经阴道宫腔声学造影对宫腔良性病变的诊断价值

目的探讨经阴道宫腔声学造影对宫腔良性病变的诊断价值。方法对37例经阴道超声检查（TVS）疑有宫腔良性病变患者行经阴道宫腔声学造影（TVS—SHG）、宫腔镜检查和病理检查,将TVS—SHG、官腔镜检查、病理结果进行对照分析。结果TVS—SHG对子宫内膜息肉、子宫黏膜下肌瘤及子宫内膜增生过长等病变能作出较明确的诊断,并显示出不同的声像图特征。结论TVS—SHG是诊断和鉴别诊断宫腔良性病变简便、有效、廉价的方法。     

103例经阴道超声检查宫腔异常回声团的宫腔镜检查与病理结果分析

目的:探讨经阴道超声检查(transvaginal sonography,TVS)对子宫内膜病变诊断的临床价值及宫腔异常回声团的成因。方法:对103例阴道超声提示“宫腔异常回声团”的患者行宫腔镜检查并取病理。结果:103例中子宫内膜息肉86例,息肉样腺肌瘤9例,子宫内膜单纯性增生2例,鳞状上皮1例,正常内膜3例,宫腔粘连1例,无组织刮出1例;TVS对子宫内膜病变检出的假阳性率3.88%,宫腔镜检查与病理诊断符合率84.47%。结论:TVS可作为子宫内膜病变的初筛手段,宫腔镜检查是确定病因的重要手段,但不能替代显微镜下的病理诊断。宫腔异常回声团多由子宫内膜息肉引起,常见于围绝经期及绝经后妇女。     

经阴道超声宫腔造影术对子宫内膜病变诊断价值的研究

目的：探讨经阴道超声宫腔造影术（SHG）对子宫内膜病变的诊断价值。方法：对阴道不规则出血的患者行经阴道超声（TVS）检查,发现异常者行SHG及宫腔镜检查,并在宫腔镜下取组织活检或诊断性刮宫并活检,将病理诊断结果与TVS检查结果、SHG检查结果、宫腔镜检查结果进行对比分析。结果：SHG与TVS相比,其对子宫内膜病变类型的鉴别明显优于TVS;与宫腔镜相比,其对子宫内膜病变诊断的敏感性与宫腔镜一致或略低于宫腔镜,特异性与宫腔镜一致或略高于宫腔镜。结论：SHG是诊断子宫内膜病变的一种无创、安全、简便且准确性高的检查方法。     

经阴道超声宫腔造影术对子宫内膜病变诊断价值的研究

目的：探讨经阴道超声宫腔造影术（SHG）对子宫内膜病变的诊断价值。方法：对阴道不规则出血的患者行经阴道超声（TVS）检查，发现异常者行SHG及宫腔镜检查，并在宫腔镜下取组织活检或诊断性刮宫并活检，将病理诊断结果与TVS检查结果、SHG检查结果、宫腔镜检查结果进行对比分析。结果：SHG与TVS相比．其对子宫内膜病变类型的鉴别明显优于TVS；与宫腔镜相比，其对子宫内膜病变诊断的敏感性与官腔镜一致或略低于宫腔镜，特异性与宫腔镜一致或略高于宫腔镜。结论：SHG是诊断子宫内膜病变的一种无创、安全、简便且准确性高的检查方法。     

经阴道超声宫腔造影诊断宫腔内病变的临床应用价值

目的:探讨经阴道超声宫腔造影术(SHG)在诊断宫腔内病变中的临床价值。方法:对59例经阴道超声(TVS)疑为宫腔内病变的患者行阴道超声宫腔造影检查,后经诊刮或宫腔镜手术及病理对照。结果:59例患者中内膜息肉29例,黏膜下肌瘤13例,内膜增生过长11例,宫腔粘连2例,正常4例,经过跟踪诊刮或宫腔镜及病理结果,诊断宫腔内膜息肉、黏膜下肌瘤、内膜增生过长、宫腔粘连的符合率分别为96.6%、92.9%、90.9%、100%。结论:经阴道超声宫腔造影术具有简便经济,痛苦小,敏感性高、特异性强等优点,在宫腔内病变患者的诊断中具有重要的临床应用价值。     

阴道超声与宫腔镜在子宫内膜病变中的诊断价值的研究

目的　比较阴道超声 ( TVS)监测与宫腔镜检查在子宫内膜病变中的诊断价值。方法　对 5 5例异常子宫出血的病人行阴道超声检查和宫腔镜联合检查并与病理检查对照分析。结果　阴道超声监测内膜息肉的诊断符合率明显低于宫腔镜 ( P <0 .0 5 ) ;对粘膜下肌瘤、内膜增生过长和子宫内膜癌的诊断 ,二者比较无显著性差异 ( P >0 .0 5 )。结论　宫腔镜监测内膜息肉优于阴道超声 ;在排除粘膜下肌瘤、内膜增生过长和子宫内膜癌上阴道超声与宫腔镜具有相当的诊断价值。     

宫腔镜检查在诊断子宫内膜良恶性病变中的临床价值

目的:探讨宫腔镜检查在诊断子宫内膜良恶性病变中的临床价值。方法:选取我院2014年8月—2017年6月收治的疑似子宫内膜病变的患者82例作为观察对象,所有患者均采用阴道超声(设为TVS组)和宫腔镜(设为HS组)进行检查,并与病理实验结果进行比较,评定两种检查方法的诊断价值。结果:HS组诊断符合率明显高于TVS组,组间差异存在统计学意义(P<0.05);两组灵敏度、特异度、阴性预测值、阳性预测值进行比较,HS组均优于TVS组,差异具有统计学意义(P<0.05)。结论:宫腔镜检查在子宫内膜异常病变中具有重要的诊断价值,可为准确鉴别内膜组织病变良恶性提供参考信息,值得临床借鉴和优先推广。     

阴道超声与宫腔镜在子宫内膜病变中的诊断价值的研究

目的比较阴道超声(TVS)监测与宫腔镜检查在子宫内膜病变中的诊断价值.方法对55例异常子宫出血的病人行阴道超声检查和宫腔镜联合检查并与病理检查对照分析.结果阴道超声监测内膜息肉的诊断符合率明显低于宫腔镜(P<0.05);对粘膜下肌瘤、内膜增生过长和子宫内膜癌的诊断,二者比较无显著性差异(P>0.05).结论宫腔镜监测内膜息肉优于阴道超声;在排除粘膜下肌瘤、内膜增生过长和子宫内膜癌上阴道超声与宫腔镜具有相当的诊断价值.     

经阴道超声诊断绝经后出血86例分析

目的:探讨经阴道超声检查(TVS)对绝经后出血患者子宫内膜病变的诊断价值。方法:对86例绝经后出血的患者行TVS检查,将超声检查结果与诊刮后(和/或手术后)病理检查结果进行对照分析。结果:本组86例患者中,39例(占45.35%)为子宫内膜非器质性病变,41例(占47.67%)为子宫内膜的良性病变,6例(占6.98%)为子宫内膜癌。结论:TVS能初步有效地鉴别诊断子宫内膜病变,可作为绝经后阴道出血患者首选的筛查手段。     

经阴道三维超声在诊断宫腔病变中的应用价值

目的探讨经阴道三维超声（3D-TVS）在诊断子宫腔病变中的临床应用价值。方法分析56例宫腔内病变患者的3D-TVS诊断资料,并与宫腔镜检查及临床病理结果进行对照研究。用Kappa检验评价经阴道三维超声与宫腔镜、病理检查的一致性。结果病理结果为子宫内膜息肉25例,子宫黏膜下肌瘤15例,子宫内膜增生症11例,子宫内膜癌5例。对于子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜增生症的诊断,3D-TVS与宫腔镜检查的一致性检验Kappa值分别为0.856、0.909和0.887,3D-TVS与病理检查的一致性检验Kappa值分别为0.748、0.818和0.774。结论 3D-TVS对宫腔病变的诊断与宫腔镜及病理结果有较好的一致性,在诊断宫腔病变中具有很高的临床价值。     

经阴道彩超对异常子宫出血的诊断

目的:利用彩色多谱勒经阴道超声探讨异常子宫出血的病因。方法:对妇科住院经阴道超声诊断54例子宫异常出血的妇女行宫腔镜检查,了解子宫内膜病变情况,与宫腔镜及病理结果进行对照。结果:本组患者异常子宫出血绝经前病因:内膜增殖50%(20/40),内膜息肉22.5%(9/40)内膜癌2.5%(1/40),其他25%(10/40);绝经后病因内膜癌28.6%(4/14),内膜息肉21.4%(3/14),内膜增殖28.6%(4/14),其他21.4%(3/14);经阴道彩超诊断异常子宫出血与术后病理检查结果无显著差异性,与宫腔镜检查结果相吻合。因此,经阴道超声可以对异常子宫出血病因的做出诊断。结论:经阴道彩超可对异常子宫出血内膜病变病因做出初步诊断,可作为此类患者随访的一种可靠的检查手段。     

Transvaginal sonography versus hysteroscopy in evaluation of abnormal uterine bleeding

Background

Abnormal uterine bleeding (AUB) accounts for 33% of female patients referred to gynaecologists. Common causes of AUB include endometrial polyps, endometrial hyperplasia, submucous fibroids and anovulation. Accurate diagnosis of the cause of AUB can reduce the frequency of hysterectomy. This study was aimed at assessing the usefulness of TVS in comparison with hysteroscopy in AUB evaluation.

Methods

100 female patients with AUB were enrolled in the study. Each patient was subjected to TVS where uterine cavity was studied in detail and hysteroscopy under anaesthesia using saline as distension medium. Sensitivity, specificity and predictive value of TVS as compared to hysteroscopy were calculated. Subgroup analysis within each group was also performed.

Results

Menorrhagia was the commonest presenting symptom in the study population (n = 58) followed by metrorrhagia, menometrorrhagia and continuous bleeding >21 days. 74 female patients had normal size uterus. In 57 patients, the uterine cavity was normal on TVS. Thickened endometrium, endometrial polyp and submucous fibroids were seen in 19, 16 and 6 patients respectively. Hysteroscopy showed normal cavity in 59 female patients and polypoidal endometrium, polyps or submucous fibroids in 41. TVS was found to have high sensitivity and specificity (95.23 and 94.82 respectively) and high positive and negative predictive value. Strength of agreement between TVS and hysteroscopy was high (kappa value 0.898).

Conclusion

TVS is recommended as first line investigation in AUB. If TVS shows normal cavity, further evaluation can be omitted and patient started directly on medical treatment for her symptoms.     

宫腔镜和阴道B超在绝经后阴道出血中的应用价值

目的本研究旨在通过比较阴道超声（TVS）和宫腔镜（HSC）对PMB的诊断,分析其应用价值。方法对128例PMB患者进行TVS检查,测量其子宫内膜厚度,随后进行HSC检查并行内膜活检,分别将结果与病理检查结果进行对比分析。结果以子宫内膜厚度〉5mm为临界值来判断有无子宫内膜病理性改变,敏感性97.6%,特异性87.2%,准确性89.3%,阳性预测值83.6%,阴性预测值94.1%。宫腔镜检查的特异性为91.2%,敏感性为97.0%,阳性预测值为98.4%。结论 TVS和HSC对诊断PMB的敏感性都很高,HSC的特异性高于TVS。TVS与宫腔镜联合定位活检是诊断绝经后阴道出血的最佳手段。     

Comparative study of transvaginal ultrasonographic and diagnostic hysteroscopic findings in postmenopausal breast cancer patients treated with tamoxifen

Background  There is an association between postmenopausal tamoxifen therapy and endometrial pathologies. We investigated the usefulness of diagnostic hysteroscopy and transvaginal ultrasonography (TVS) and estimated whether diagnostic hysteroscopy improves detection of endometrial pathologies in postmenopausal breast cancer patients on tamoxifen.

Methods  Ninety-seven postmenopausal breast cancer patients who had been taking tamoxifen 20 mg/d for ≥6 months went through TVS, diagnostic hysteroscopy, and endometrial biopsy examinations. The presence of endometrial histopathologic features with abnormal TVS and diagnostic hysteroscopic findings were correlated.

Results  No endometrial cancer was found in any of the 97 patients. Fifty-three patients (54.6%) developed endometrial polyps as diagnosed histopathologically. Fifty-nine patients (60.8%) tested positive in TVS exams, of whom 43 had polyps, four had hyperplasia, and 12 atrophy. Thirty-eight patients (39.2%) tested negative in TVS exams, of whom 10 had polyps, three hyperplasia, and 25 atrophy. TVS exams presented 63.6% specificity, 81.8% sensitivity, 72.9% positive-predictive value, and 73.7% negative-predictive value, whereas the corresponding values of diagnostic hysteroscopy were 100%, 98.1%, 100%, and 97.8% respectively. The correct ratio of hysteroscopy was significantly higher than that of TVS (P=0.000).

Conclusions  In postmenopausal breast cancer patients treated with tamoxifen, TVS alone is not sufficient for the detection of endometrial pathologies. Additional use of diagnostic hysteroscopy considerably improves the detection of polyps, thus significantly reducing the rate of false-negative findings of endometrial pathologies.

     

Comparative evaluation of perimenopausal abnormal uterine bleeding by transvaginal sonography, hysteroscopy and endometrial biopsy

To evaluate the causes of abnormal uterine bleeding in perimenopausal women and to achieve the greatest diagnostic accuracy with the least risk, a cross-sectional study was done among 85 patients between the ages 40 and 55 years. Transvaginal sonography, hysteroscopy and histopathological examination of endometrium were done in all the cases. Kappa statistics was calculated to show the agreement between the different investigations. Considering histopathological report to be the gold standard, for diagnosis of hyperplastic endometrium, transvaginal sonography and hysteroscopy showed fair agreement (k=0.34) and good agreement (k=0.51) and hysteroscopic diagnosis of polyp showed strong agreement (k=0.81). Sensitivity, specificity, positive predictive value, negative predictive value for diagnosis of hyperplastic endometrium were 43.75%, 95.65%, 70% and 88% respectively whereas in polyp by transvaginal sonography they were 50%, 89.16%, 100%, 98.67% respectively; by hysteroscopy these were 50%, 95.78%, 70%, 90.36% respectively in hyperplasia and 71.43%, 100%, 100%, 94.67% respectively in polyp. Transvaginal sonography is most important for diagnosis of anatomical lesion. Hysteroscopy is most specific and sensitive for diagnosis of polyp but less specific for endometrial hyperplasia.     

孕早期宫角妊娠与子宫肌层妊娠的声像图特征

目的探讨孕早期宫角部妊娠与子宫肌层妊娠的声像图特征及鉴别要点。方法经腹超声与经阴道超声联合扫查:①观察妊娠囊位于子宫的位置;②判定妊娠囊与蜕膜化子宫内膜关系及妊娠囊与外周肌层的关系;③将超声诊断与超声引导下清宫、手术后及病理结果对照。结果超声诊断的7例宫角妊娠,6例经超声引导下行清宫及病理证实,1例经手术病理证实;1例子宫肌层妊娠与输卵管间质部妊娠超声诊断不能确定的,经手术及病理证实为子宫肌层妊娠。结论经腹部超声与经阴道超声联合扫查在诊断宫角部妊娠与子宫肌层妊娠确有重要价值。     

Evaluation of endometrial changes and p53 expression in tamoxifen treated women: Comparision of various methods.

Objective: To compare transvaginal sonography (TVS), sonohysterography (SHG), hysteroscopy and endometrial aspiration (EA) and p53 expression in assessing endometrial abnormalities in women on tamoxifen. Methods: In a cross sectional study of 50 pre- and post-menopausal women receiving tamoxifen for > 2 years, all participants underwent TVS and EA. Those with endometrial thickness > 4 mm on TVS underwent hysteroscopy and SHG. Serum p53 antibody and p53 immunohistochemistry were tested in all women. Results: The sensitivity and specificity when compared with histopathology as the reference standard were as follows: TVS 100% and 33.3%, SHG 85.7% and 50%, hysteroscopy 92.8% and 80.8%, serum p53 50% and 83.3%, and p53 immunohistochemistry 57.1% and 61.1%. Prevalence of endometrial abnormalities was not significantly different in asymptomatic and symptomatic women. Conclusion: Tamoxifen-users require routine testing for endometrial evaluation. TVS followed by hysteroscopy and biopsy is an effective option. p53 expression correlates with histological abnormalities. Key words: Tamoxifen, Sonography, Sonohysterography, Hysteroscopy, Endometrium, p53.     

经阴道彩色多普勒超声诊断宫内少量妊娠残留物的临床研究

目的：探讨经阴道彩超在诊断宫内少量妊娠残留物中的应用价值。方法：50例患者行人工流产、药物流产后经腹超声诊断为宫内未见明显异常,改为经阴道彩超检查。结果：30例宫内少量妊娠残留物（30／50）,11例内膜增厚（11／50）,9例宫腔内血块（9／50）,均经清宫术和病理证实,诊断率100％,两组比较差异有统计学意义（P〈0．01）。结论：经阴道彩超检查对宫内少量妊娠残留物的诊断有较高的诊断价值。     

阴道超声对不孕症患者子宫内膜病变的诊断价值

目的探讨经阴道超声对不孕症患者子宫内膜病变的诊断价值及与宫腔镜检查结果的关系。方法对准备实施体外受精-胚胎移植(in vitro fertilization embryo transferred,IVF-ET)治疗的不孕症患者,在自然周期的排卵期,采用经阴道超声对子宫内膜进行仔细监测,对内膜异常的763例患者(观察组)进行宫腔镜检查。对照组是IVF-ET前、后,超声未发现内膜异常,常规进行宫腔镜检查的80例不孕患者。结果观察组中,宫腔镜检查确诊出现异常内膜为672例(672/763,88.07%),对照者为8例(8/80,10%)。结论经阴道超声是诊断不孕症患者宫腔内病变的一种简便、经济、无损伤、诊断率高的方法,是筛除IVF-ET术前子宫内膜病变的首选方法,而宫腔镜检查可为内膜病变提供准确的诊断。