B超和宫腔镜对绝经后子宫出血的诊断价值

目的 :比较B超和宫腔镜检查对绝经后子宫出血患者的诊断价值。方法 :应用B超及宫腔镜对 76例绝经后子宫出血患者进行检查的资料进行回顾性分析。结果 :宫腔镜对宫内病变的诊断正确性几乎达 10 0 %,但是 ,只能发现病灶 ,而不能对患者作出最后的诊断 ;B超检查可提示萎缩的子宫内膜厚度 ,但不能作出病因诊断 ;单纯诊断性刮宫术有 2 8%的遗漏率。结论 :对绝经后子宫出血患者 ,可先作B超了解子宫及盆腔情况 ,再在宫腔镜下 ,同时行诊刮 ,作组织病理检查 ,已成为绝经后子宫出血的最佳诊断手段。     

宫腔镜电切术治疗异常子宫出血140例临床分析

目的 探讨宫腔镜电切术治疗异常子宫出血的疗效。方法 2000年1月～2004年5月应用连续灌流式宫腔镜对140例异常子宫出血患者行宫腔镜电切术治疗，对72例保守治疗无效、无生育要求的患者行子宫内膜电切术(TCRE)，其中12例同时行黏膜下子宫肌瘤电切术，59例行单纯黏膜下子宫肌瘤及内突壁间肌瘤切除术(直径≤5．0cm)，9例子宫内膜息肉切除术。结果 术后随访1个月～2年，月经改善率98．5％，TCRE后62例无月经，8例月经减少，68例月经正常。结论 宫腔镜电切术治疗功能性子宫出血、黏膜下子宫肌瘤及子宫内膜息肉引起的异常子宫出血，疗效满意。     

宫腔镜治疗妇科疾病65例的临床分析

目的 探讨宫腔镜在妇科疾病诊断及治疗中的应用价值。方法 对65例已婚妇女因异常子宫出血,宫内异常回声等原因而行宫腔镜检查治疗。术中对异常子宫出血患者26例行宫腔镜检查并诊断性刮宫术,粘膜下子宫肌瘤16例、子宫内膜息肉疾病患者23例行宫腔镜电切术。结果 进行宫腔镜检查的65例患者中,异常子宫出血是因宫内膜增生过长所致26例;宫腔镜电切术均顺利完成39例,手术时间15~50 min,无子宫穿孔及水中毒等并发症。结论 宫腔镜检查直观,准确,在诊断治疗宫内膜息肉、异常子宫出血、粘膜下肌瘤等方面有重要价值。宫腔镜电切术可以替代子宫切除治愈异常子宫出血,粘膜下肌瘤、宫内膜息肉等妇科良性疾病。     

绝经后子宫出血的宫腔镜检查与治疗

目的研究分析宫腔镜对绝经后子宫出血的诊断治疗价值。方法回顾性分析本院2011年7月~2014年3月收治的绝经后子宫出血患者165例,全部患者均采用宫腔镜进行检查,并在宫腔镜下行病理组织学活检明确诊断结果。结果通过宫腔镜检测发现,165例绝经后子宫出血中子宫内膜息肉76例(46.0%);黏膜下肌瘤32例(19.4%);子宫内膜炎30例(18.2%);子宫内膜癌27例(16.4%)。与病理学组织活检诊断结果对比发现宫腔镜检测符合率高达92.1%。结论采用宫腔镜检测绝经后子宫出血症状可准确判断相关病因,配合病理学明确诊断,制定相应的治疗方案,减少患者痛苦。     

宫腔镜、B超检查诊断异常子宫出血病因与病理诊断符合率的临床分析

目的:探讨宫腔镜检查在各种异常子宫出血病因中的诊断价值。方法:我院应用宫腔镜检查异常子宫出血500例,术前均行B超检查,术中行定位取材或诊断性刮宫。结果:在异常子宫出血病因诊断中,宫腔镜诊断子宫内膜增生过长99例,与病理诊断的符合率为65.56%;子宫内膜息肉127例,符合率为98.45%;慢性子宫内膜炎90例,符合率为93.75%;宫腔内胚物残留52例,符合率为100%;子宫粘膜下肌瘤26例,符合率为89.65%。结论:对异常子宫出血的病因诊断中,宫腔镜检查可以提高子宫内膜息肉及子宫粘膜下肌瘤的诊断率,尽管对子宫内膜增生过长及子宫内膜癌需经病理诊断,但因镜下可以定位诊刮,提高了诊断率。     

宫腔镜电切术治疗异常子宫出血56例临床分析

目的：探讨宫腔镜电切术治疗异常子宫出血的疗效。方法：2001年9月至2002年3月应用连续灌流式宫腔镜，对56例异常子宫出血患者进行宫腔镜电切手术治疗，其中25例行子宫内膜切除术，13例行子宫肌瘤切除术，10例行子宫肌瘤及子宫内膜切除术，8例行子宫内膜息肉及子宫内膜切除术。结果：56例术后随访9—16个月，月经改善率为98．2％，其中无月经37．5％，月经减少46．4％，月经正常14.3%。结论：宫腔镜电切术术治疗因功能失调性子宫出血、子宫粘膜下肌瘤及子宫内膜息肉所致的异常子宫出血，近期疗效高，并发症少。     

子宫内膜腺肌瘤样息肉91例临床分析

目的:探讨子宫内膜腺肌瘤样息肉的临床特点及诊治,以提高对该病的认识。方法:回顾性分析91例子宫内膜腺肌瘤样息肉患者的临床特点、诊治及复发情况。结果:91例患者年龄20~72岁,平均46.70岁;65例绝经前期患者平均体重指数(BMI)22.33±3.23 kg/m2,23例绝经后患者平均BMI 25.38±4.14 kg/m2。临床表现中月经改变或异常阴道流血71例,占78.02%。89例阴道彩超检查提示边界清晰的宫腔或宫颈管占位。子宫内膜腺肌瘤样息肉病灶可分布于宫腔的任何位置,以后壁最常见(51.95%,40/77)。91例均经术后病理检查确诊。术后随访7~257个月,在50例取得随访资料的病例中宫腔镜下电切术42例,术后临床症状明显好转,仅5例复发。结论:子宫内膜腺肌瘤样息肉的临床表现、阴道彩超特征、肿块形态位置无明显特异性,病理检查是明确诊断的金标准。宫腔镜下电切术是子宫内膜腺肌瘤样息肉的首选治疗方式。     

绝经后子宫内膜出血的临床病理分析

目的：研究绝经后子宫出血的病因,诊刮子宫内膜的病检及意义。方法：我院85例绝经后子宫出血的患者行诊刮术后子宫内膜组织送病检,标本以中性甲醛液固定,常规行石蜡包埋,HE染色后光镜下划分病理类型,作出结果统计。结采恶性肿瘤8例,腺癌为主;良性病变42例,单纯性增生及子宫内膜炎为主;非器质性病变35例,萎缩性子宫内膜占多数。结论：患者一旦出现绝经后子宫出血,需及时诊刮作病理检查,特别是老年妇女并绝经时间长者,在常规妇检后,须对可疑者行分段刮宫取子宫内膜作病理诊断。     

宫腔镜诊治子宫内膜息肉782例临床分析

目的:探讨宫腔镜诊治子宫内膜息肉的有效性。方法:回顾分析我院2004年1月至2010年12月共782例宫腔镜术前被诊断为子宫内膜息肉的患者行宫腔镜电切的临床及病例资料。结果:782例中,术后病例证实为子宫内膜息肉596例,粘膜下肌瘤82例,子宫内膜增殖症40例。分泌期子宫内膜20例;增生期子宫内膜18例,恶性肿瘤10例,不全纵隔10例,息肉样腺肌病6例;绝经前更容易发生子宫内膜息肉;有症状的子宫内膜息肉更容易发生病理结果异常。结论:宫腔镜下组织活检术及内膜息肉电切术是诊治子宫内膜息肉的金标准。     

乳腺癌术后服用他莫昔芬对子宫内膜的影响研究

目的探讨乳腺癌术后服用他莫昔芬(TAM)对子宫内膜的病理影响。方法收集2011年1月至2017年12月首都医科大学附属北京妇产医院收治的乳腺癌手术治疗患者共622例,术后197例服用TAM,其中59例患者因异常阴道流血或超声子宫内膜异常行宫腔镜诊刮术,将其分为绝经前组及绝经后组,以服药时间3年及5年为界值,分析子宫内膜病理情况。子宫内膜异常增生包括子宫内膜癌、子宫内膜不典型增生,其余为良性子宫内膜病变及正常子宫内膜,根据子宫内膜病理结果分析绝经前及绝经后超声诊断异常子宫内膜增生的标准。结果乳腺癌术后服用TAM患者197例,其中59例行宫腔镜诊刮术,因异常阴道流血就诊者占32.2%(19/59),经病理证实有子宫内膜病变者占76.3%(45/59),其中子宫内膜息肉的发生率最高;绝经前子宫内膜癌发生率为3.4%(1/29),子宫内膜不典型增生发生率为20.7%(6/29);绝经后子宫内膜癌发生率为20.0%(6/30),无子宫内膜不典型增生的发生。TAM服用时间超过3年或5年,子宫内膜癌及不典型增生的发生率均增加(P0.05)。绝经前子宫内膜厚度与子宫内膜异常增生有关(P=0.035),当超声子宫内膜厚度达15mm时可作为诊断绝经前异常子宫内膜增生的最佳超声诊断阈值;而绝经后子宫内膜厚度与子宫内膜异常增生无关(P=0.631)。结论乳腺癌术后服用TAM能够引起子宫内膜息肉及子宫内膜增生,绝经前患者亦有子宫内膜癌及不典型增生的发生,不可忽视对服用TAM绝经前妇女子宫内膜的监测。服用TAM时间超过3年者,需更加警惕子宫内膜病变的发生。绝经前超声子宫内膜厚度15mm可作为诊断异常子宫内膜增生的最佳超声诊断阈值;绝经后仍以超声子宫内膜厚度5mm作为子宫内膜异常增生标准。     

宫腔镜联合B超在异常子宫出血中的诊断价值

目的评价宫腔镜联合B超对异常子宫出血的诊断价值。方法应用宫腔镜联合B超检查异常子宫出血106例。术中行定位取材或诊断性刮宫。结果宫腔镜联合B超诊断子宫内膜增生过长35例，符合率为65．71％；子宫内膜息肉28例，符合率为96．42％；子宫黏膜下肌瘤10例，符合率为90．00％；子宫内膜癌2例，符合率为100．00％。结论官腔镜联合B超检查对异常子宫出血可以提高对子宫内膜息肉及子宫黏膜下肌瘤的诊断率。尽管对子宫内膜增生过长及子宫内膜癌的敏感性与单纯诊刮相似，但可观察到更详细的形态学变化。     

Detection of benign intracavitary lesions in postmenopausal women with abnormal uterine bleeding: a prospective comparative study on outpatient hysteroscopy and blind biopsy

STUDY OBJECTIVE: To evaluate the specificity of blind biopsy in detecting benign intracavitary lesions as causes of postmenopausal bleeding in comparison with directed biopsy via hysteroscopy. DESIGN: Prospective trial without randomization (Canadian Task Force classification II-1). SETTING: University hospital. PATIENTS: Three hundred nineteen postmenopausal women with abnormal uterine bleeding. INTERVENTIONS: All patients underwent both blind biopsy (Novak's curette) and directed biopsy via hysteroscopy (after at least a week). All patients with benign intracavitary lesions underwent operative hysteroscopy to enable the removal of polyps and intracavitary myomas or endometrial resection if required. All patients with pathologic reports of complex hyperplasia and atypical hyperplasia (20 patients) underwent vaginal hysterectomy with bilateral adnexectomy. All patients with histology reports of endometrial carcinoma (15 patients) underwent abdominal hysterectomy, bilateral adnexectomy, and pelvic lymphadenectomy. Histopathologic findings from endometrial specimens obtained after operative hysteroscopy or uterine specimens obtained after hysterectomy were used as a reference test to establish the prevalence of disease. MEASUREMENTS AND MAIN RESULTS: The sensitivity, specificity, accuracy, and positive and negative predictive values of blind biopsy and hysteroscopy were assessed to distinguish benign intracavitary formations such as polyps, submucous myomas, and endometrial hyperplasia in postmenopausal patients with abnormal uterine bleeding. The level of agreement was evaluated by use of the coefficient of concordance kappa. Blind biopsy showed a sensitivity of 11% and a specificity of 93%, with an accuracy of 59% in detecting endometrial polyps, a sensitivity and specificity of 13% and 100%, respectively, with an accuracy of 98% for submucous myomas, and values of 25%, 92%, and 80%, respectively, in diagnosing hyperplasia. On the other hand, hysteroscopy demonstrated a sensitivity of 100% and a specificity of 97%, with an accuracy of 91% in diagnosing endometrial polyps, a sensitivity and specificity of 100% and 98%, respectively, with an accuracy of 99% for submucous myomas. The coefficient of concordance kappa (95% CI) was 0.12 for blind biopsy and 0.82 for hysteroscopy, corresponding, respectively, to slight concordance and almost perfect agreement with final pathologic diagnosis. CONCLUSIONS: Blind biopsy (Novak's curette) demonstrates very low sensitivity and accuracy in the diagnosis of benign focal intracavitary lesions. Hysteroscopy is confirmed as the gold standard in the assessment of abnormal uterine bleeding in menopause, permitting the elimination of the false-negative results of blind biopsy through direct visualization of the uterine cavity and the performance of targeted biopsy in case of doubt.     

Direct aspiration endometrial biopsy via flexible hysteroscopy

Study ObjectiveTo determine feasibility and efficacy of direct aspiration endometrial biopsy via the fluid channel of a flexible diagnostic hysteroscope.DesignRetrospective review (Canadian Task Force classification II-3).SettingAbnormal uterine bleeding clinic in a tertiary care center.PatientsAll women who underwent direct aspiration endometrial biopsy from January 2007 through August 2011 via a flexible diagnostic hysteroscope because traditional office-based endometrial biopsy using a suction piston device was not technically possible.InterventionsDiagnostic hysteroscopy followed by direct aspiration endometrial biopsy, accomplished by applying suction to the fluid channel of a 3.1-mm flexible diagnostic hysteroscope via a 10-mL syringe. The hysteroscope tip was agitated within the uterine cavity to obtain a tissue sample.Measurements and Main ResultsThe median age of the 32 identified patients was 50 years; 18 women (56%) were nulliparous, and 10 (31%) were postmenopausal. Thirty-one patients underwent hysteroscopy/direct aspiration biopsy because of abnormal uterine bleeding or postmenopausal bleeding. The vaginoscopic approach was used in 19 patients (59%). Indications for direct aspiration endometrial biopsy included cervical stenosis, inability to pass the endometrial biopsy instrument into the uterine cavity, and patient intolerance of endometrial biopsy. Adequate endometrial samples were obtained in 28 patients (87.5%). In 3 of 4 patients in whom direct aspiration endometrial biopsy did not provide sufficient tissue, hysteroscopy revealed an atrophic-appearing endometrium. The direct aspiration endometrial biopsy diagnosis was confirmed in 5 of 7 patients who subsequently underwent dilation and curettage or hysterectomy.ConclusionDirect aspiration endometrial biopsy is a simple and effective endometrial sampling method when traditional office-based endometrial biopsy is not feasible. Further prospective studies including larger populations are needed to confirm these results.     

Hysteroscopic evaluation of menopausal women with endometrial thickness of 4 mm or more

STUDY OBJECTIVE: To assess the diagnostic and operative potential of hysteroscopy in postmenopausal patients selected by ultrasound criteria. DESIGN: Cohort study (Canadian Task Force classification II-2). SETTING: Outpatient ultrasound and hysteroscopy department of a university-affiliated hospital. PATIENTS: One hundred fifty-five postmenopausal women with endometrial thickness of 4 mm or more by ultrasound, in menopause for at least 1 year, with or without menopausal complaints. INTERVENTIONS: Transvaginal ultrasound and office hysteroscopy with eye-directed biopsy specimens using a 5-mm, continuous-flow, operative hysteroscope. MEASUREMENTS AND MAIN RESULTS: Of the 155 women, 129 (83%) were asymptomatic (irregular bleeding). Hysteroscopy showed endometrial pathology in 28% of asymptomatic patients (23 polyps, 5 cases of hyperplasia, 8 submucous myomata) and 76% of symptomatic women (13 polyps, 6 hyperplasia, 1 submucous myoma). Hysteroscopic results compared with histologic diagnosis showed a positive predictive value equal to 97. 1% and 95% in asymptomatic and symptomatic women, respectively, and a negative predictive value equal to 100% in both groups. CONCLUSION: Office hysteroscopy with endometrial biopsy samples has a diagnostic and operative role in postmenopausal patients selected based on endometrial thickness on ultrasound, in view of the high prevalence of endometrial pathology in both symptomatic and asymptomatic women.     

Hysteroscopic diagnosis in patients with abnormal uterine hemorrhage and previous endometrial curettage]

Thirty-four patients, with a history of persistent abnormal uterine bleeding and dilatation and curettage or suction curettage performed within the previous year, were evaluated by office hysteroscopy and biopsy. For 16 patients (47%) the hysteroscopic diagnosis was in agreement with the curettage. Hysteroscopy revealed more information in 18 patients (53%): 8 had polyps, 6 had submucous or pedunculated myoma, 2 had endometrial neoplasia, 1 had myoma and polyp, 2 had endometrial neoplasia and 1 had synechia. Moreover in 3 patients with diagnosis of suspected myoma by curettage, hysteroscopy revealed a normal cavity. The high incidence of missed diagnosis of pathologic conditions by "blind" curettage supports the opinion that diagnostic hysteroscopy is the method of choice in the evaluation of abnormal uterine bleeding.     

绝经后子宫出血宫腔镜下的诊断和治疗

为评价宫腔镜对绝经后子宫出血的诊断和治疗价值，对我院１９９０年７月－１９９４年７月收治的１３５例绝经后子中出血病例进行宫腔检查，部分行镜下手术治疗。结果：萎缩性子宫内膜６２例、子宫内膜息肉２５例、宫颈息肉１３例、子宫内膜癌１３例、子宫内膜增殖症１１例、粘膜下肌瘤５例、宫内节育器６例。和病理诊断的符合率分别为１００％、９６％、１００％、６９％、７３％及８０％。１３５例中６例曾作诊断性刮宫检查无异常者     

Transvaginal sonography combined with saline contrast sonohysterography to evaluate the uterine cavity in patients with abnormal uterine bleeding and postmenopausal endometrium more than 5 mm

OBJECTIVES: To determine whether saline contrast sonohysterography (SCSH) gives additional information to that obtained by transvaginal sonography (TVS) for predicting endometrial abnormality in premenopausal, menopausal and postmenopausal patients with abnormal uterine bleeding and postmenopausal patients with endometrial thickness > 5 mm. METHODS: This was a prospective study at the Ege University Obstetrics and Gynecology Clinic in Izmir, Turkey. Patients presenting with abnormal bleeding related to uterine pathologies, postmenopausal patients with endometrial thickness more than 5 mm and scheduled for surgical treatment were prospectively included in our study conducted between 1 July, 2000 and 31 January, 2002. The uterine cavity was first evaluated with TVS in 53 premenopausal, menopausal, postmenopausal patients with abnormal uterine bleeding and postmenopausal patients whose endometrial thickness was > 5 mm measured by conventional ultrasound examination. SCSH was carried out later with the intention of establishing further surgical management (hysterectomy). Twenty of the patients had operative hysterectomy within the 1.5 year period of time. The presence of focally growing lesions and the type of lesion (endometrial polyp, submucous myoma, malignancy or unclear focal lesion) were noted at ultrasound examination and at hysteroscopy, and then hysterectomy material was examined by Ege University's Pathology Department which provided a detailed evaluation of the uterine cavity. RESULTS: Based on normal endometrial morphology alone, the results for detection of an abnormal uterine cavity were as follows: sensitivity of TVS 0.94, SCSH 0.97; specificity of TVS 0.56, SCSH 0.62; positive predictive value of TVS 0.79, SCSH 0.81; negative predictive value of TVS 0.83, SCSH 0.93. Transvaginal sonography combined with SCSH was superior to TVS for detection of intracavitary abnormalities. When normal endometrial morphology was combined with an endometrial thickness of < 12 mm for evaluation of all abnormalities including hyperplasia, the diagnostic potential of TVS or SCSH was almost unchanged. Transvaginal sonography missed 24% of the polyps. CONCLUSIONS: Sonohysterography was a sensitive tool and was superior to TVS used alone for evaluation of the uterine cavity in patients who underwent operative surgery for abnormal uterine bleeding.     

Hysteroscopy in the diagnosis of postmenopausal uterine bleeding

Postmenopausal bleeding is a special diagnostic problem in gynecology on account of inadequate specimen obtained during dilatation and curettage for pathologic examination. Instead, hysteroscopy proves to be an ideal procedure in defining the cause of bleeding through direct vision of the pathologic lesions in the uterine cavity. In this series, hysteroscopy was performed in 150 patients with postmenopausal bleeding. The causes of bleeding enumerated by the order of frequency of occurrence are atrophic endometrium, exogenous estrogen effect, unremoved IUD, endometrial carcinoma, submucous myoma and endometrial polyps.     

子宫声学造影对异常子宫出血的诊断价值

目的评价子宫声学造影对异常子宫出血的诊断价值.方法对78倒异常子宫出血患者进行子宫声学造影(SHG),根据不同的结果分别对患者进行诊断性刮宫或宫腔镜检查,或直接手术治疗,并将SHG结果与病理检查结果对照分析.结果SHG识别出子宫粘膜下肌瘤23例、内膜息肉14例、内膜癌8例、内膜增生过长17例,其诊断宫内病变的敏感性和特异性分别为96.7%和82.4%.本组病例造影后均未发生并发症.结论SHG是评价异常子宫出血、诊断宫内病变的简便、有效方法.     

Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding

OBJECTIVE: To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C. METHODS: In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one. RESULTS: Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy. CONCLUSION: If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.