宫腔镜检查结合镜下定位活检诊治异常子宫出血运用效果观察

目的：探讨宫腔镜诊断异常子宫出血的临床诊断价值.方法：应用宫腔镜镜下定位取材送病检和B型超检查后诊断性刮宫送病检,比较宫腔镜和B型超声与病理诊断的符合率.结果：B型超声诊断的总符合率为69.72%,总误诊率及漏诊率均为30.28%,宫腔镜诊断的总符合率为90.83%,总误诊率与漏诊率均为9.17%,两者间差异有统计学意义（P＜0.01）.在异常子宫出血病因中,对于慢性子宫内膜炎,B型超声不能有效诊断,漏诊率为100%,宫腔镜的检出率为66.7%,误诊率达到62.50% 对于子宫内膜息肉,B型超声的检出率62.09%,准确率81.08%,宫腔镜的检出率及准确率95% 对于子宫黏膜下肌瘤,B型超声及宫腔镜的诊断与病理活检的符合率为100%,无误诊及漏诊发生 对于子宫内膜增生过长,B型超声误诊率45.92%,宫腔镜漏诊率36.92%,两者漏诊率差异无统计学意义 对于子宫内膜癌,B型超声检出率为20%,而宫腔镜的检出率可达到70%,准确率为77.38%,检出率两者间差异有统计学意义.总体上讲,宫腔镜对于异常子宫出血的多病因诊断中较B型超声诊断的灵敏度及准确度更高,误诊率和漏诊率都较低,在临床应用中具备相当的优越性.同时,宫腔镜检查结合对可疑病灶的定位活检,是诊断异常子宫出血的重要依据,值得广泛推广和使用.

Effective observation on diagnosis abnormal uterine bleeding by hysteroscopy

Objective： To investigate clinical diagnosis value of using hysteroscopy diagnosis abnormal uterine bleeding. Methods： Using hysteroscopy and B-ultrasound to examine, to compare accuracy rate of hysteroscopy and B-ultrasound. Results： The total accuracy rate of B-ultrasound was 69.72%, the total rate of misdiagnosis and missed diagnosis rates were 30.28%, the total accuracy rate of hysteros -copy was 90.83%, the total rate of misdiagnosis and missed diagnosis rates were 9.17%, two groups have significant difference （P〈0.01）. In the etiology of abnormal uterine bleeding, for chronic endometritis, B-mode ultrasound diagnosis can not be effectively, misdiagnosis rate was 100%, hysteroscopy effective rate was 66.7%, misdiagnosis rate was 62.50%, for endometrial polyps, B-ultrasound effective was 62.09%, accuracy rate was 81.08%, hysteroscopy effective and accuracy rates were 95%, for uterus submucosal myoma, the effective rate of diagnosis and biopsy of B-ultrasound and hysteroscopy were 100%, no occurrence of misdiagnosis and missed diagnosis; for endometrial hyperplasia, the misdiagnosis rate of B-ultrasound was 45.92%, missed diagnosis rate of hysteroscopy was 36.92%, both the rate of misdiagnosis was no significant difference; For endometrial cancer, B-ultrasound effective rate was 20%, hysteroscopy effective rate was 70%, accuracy rate was 77.38%, the detection rate was statistically significant difference between two groups. So multiple etiological diagnosis of abnormal uterine bleeding using hysteroscopy is better than B-ultrasound. Diagnosis of abnormal uterine bleeding by hysteroscopy is worth being applied and using.