宫腔镜在不孕症诊断中的应用分析

目的探讨电视宫腔镜检查在不孕症诊断中的应用价值。方法对本院电视宫腔镜检查的62例不孕症患者的临床资料进行回顾性分析。结果总病例中原发性不孕36例,继发性不孕26例。所有病例B超检查发现宫内异常者24例(38.7%)。宫腔镜检查发现宫内异常者37例(59.7%),比B超检出率高。宫内异常包括:子宫内膜息肉10例(16.1%),子宫肌瘤7例(11.3%),宫腔粘连6例(9.7%),子宫内膜炎4例(6.5%),子宫内异物1例(1.6%),子宫内畸形(部分或完全子宫纵隔,单角子宫等)5例(8.1%),宫颈息肉4例(6.5%)。结论宫腔镜检查宫内病变比B超灵敏。宫腔镜检查能直观、准确、全面地明确宫腔内病因,是了解宫腔疾病的最有效方法之一,它在诊断不孕症中有较高的应用价值,是诊断不孕症有效、可行的方法。     

反复夫精宫腔内人工授精失败与宫腔形态分析

 目的 了解反复夫精宫腔内人工授精(IUI)失败患者宫腔形态表现,观察做相应治疗后再次IUI的妊娠率. 方法 选取43例既往行3周期或以上IUI失败欲再次IUI的患者行宫腔镜检查,并对发现的异常进行相应治疗.和同期46例未行宫腔镜检查患者比较再次人工授精妊娠率. 结果 宫腔镜检查发现宫腔异常率为41.8%.其中子宫内膜息肉占23.3%,子宫内膜息肉样增生占4.5%,子宫内膜炎占9.3%,宫腔粘连占4.5%.观察组妊娠率(27.9%)高于对照组(10.9%),差异有统计学意义(P<0.05),其中观察组中宫腔异常组、宫腔正常组妊娠率比较差异无统计学意义. 结论反复夫精宫腔内人工授精失败患者的妊娠率与宫腔形态异常密切相关,宫腔病变作相应治疗后可提高多次人工授精失败患者的妊娠率.     

宫腔镜对IVF-ET失败患者宫腔内病变的诊断价值

目的探讨宫腔镜检查术对体外受精-胚胎移植术(IVF-ET)失败患者的应用价值。方法对379例IVF-ET失患者行宫腔镜检查。结果在379例IVF-ET失败患者中,宫腔异常者为219例(57.8%),其中子宫内膜息肉或内膜呈肉样增生者105例(27.7%),宫腔镜下子宫内膜活检病理提示内分泌紊乱者35例(9.2%),宫腔粘连者29例(7.7%),宫内膜局部呈瘢痕样改变和子宫畸形者各为22例(5.8%),黏膜下子宫肌瘤和子宫腺肌症各为3例(0.8%)。以病理断为金标准,宫腔镜对子宫内膜息肉诊断的敏感性、特异性、阳性预测值和阴性预测值分别为71.4%、92.9%、74.1%91.9%。结论宫腔镜应作为ⅣF-ET失败患者的常规检查。     

宫腔镜检查对不孕症的诊断价值

目的探讨宫腔镜检查对不孕症的诊断价值。方法对2011年1月-2013年1月因不孕症需行试管婴儿治疗的1 231例患者的临床资料进行回顾性分析。所有患者均行阴道B超及宫腔镜检查,评估宫腔镜检查对宫腔内病变的显示情况,并比较阴道B超、造影、宫腔镜三种诊断方法对不孕症患者宫腔内病变的诊断能力。结果 1 231例不孕患者中,宫腔镜检查显示宫内病变有502例,B超检查显示宫腔内病变224例,子宫输卵管造影显示宫腔内病变185例。宫腔镜检查的诊断阳性率明显高于B超和造影,而B超和造影检查在不同方面有各自的优势。结论宫腔镜检查可作为不明原因不孕症患者拟行试管婴儿前的常规检查方法,其对不孕症患者宫腔内病变有重要的诊断价值。     

经阴道二维和三维超声检查对宫腔异常的临床诊断价值

目的探讨经阴道二维超声和三维超声对宫腔异常的临床诊断价值。方法对在山东中医药大学附属医院生殖与遗传中心就诊患者,以宫腔镜或者宫腹腔镜证实宫腔异常者为观察对象,回顾分析其有创检查前的二维和三维超声检查结果,探讨不同超声检查方式对宫腔异常的临床诊断价值。结果 83例怀疑子宫畸形患者,宫腔镜检查证实弓形子宫44例,二维超声检查漏诊6例,三维超声检查全部诊断正确;经宫腹腔镜检查证实不全纵隔子宫23例,二维超声检查误诊5例(均误诊为弓形子宫),三维超声检查全部诊断正确;经宫腹腔镜检查证实完全纵隔子宫4例,二维及三维超声检查全部诊断正确;经宫腔镜检查证实单角子宫12例,二维及三维超声检查全部诊断正确。123例怀疑宫腔病变患者,经宫腔镜及病理结果证实宫腔占位68例,其中粘膜下肌瘤4例,子宫内膜息肉64例,二维超声检查漏诊9例内膜息肉,三维超声检查漏诊5例内膜息肉,二维及三维超声检查正确诊断所有粘膜下肌瘤;经宫腔镜证实宫腔粘连55例,二维超声检查漏诊23例,三维超声检查漏诊18例。结论三维超声检查对子宫畸形的诊断准确率可达100%;三维超声检查对宫腔病变的诊断存在一定的漏诊率,但漏诊率低于二维超声检查;三维超声检查对宫腔异常的诊断准确率高于二维超声检查。     

宫腔镜及B超联合诊治绝经后出血的临床价值

目的:探讨宫腔镜及B超联合诊治技术对于绝经后出血患者的临床价值。方法:对我科2000年2月~2005年8月收治的167例绝经后出血患者进行了宫腔镜及B超联合诊治。所有患者均先进行B超检查,之后行宫腔镜诊治,必要时辅以B超引导监护。结果:167例中84例内膜厚度<5mm,5~10mm者64例,>10mm者19例;同时提示宫腔内病变者12例。出血的病因依次为子宫内膜炎54例(32.3%)、子宫粘膜下肌瘤38例(22.8%)、子宫内膜息肉32例(19.2%)、子宫内膜癌22例(13.2%)、子宫内膜增生11例(6.6%)、宫颈息肉6例(3.6%),其它4例(2.3%)。保守治疗11例,化疗1例,31例同时进行了宫腔镜下治疗,99例实施宫腔镜电切手术,25例开腹手术,病理学诊断总的符合率为80.8%。结论:宫腔镜检查联合B超应作为绝经后出血患者的首选,内膜厚度<5mm者应慎行刮宫术。宫腔镜联合B超进行宫腔内病变治疗及电切手术对于老年宫腔内良性疾患的治疗具有重要临床价值。     

经阴道超声宫腔造影对子宫内膜息肉的诊断价值

目的:探讨经阴道超声宫腔造影对子宫内膜息肉的诊断价值。方法:临床疑诊子宫内膜息肉139例患者,行常规阴道超声、经阴道超声宫腔造影及宫腔镜检查,以病理结果为确诊依据,对照不同检查方法的差异。结果:临床疑诊子宫内膜息肉139例患者,最后经病理检查确诊123例。常规阴道超声诊断子宫内膜息肉98例,符合率为79.67%;经阴道超声宫腔造影诊断子宫内膜息肉118例,符合率为95.93%;宫腔镜诊断子宫内膜息肉122例,符合率为99.19%。经阴道超声宫腔造影及宫腔镜诊断符合率明显高于常规阴道超声。3种检查方法与病理诊断结果符合率之间的差异有统计学意义(χ2=34.935,P0.05),进一步两两比较发现,常规阴道超声和经阴道超声宫腔造影诊断符合率之间差异有统计学意义(χ2=15.185,P0.05),而经阴道超声宫腔造影和宫腔镜诊断符合率的差异无统计学意义(χ2=2.733,P0.05)。结论:经阴道超声宫腔造影是诊断子宫内膜息肉的一种无创、安全、简便且准确性高的检查方法,具有很高的诊断价值。     

宫腔镜检查联合病理对绝经后子宫出血的290例诊断评价

目的:评价宫腔镜联合病理对绝经后子宫出血诊断和治疗价值.方法:对我院2003-02～2009-04收治的290例绝经后阴道流血患者进行宫腔镜检查加病理,对其中114例良性、器质性病变患者宫腔镜手术治疗.结果:子宫内膜息肉62例、萎缩宫腔58例、炎症54例、宫颈管息肉46例、子宫内膜增殖症38例、子宫内膜不典型增生及子宫内膜癌12例、节育器14例、子宫黏膜下肌瘤6例.B超下子宫内膜＜4.0 mm者宫腔内器质性病变33.3%,而≥4.0 mm者器质性病变58.6%,12例子宫内膜癌及癌前病变患者内膜均≥4.0 mm,良性子宫内膜器质性病变者均宫腔镜下手术1次治愈.结论:宫腔镜检查辅以病理是诊断绝经后子宫出血的有效方法.     

宫腔镜电切术治疗宫内占位病变的临床分析

目的评价宫腔镜电切术治疗宫内占位病变的疗效及安全性。方法应用宫腔电切镜经阴道切除宫腔内占位病变126例,其中宫腔镜下子宫内膜息肉切除术(TCRP)70例,子宫黏膜下肌瘤切除术(TCRM)56例,并对其术中术后情况进行临床分析。结果手术成功率达100.0%,手术时间(45.9±11.2)min,术中出血量(40.8±8.7)ml。术前月经异常者102例,术后月经恢复正常或好转者96例(94.1%),贫血缓解率96.1%。18例痛经患者术后有12例缓解。5例不孕患者术后有3例正常妊娠分娩,其余仍在随访观察中。结论宫腔镜电切术治疗宫腔内占位病变,具有不开腹、不切开子宫肌层、创伤小、出血少、手术时间短、术后恢复快,以及更多地保留器官功能、更利于生殖预后等优点。     

宫腔镜检查联合病理对绝经后子宫出血的290例诊断评价

目的：评价宫腔镜联合病理对绝经后子宫出血诊断和治疗价值。方法：对我院2003—02—2009—04收治的290例绝经后阴道流血患者进行宫腔镜检查加病理，对其中114例良性、器质性病变患者宫腔镜手术治疗。结果：子宫内膜息肉62例、萎缩宫腔58例、炎症54例、宫颈管息肉46例、子宫内膜增殖症38例、子宫内膜不典型增生及子宫内膜癌12例、节育器14例、子宫黏膜下肌瘤6例。B超下子宫内膜〈4．0mm者宫腔内器质性病变33．3％，而≥4．0mm者器质性病变58．6％，12例子宫内膜癌及癌前病变患者内膜均≥4．0mm，良性子宫内膜器质性病变者均宫腔镜下手术1次治愈。结论：宫腔镜检查辅以病理是诊断绝经后子宫出血的有效方法。     

Sonohysterography for evaluation of the endometrium in women treated with tamoxifen.

OBJECTIVE: This study was performed to evaluate sonohysterography for the diagnosis of endometrial abnormalities in women treated with tamoxifen. MATERIALS AND METHODS: Fifty sonohysterograms were obtained in 48 consecutive tamoxifen-treated women. All women were postmenopausal and had been undergoing tamoxifen therapy for a mean of 2.6 years. Forty-six sonohysterograms (92%) were completed and four were unsuccessful. Sonohysterogram findings were correlated with prior endometrial biopsy results for 23 sonohysterograms (46%) that were preceded by endometrial biopsy. Sonohysterogram findings were also compared with histopathology results, available for 38 sonohysterograms (76%) that were followed by hysteroscopy with dilatation and curettage. RESULTS: Sonohysterography revealed 31 endometrial polyps (62%), six thickened endometria (12%), five normal endometria (10%), and four subendometrial cysts (8%). Surgery was avoided when seven sonohysterograms (14%) revealed normal endometria or subendometrial cysts. In the group with histopathologic correlation, 23 of 28 polyps were confirmed and two of five thickened endometria were shown to represent endometrial hyperplasia. Twelve (63%) of 19 sonohysterograms with prior normal endometrial biopsy findings had abnormalities on sonohysterography, including 10 polyps and two thickened endometria. CONCLUSION: Sonohysterography aids the diagnosis of endometrial abnormalities in tamoxifen-treated women even if prior endometrial biopsies have negative findings. In 14% of cases, visualization of a normal endometrium on sonohysterography obviated surgery.     

Imaging the endometrium: disease and normal variants.

The endometrium demonstrates a wide spectrum of normal and pathologic appearances throughout menarche as well as during the prepubertal and postmenopausal years and the first trimester of pregnancy. Disease entities include hydrocolpos, hydrometrocolpos, and ovarian cysts in pediatric patients; gestational trophoblastic disease during pregnancy; endometritis and retained products of conception in the postpartum period; and bleeding caused by polyps, submucosal fibroids, endometrial hyperplasia, or endometrial adenocarcinoma. Other findings include tamoxifen-associated changes, intrauterine fluid collections, and endometrial adhesions. Although ultrasound (US) is almost always the first modality used in the radiologic work-up of endometrial disease, findings at sonohysterography, hysterosalpingography, magnetic resonance imaging, and computed tomography are often correlated with US findings. It is important to understand that the appearance of the endometrium is related to multiple factors, including the patient's age, stage in the menstrual cycle, and pregnancy status and whether she has undergone hormonal replacement therapy or tamoxifen therapy. Accurate diagnosis requires that these factors be taken into account in addition to clinical history and physical examination findings.     

宫腔镜在宫腔粘连诊治中的应用

目的探讨宫腔镜诊断和治疗宫腔粘连的临床效果。方法对56例宫腔粘连患者进行宫腔镜检查,并在镜下电切分离子宫内粘连,术后予以抗生素、人工周期、IUD留置治疗。结果宫腔粘连Ⅰ度为35.7%,Ⅱ度25.0%,Ⅲ度19.6%,Ⅳ度12.5%,V度5.4%。56例患者宫腔粘连完全分离,无并发症发生。结论宫腔镜是目前诊断和治疗宫腔粘连较准确、较理想的方法,值得推广应用。     

宫腔镜手术治疗绝经期子宫内膜息肉的应用

 目的探讨官腔镜手术在治疗绝经期子宫内膜息肉方面的临床效果.方法回顾性分析1999年10月～2004年10月在我院经门诊宫腔镜诊断为子宫内膜息肉而行官腔镜手术的49例绝经后妇女的临床资料.41例行单极电切手术:其中13例行单纯息肉切除,15例息肉切除同时行滚球电极子宫内膜剥除,13例息肉切除同时行热球子宫内膜剥除;5例行双极汽化电切息肉及子宫内膜剥除;余3例患者因术中诊为黏膜下子宫肌瘤而行官腔镜下肌瘤切除术.结果49例中术后病理诊断为子宫内膜息肉46例,其中1例合并子宫内膜复杂性伴轻度非典型增生;黏膜下子宫肌瘤3例.宫腔镜检查诊断子宫内膜息肉的符合率为93.88%(46/49).所有患者均耐受手术,无麻醉意外及手术并发症.31例绝经后出血患者均未再出现异常出血.结论官腔镜手术是绝经后妇女子宫内膜息肉的首选微创诊治方法,为了防止息肉复发可于息肉切除同时行子宫内膜去除术.     

Endometrial evaluation with transvaginal US and hysterosonography in asymptomatic postmenopausal women with breast cancer receiving tamoxifen

PURPOSE: To determine performance characteristics of transvaginal ultrasonography (US) and hysterosonography for diagnosing endometrial abnormality in asymptomatic postmenopausal women with breast cancer receiving tamoxifen. MATERIALS AND METHODS: The authors prospectively examined 138 women receiving tamoxifen by using transvaginal US, hysterosonography, and office hysteroscopy. The combined hysteroscopic-histopathologic diagnosis was the reference standard. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of transvaginal US and hysterosonography were calculated. RESULTS: All 138 women underwent transvaginal US; 104, successful hysterosonography; and 117, successful hysteroscopy. Uterine abnormality was present in 47 (40.2%) of 117 women: 45 with polyps and two with submucosal fibroids. Receiver operating characteristic curve analysis revealed 6 mm to be the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities. When a thickness greater than 6 mm or a focal endometrial finding was considered abnormal, transvaginal US had a sensitivity of 85.1% and a specificity of 55.7%. In 92 women who completed transvaginal US, hysterosonography, and hysteroscopy, hysterosonography was more specific (79.2%; P =.008) but not significantly more sensitive (89.7%; P =.508) than transvaginal US. When women with abnormal transvaginal US findings were further examined with hysterosonography, the sequential combination of transvaginal US and hysterosonography was more specific (77.1%) than transvaginal US alone (P <.001), without a significant decrease in sensitivity (78.7%; P =.25). CONCLUSION: In asymptomatic postmenopausal women receiving tamoxifen, 6 mm is the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities with transvaginal US. Further examination with hysterosonography can improve specificity by reducing the high false-positive rate of transvaginal US.     

Diagnostic value of hysterosalpingography in the detection of intrauterine abnormalities: a comparison with hysteroscopy

OBJECTIVE: The purpose of this study was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in comparison with hysteroscopy in the detection of intrauterine abnormality in infertile patients. MATERIALS AND METHODS: Seventy-eight patients being investigated for infertility and undergoing HSG and hysteroscopy were studied retrospectively. Radiologic findings on HSG, including single or multiple filling defects and uterine wall irregularities, were evaluated and compared with hysteroscopic findings, which were considered the reference standard. RESULTS: HSG showed a sensitivity of 81.2% compared with that of hysteroscopy and a specificity of 80.4%, with a positive predictive value of 63.4% and a negative predictive value of 83.7%. HSG also had a false-negative rate of 90% and a false-positive rate of 21.8%. Overall agreement between the two procedures was 73%. CONCLUSION: HSG is still a useful screening test for the evaluation of the uterine cavity in the study of primary or secondary infertility. In addition, HSG provides information concerning the assessment of tubal morphology and patency. We believe that these two procedures are complementary in the evaluation of the uterine cavity.     

宫腔镜检查诊断子宫异常出血1245例临床分析

目的探讨宫腔镜技术诊治子宫异常出血的效果和安全性。方法选取2008年6月—2014年2月我院收治的子宫异常出血患者1 245例,按绝经及婚育史分为:绝经组476例,育龄有妊娠史组537例,育龄未孕组232例。并分别进行宫腔镜检查和治疗。结果 (1)绝经组:检出子宫内膜息肉146例,子宫内膜癌23例,子宫内膜不典型增生15例,子宫内膜复杂增生39例,子宫内膜单纯增生98例,子宫肌瘤26例。宫腔镜阳性诊断率为72.9%。(2)育龄有妊娠史组:检出子宫内膜息肉128例,子宫内膜癌19例,子宫内膜不典型增生17例,子宫内膜复杂增生48例,子宫内膜单纯增生86例,子宫肌瘤36例,胚物残留5例,宫腔镜阳性诊断率为63.1%。(3)育龄未孕组:检出子宫内膜息肉101例,子宫内膜癌6例,子宫内膜不典型增生8例,子宫内膜复杂增生6例,子宫内膜结核8例,宫腔镜阳性诊断率为55.9%。结论宫腔镜检查技术的临床应用对于子宫异常出血患者的诊断及指导治疗有重要意义。     

Endometriosis detection by US with laparoscopic correlation

Endometriosis is a common cause of female infertility. It may affect as many as 40% of infertile women and may be the sole contributing factor to infertility in 15%. A study was undertaken to determine the usefulness of the routine pelvic ultrasound (US) examination in the detection of endometriosis by correlating pelvic US findings with laparoscopic findings in 85 patients who underwent both examinations. Forty-eight patients (56.5%) had no laparoscopic evidence of endometriosis, and 37 patients (43.6%) had endometriosis. Eight of the patients had abnormal sonograms; of these patients, only four had sonographic abnormalities that corresponded to laparoscopically identified endometriosis. Thus, US was successful in detecting endometriosis in only four (10.8%) of 37 patients. US is neither sensitive nor specific in diagnosing endometriosis. Furthermore, we believe that US does not have a significant role in the diagnosis or management of endometriosis in patients in whom a pelvic mass or other obvious pelvic abnormality is not suspected.     

Hysterosalpingography

During the past decade, there has been a dramatic increase in the number of women seeking infertility evaluation. Hysterosalpingography (HSG) is an invaluable procedure for evaluating internal architecture of the female reproductive tract. Utilizing HSG, it may be possible to minimize the use of invasive procedures, such as hysteroscopy and laparoscopy, in defining such problems as peritubal adhesions, leiomyomas, and congenital anomalies. This review re-emphasizes the wide range of available information and advantages of HSG which can be extremely useful in the diagnosis and management of infertile patients.