宫腔镜在绝经后妇女子宫内膜病变中的诊治价值

目的探讨宫腔镜在绝经后子宫内膜病变中的诊治价值。方法回顾性分析2002年1月～2006年11月行官腔镜诊治的107例绝经后子宫内膜病变患者的临床资料，包括绝经后不规则阴道出血68例，B超检查子宫内膜增厚无阴道出血39例。并对手术时间、术中出血、并发症、术后病理和随访结果进行分析。结果106例顺利完成宫腔镜下检查及治疗，1例子宫穿孔，保守治愈。手术时间15～60min，（26．8±9．5）min，出血量10～60ml，（30．2±18．3）ml。术后病理结果：子宫内膜息肉69例（64．5％），黏膜下子宫肌瘤18例（16．8％），子宫内膜不典型增生12例（11．2％），子宫内膜癌2例（1．9％），正常子宫内膜6例（5．6％）。90例（84．1％）术后随访3～12个月，（6．0±3．8）月，其中8例子宫内膜息肉复发，再次宫腔镜手术治疗。结论官腔镜检查是绝经后子宫内膜病变首选的检查方法，可直视下观察子宫内膜的形态变化并取活检送病理；官腔镜治疗可以完整切除子宫内膜息肉、子宫黏膜下肌瘤等子宫内膜良性病变。

Hysteroscopy for Diagnosis and Treatment of Endometrial Diseases in Postmenopaosal Women

Objective To evaluate the value of hysteroscopy for diagnosis and treatment of endometrial diseases in postmenopausal women. Methods A retrospective analysis. The clinical data of 107 postmenopausal women suffering from endometrial diseases were collected from January 2002 to November 2006. Among the patients, 68 suffered from abnormal vaginal bleeding and 39 had endometrial thickening shown by B-ultrasonography without vaginal bleeding. All of the patients underwent hysteroscopic diagnosis and treatment in our department. The operation time, blood loss, complications, postoperative pathology, and follow-up results of these cases were recorded and analyzed statistically. Results Hysteroscopic diagnosis and treatment were completed in all of the 106 patients. One of the cases developed uterine perforation and was cured by conservative treatments. The mean operation time in the patients was （26.8 ±9.5） min, blood loss ranged from 10 to 60 ml with a mean of （30.2±18.3） ml. Postoperative pathological examination showed endometrial polyps in 69 cases （64.5%） , submucosal leiomyoma in 18 （ 16. 8% ） , atypical hyperplasia in 12 （ 11. 2% ） , endometrial carcinoma in 2 （ 1.9% ） , and normal endometrium in 6 （5.6%）. 90 （ 84. 1% ） of the patients were followed up for 3 to 12 months. During the period, 8 patients showed recurrent endometrial polyp and received a second hysteroscopie surgery. Conclusions Hysteroscopy is the first choice for the diagnosis and treatment of endometrial diseases in postmenopausal women. By using the method, we can observe the endometrium as well as do biopsy directly. Benign endometrial diseases including endometrial polyps and submucosal leiomyoma can be resected completely under a hysteroscope.