62.5%,83.33%,60%,60%,75%,100%,100%。盆腔粘连,宫腔粘连,输卵管炎,子宫内膜异位症是引起不孕症的主要病因。结论:应用宫-腹腔镜技术能早期,直观,准确地明确不孕症盆腔病因并予以针对性治疗,并在直视下通夜,动态观察输卵管通畅度和形态。大大降低了常规通夜术的假阳性,假阴性率。     

宫腔镜诊断子宫内膜异常回声236例临床分析

目的通过对宫腔镜检查结果与病理的确定诊断结果进行比较分析，探讨宫腔镜检查在临床应用中的价值。方法236例子宫内膜异常回声者，行宫腔镜检查及病理检查，比较二者诊断结果的符合率。结果236例子宫内膜异常回声病例中，子宫内膜息肉123例，子宫内膜增生症64例，子宫粘膜下肌瘤40例，子宫内膜腺肌瘤型息肉5例，子宫内膜癌2例，宫腔内胚物残留2例。病理诊断与宫腔镜诊断的符合率为96．61％。结论经宫腔镜直视检查及定位活检后，可提高确诊率。宫腔镜作为一种微创、安全的技术手段，是目前不可替代的检查方法。     

宫腔镜治疗子宫颈糜烂的疗效观察

目的探讨宫腔镜治疗宫颈糜烂的价值。方法将２１４例宫颈糜烂的患者随机分为宫腔镜手术治疗组和ＣＯ２激光治疗组分别采用宫腔镜直视下电切加局部电凝和ＣＯ２激光汽化进行治疗。结果宫腔镜手术治疗组治疗宫颈糜烂一次治愈率为９４．４６％（１０２／１０８）,而ＣＯ２激光治疗组一次治愈率为７１．２０％（７６／１０６）,有非常显著性差异（Ｐ＜０．００１）;宫腔镜手术组术中出血明显少于ＣＯ２激光组,有显著性差异（Ｐ＜０．０１）;两组治疗后的不良反应无明显差异（Ｐ＞０．０５）。结论宫腔镜治疗子宫颈糜烂一次治愈率高,术中出血少,有临床应用价值。     

宫腔镜输卵管妊娠插管注射MTX治疗宫外孕24例

目的利用宫腔镜插管对输卵管妊娠保守治疗，探讨其临床价值。方法2006～2008年24例宫外孕患者行患侧输卵管插管注入MTX 20～40mg，成功杀死胚胎。结果方法简便可行，费用少，值得推广。结论采用宫腔镜输卵管妊娠插管保守治疗成功率高，消除了手术的痛苦，保存了完整输卵管，减少并发症。     

超声监护在完全子宫纵隔伴有双宫颈双阴道畸形宫腔镜电切术的临床应用

目的探讨超声监视下宫腔镜电切术治疗完全子宫纵隔伴有双宫颈双阴道畸形的临床价值。方法在超声监视下，对17例完全子宫纵隔伴有双宫颈双阴道患者行宫腔镜子宫纵隔切开术。结果在超声监视下17例均一次完成纵隔电切手术，无子宫穿孔，膀胱、肠管损伤及水中毒等并发症。术后1年随访，宫腔形态正常，无粘连积血。17例患者术后妊娠情况与术前妊娠情况比较：足月活产率明显增高，流产及早产率明显下降，均有显著性差异（P〈0．001），足月分娩者均未发生子宫破裂、胎盘植入及产后大出血等分娩并发症发生。结论超声监护可以辅助完全子宫纵隔伴有双宫颈双阴道畸形宫腔镜电切术顺利进行并取得良好的效果，值得推广。