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。     

0.9%氯化钠液子宫腔声学造影对子宫内膜息肉的诊断价值

目的:探讨0.9%氯化钠液子宫腔声学造影检查对诊断子宫内膜息肉的价值,寻找一种诊断子宫内膜息肉的有效方法。方法:回顾性分析49例经0.9%氯化钠液子宫腔声学造影检查诊断为子宫内膜息肉,宫腔镜手术后并经病理检查确诊患者的临床资料。结果:经0.9%氯化钠液子宫腔声学造影检查诊断为子宫内膜息肉的49例患者,经病理检查证实46例患者诊断符合,符合率为93.88%,另3例为子宫内膜增生。结论:经0.9%氯化钠液子宫腔声学造影检查是诊断子宫内膜息肉的一种简单、方便、可靠的方法。     

宫腔镜联合B超检查诊断异常子宫出血的临床探讨

目的 探讨宫腔镜与B超联合检查在各种异常子宫出血中的诊断价值。方法 2001年7月至2002年7月应用宫腔镜联合B超检查异常子宫出血176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46例，符合率为63．04％；子宫内膜息肉45例，符合率为95．56％；子宫粘膜下肌瘤8例，符合率为87．50％；子宫内膜癌3例，符合率为75．00％。结论 宫腔镜联合B超检查异常子宫出血，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。     

宫腔镜检查诊断未婚女性异常子宫出血的可行性探讨

目的评价宫腔镜诊断未婚女性异常子宫出血的临床应用价值。方法2003-01-2005-08天津中医学院第一附属医院在静脉麻醉下对37例未婚异常子宫出血患者行宫腔镜检查,同时宫腔镜下取病理进行病理组织学检查,术中超声全程监测。结果37例患者均成功在宫腔镜下完成了检查及病理取材,无一例处女膜损伤,无宫颈损伤和子宫穿孔。病理诊断正常增殖期宫内膜13例,子宫内膜息肉1例,宫内膜微小息肉合并子宫内膜单纯增生2例,子宫内膜单纯性增生8例。增殖期宫内膜增生现象8例,子宫内膜炎1例,子宫内膜异位症1例,粘膜下肌瘤2例。结论对未婚患者的可疑宫内病变,在不损伤处女膜的情况下宫腔镜检查同时进行病理诊断是可行的。     

宫腔镜检查断未婚女性异常子宫出血的可行性探讨

目的 评价宫腔镜诊断未婚女性异常子宫出血的临床应用价值.方法 2003-01-2005-08天津中医学院第一附属医院在静脉麻醉下对37例未婚异常子宫出血患者行宫腔镜检查,同时宫腔镜下取病理进行病理组织学检查,术中超声全程监测.结果 37例患者均成功在宫腔镜下完成了检查及病理取材,无一例处女膜损伤,无宫颈损伤和子宫穿孔.病理诊断正常增殖期宫内膜13例,子宫内膜息肉1例,宫内膜微小息肉合并子宫内膜单纯增生2例,子宫内膜单纯性增生8例.增殖期宫内膜增生现象8例,子宫内膜炎1例,子宫内膜异位症1例,粘膜下肌瘤2例.结论 对未婚患者的可疑宫内病变,在不损伤处女膜的情况下宫腔镜检查同时进行病理诊断是可行的.     

子宫内膜息肉的诊断和鉴别诊断

子宫内膜息肉在育龄妇女和绝经后妇女均可能发生。以异常子宫出血和宫腔占位性病变为主要临床表现。经阴道超声是首选的影像学评估方法。经临床表现、妇科检查和影像学评估高度怀疑子宫内膜息肉者，宫腔镜下子宫内膜病灶切除病理检查是诊断的金标准。子宫内膜息肉应与所有导致异常子宫出血和宫腔占位性病变的情况相鉴别。     

宫腔镜对诊断子宫内膜癌的价值

目的 探讨宫腔镜检查对子宫内膜癌和子宫内膜增生的诊断价值。方法 对206例具有临床症状伴子宫内膜高危因素者行宫腔镜检查的结果进行回顾性分析。结果 宫腔镜下诊断为子宫内膜癌及可疑癌共37例(18.6％),经病理证实为子宫内膜癌22例,其中19例进行了手术,术后病理报告宫颈管未受侵15例,受侵4例,与术前宫腔镜诊断符合率94.7％。术中腹水细胞学检查阴性13例,阳性1例,可疑1例。206例中经病理证实Ⅰ～Ⅲ级非典型增生12例,宫腔镜诊断分别为:可疑癌4例,子宫内膜增生3例,正常或萎缩宫内膜4例,内膜结核1例。结论:宫腔镜检查直观病灶,准确定位活检,尤其适用于早期诊断。另外宫腔镜检查能够明确病灶部位和范围,提高宫颈管术前是否受侵的诊断率。     

分析宫腔镜诊断异常子宫出血的应用价值

目的分析宫腔镜诊断异常子宫出血的应用价值。方法回顾性分析2014年5月~2015年2月我院收治的异常子宫出血患者161例的临床资料,均采用宫腔镜进行检查,并进行病理诊断,统计并分析宫腔镜诊断、病理诊断结果。结果宫腔镜诊断结果与病理检查结果总符合率为94.04%,其中子宫黏膜下肌瘤、子宫内膜增生、子宫内膜息肉、子宫内膜炎、子宫内胚物残留、子宫内膜癌的诊断符合率分别为92.30%、96.22%、95.00%、89.47%、94.44%、100.00%。结论采用宫腔镜对异常子宫出血患者进行检查,可以直视宫腔内的病变组织的形态、数量、质地等,及早发现宫颈管与子宫内的病变组织,准确度、特异度较高,联合病理检查能更一步提高其临床诊断的准确度,诊断价值高,具有临床应用价值。     

超声联合宫腔镜检查子宫异常出血的诊断价值

目的:超声和宫腔镜联合检查诊断子宫异常出血的原因。材料与方法:经腹部超声检查测量子宫内膜厚度,超声和宫腔镜联合检查观察子宫腔内病变并在超声监测下诊断性刮宫。结果:75例患者中,子宫内膜厚度16mm者55例,其中子宫内膜息肉、子宫粘膜下肌瘤以及子宫内膜息肉合并粘膜下肌瘤43例,子宫内膜癌5例,子宫内膜增生7例;子宫内膜16mm者20例,其中子宫内膜息肉3例,宫颈息肉7例。结论:超声检查可以作为子宫异常出血患者的首选检查方法,超声和宫腔镜联合检查可进一步提高病因诊断。     

电视宫腔镜诊治91例绝经后子宫出血的效果分析

目的回顾性分析电视宫腔镜对绝经后子宫出血的诊断和治疗效果.方法对91例绝经后子宫出血患者行宫腔镜检查,其中21例行电切术或病灶摘除术,病变组织送病理.结果绝经后出血的病因依次为粘膜下肌瘤、子宫内膜炎、子宫内膜息肉、子宫内膜单纯增生、萎缩性子宫内膜、子宫内膜癌等,宫腔镜诊断与病理诊断符合率依次为95.2%、100%、88.9%、100%、90%、80%.宫腔镜治疗宫腔良性病变所致子宫出血无一例复发.结论宫腔镜诊断绝经后子宫出血,优于诊断性刮宫;部分患者可同时行病灶摘除或电切术,减少了开腹手术对患者的创伤.     

Découvertes hystéroscopiques chez les femmes de 40 ans et moins avec saignement utérin anormal

Objective: describe hysteroscopic findings among women of 40 years old or less with abnormal uterine bleeding.Methods: this is a retrospective cohort study, using hospital and clinic files for the period of January 1988 to April 1997, where 191 patients 40 years old or younger had a diagnostic hysteroscopy for abnormal uterine bleeding. The rate of successful hysteroscopies, the type of anaesthesia, and hysteroscopic complications were listed. Type and frequency of intrauterine pathology, such as endometrial polyps, submucous myomas, hyperplasia and atrophy, were analyzed. Particular attention was devoted to the incidence of pathology which were not identified by endometrial biopsy (polyps and submucous myomas. Prior treatment before hysteroscopy was also assessed.Results: hysteroscopy was successfully completed in 95.8 percent of cases and the majority of the procedures 67.5% were done under local anaesthesia (paracervical block). No perforation or other major complication has been listed. Intrauterine pathology was diagnosed in 24 percent of patients and, among them, 9.8 percent had an endometrial polyp and 6.6 percent had a submucous myoma. About half of patients 45.9% had no treatment prior to hysteroscopy. Among those with previous treatments, 41 percent failed to respond to oral contraceptive therapy: in those patients, 13.3 percent had an endometrial polyp and 8.0 percent had a submucous myoma.Conclusion: hysteroscopy is a useful diagnostic approach for the investigation of patients 40 years old or less with abnormal uterine bleeding. In 24 percent of these patients, hysteroscopy enables the detection of intrauterine lesions. Most of which could not be detected by endometrial biopsy. According to this retrospective study, it seems preferable to recommend a diagnostic hysteroscopy rather than an endometrial biopsy for the investigation of abnormal uterine bleeding among women 40 years old or younger.     

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.     

Is outpatient diagnostic hysteroscopy more useful than endometrial biopsy alone for the investigation of abnormal uterine bleeding in unselected premenopausal women? A randomised comparison

Objective To formally evaluate the clinical benefit of additional outpatient hysteroscopy over traditional vaginal examination and endometrial biopsy.
Design A prospective randomised controlled trial.
Setting A large teaching hospital in the northeast of Scotland.
Sample Premenopausal women with abnormal uterine bleeding referred to the general gynaecologic clinic and requiring endometrial biopsy.
Methods Women were randomised to either outpatient hysteroscopy and endometrial biopsy or endometrial biopsy alone.
Main outcome measures Primary outcome: initial surgical intervention rates. Secondary outcomes: procedural success and acceptability, intrauterine pathology identified and changes in management.
Results Three hundred and seventy women were recruited to the study. Initial trends in clinical management were comparable in both groups. No woman was advised to have removal of a localised lesion found at outpatient hysteroscopy and a normal uterine cavity at hysteroscopy did not influence the hysterectomy rate, which was similar in both groups. Outpatient hysteroscopy was found to be as acceptable as an outpatient endometrial biopsy and successfully completed in 85% compared with 91% of women who underwent endometrial biopsy alone. No cases of endometrial malignancy were identified.
Conclusions Outpatient diagnostic hysteroscopy is an acceptable procedure and may give more reassurance. It did not influence clinical management, especially with respect to hysterectomy rate. Outpatient hysteroscopy may be useful in selected cases, but when performed in a non-selective manner, it has little influence on clinical management and increases costs.     

Evaluation of abnormal uterine bleeding by transvaginal 3-D hysterosonography and diagnostic hysteroscopy

AIM: To compare 3-D hysterosonography (3-DHS) and diagnostic hysteroscopy in women with abnormal uterine bleeding. MATERIALS AND METHODS: Of 248 women with abnormal uterine bleeding who were referred to our department, 3-D hysterosonography and hysteroscopy were performed in 242 women and the results were estimated. In six women 3-DHS could not performed because of cervical stenosis. Sensitivity and specificity of 3-DHS compared to those of hysteroscopy. RESULTS: From the 242 women who underwent examination, we found 30 patients with polyps, 22 with myomas, four with mullerian anomalies, ten with endometrial cancer, 12 with adhesions and 165 with a normal uterine cavity. There was agreement between the two methods in 28 cases of polyps, 22 cases of myomas, four cases of mullerian anomalies, ten cases of endometrial cancer, eight cases of adhesions and in 165 cases of normal endometrium. The sensitivity and specificity of 3D hysterosonography was 93.5% and 99.4%, respectively, with a positive prognostic value (PPV) of 98.6% and a negative prognostic value (NPV) of 97%. The sensitivity and specificity of hysteroscopy was 98.7% and 99.4%, respectively, with a PPV of 98.7% and a NPV of 99.4%. CONCLUSIONS: Three-D hysterosonography accurately assessed intrauterine pathology.     

The clinical significance of small endometrial polyps

Objective

Small endometrial polyps are relatively common in asymptomatic women and may regress spontaneously. In symptomatic women, the finding of a small polyp (<1 cm diameter) raises the question of the clinical pertinence and necessity of excision. Sparse data are available on the effectiveness of hysteroscopic excision of small polyps to manage abnormal uterine bleeding. The aim of this study was to assess outcome after hysteroscopic excision of small endometrial polyps in symptomatic patients.

Study design

This was an observational cohort study enrolling 255 premenopausal women presenting with abnormal uterine bleeding and a small endometrial polyp on office hysteroscopy, undertaken between January 2004 and February 2007. The study group was referred for polypectomy by operative hysteroscopy. The outcome of the procedure was reviewed 6–12 months later by a telephone interview to assess the pattern of uterine bleeding after the procedure and overall satisfaction.

Results

Significant improvement in the magnitude of bleeding was experienced by 70% of participants, but only 30% of them reported return to regular menses. Satisfaction with the procedure was reported by 80%. Younger patients reported a less favorable bleeding pattern and were found to be less satisfied with the outcome of the procedure.

Conclusions

Symptomatic women with small endometrial polyps can be treated safely and efficiently with hysteroscopic excision. In the younger age group of patients, however, the outcome of the procedure may be less favorable and may necessitate the addition of endometrial ablation to improve outcome and increase patient satisfaction.     

Hysteroscopy and transvaginal ultrasonography in postmenopausal women with uterine bleeding.

OBJECTIVE: To evaluate the accuracy of hysteroscopy and transvaginal ultrasonography (TU), based on a histopathological report from endometrial specimens, in diagnosing endometrial pathology in menopausal women with uterine bleeding. METHODS: Four-hundred and nineteen postmenopausal women with uterine bleeding underwent TU, hysteroscopy and endometrial biopsy. Hysteroscopic and sonographic findings have been evaluated on the basis of the final diagnosis established by histologic examination. Sensitivity, specificity and positive predictive value of TU at an endometrial thickness cut-off point of 4 and 8 mm (double layer technique) and of panoramic hysteroscopy have been detected. RESULTS: Normal and abnormal endometrium was found in 222 and in 197 women, respectively. TU showed sensitivity of 95.1%, specificity of 54.8% and positive predictive value of 63.7% at a cut-off limit of 4 mm. With a cut-off limit of 8 mm the corresponding figures were 83.8%, 81.3% and 79.4%. Hysteroscopy demonstrated a sensitivity of 96.5%, specificity of 93.6% and positive predictive value of 92.6%. The combination of the two diagnostic tools showed a 100% sensitivity, 94.8% specificity and 93.3% positive predictive value. CONCLUSIONS: With cut-off limit of 4 mm, TU can be considered the first choice modality of endometrial investigation in women with postmenopausal uterine bleeding to select patients at risk to carry endometrial pathology. Hysteroscopy is a more accurate technique than TU because of better specificity and must be indicated for all patients showing an endometrial strip more than 4 mm. When an endometrial thickness below 4 mm is detected by ultrasound, hysteroscopy may be indicated on clinical background because of the possibility to miss infrequent (2.5% in our series), but relevant endometrial pathologies. Endometrial sampling should follow hysteroscopic view in all cases showing abnormal or suspicious lesions as well as in all cases with irregularly shaped endometrial lining and/or suboptimal endoscopic vision.     

Accuracy of preoperative diagnostic tools and outcome of hysteroscopic management of menstrual dysfunction

STUDY OBJECTIVES: To review diagnoses, complications, and surgical findings in women treated for abnormal uterine bleeding by operative hysteroscopy, and to assess the accuracy of preoperative transvaginal ultrasound (TVS), saline-infusion sonography (SIS), diagnostic hysteroscopy, and endometrial biopsy. DESIGN: Retrospective study (Canadian task force classification II-2). SETTING: Tertiary care academic medical center. PATIENTS: Three hundred seventy-five women. Intervention. Operative hysteroscopy for abnormal uterine bleeding. MEASUREMENTS AND MAIN RESULTS: Main indications for hysteroscopy were postmenopausal bleeding (164 patients, 43.7%) and abnormal premenopausal uterine bleeding (211, 56.3%). Main pathology findings were endometrial polyps (172, 45.9%) and submucous myomas (105, 28%). Polyps had histologic abnormalities in 18 patients. Sensitivity of preoperative diagnostic tools for all intrauterine abnormalities and specifically for myomas and polyps was TVS 74% and 39%, SIS 96% and 96%, hysteroscopy 100% and 99%, and Pipelle biopsy 24% and 10%. The complication rate was 1.3%. Postmenopausal women felt significantly more improvement in symptoms (p = 0.02), and were more satisfied (p 相似文献   

Clinical assessment of sonohysterography in the diagnosis and management of abnormal uterine bleeding

OVERVIEW: Abnormal uterine bleeding is a common gynecological symptom. The curettage can asses only 50-60% of endometrium surface, thereby leaving some changes unrevealed. Sonohysterography (SHG), which combines the distention of the uterine cavity trough saline solution and ultrasound examination, allows a more exact evaluation of uterine cavity abnormalities. OBJECTIVES: To assess the value of sonohysterography in the diagnosis and management of abnormal uterine bleeding. MATERIALS AND METHODS: 67 women with abnormal uterine bleeding and uterine cavity abnormalities confirmed by transvaginal ultrasound were examined with sonohysterography. RESULTS: Sonohysterography revealed 21 cases of submucous myomas, 22 endometrial polyps and 24 cases of endometrial hyperplasia. All patients underwent diagnostic hysteroscopy to verify the results. The sensitivity and specificity for sonohysterography were both 93%. The positive and negative predictive values were 96% and 93%, respectively. CONCLUSIONS: Sonohysterography is a sensitive and specific method for diagnosis of abnormal uterine bleeding. It allows faster and less invasive diagnosis. Given the low costs of examination sonhysterography can be used as an ambulatory procedure reducing delay of treatment.     

El potencial maligno de los pólipos endometriales

Objectives

To determine the pre-malignant and malignant potential of endometrial polyps, and to asses whether different clinical parameters are associated with malignancy in the polyps.

Material and methods

452 hysteroscopic resections of endometrial polyps were reviewed. Histological diagnosis and clinical characteristics (presence of abnormal uterine bleeding and polyp size) were analyzed. Statistical analysis was performed.

Results

The study included 203 pre-menopausal and 249 post-menopausal women. The mean age of pre-menopausal women was 44.3 ± 0,4 years, and 59.1 ± 0.5 years for postmenopausal women. The diagnosis of polyps was by ultrasound with or without hysterosonography, or by hysteroscopy. The main indication of hysteroscopy was abnormal uterine bleeding, which was 65.1% in the pre-menopausal group and 74.7% in the post-menopausal group. There were 23 cases (11.3%) of hyperplasia without atypia in the pre-menopausal group, and 8 cases (3.2%) in the post-menopausal group. Hyperplasia with atypia was found in 2 cases (0.9%) in the pre-menopausal group, and in 9 cases (3.6%) in the post-menopausal group. There were 16 cases of endometrial carcinoma (6.4%), all of them in post-menopausal women. In 1 of these 16 patients there was no abnormal bleeding, but an endometrial polyp was suspected in the ultrasound. Menopause status was significantly associated with pre-malignant or malignant changes. No significant association was found between the presence of abnormal uterine bleeding and polyp size with pre-malignancy or malignancy in the polyp.

Conclusions

Post-menopausal women with endometrial polyp, whether symptomatic or not, should be evaluated by hysteroscopic resection. Asymptomatic pre-menopausal patients, without any risk factor, should be followed up.