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1.
阴道B超和宫腔镜检对异常子宫出血的临床价值研究   总被引:1,自引:1,他引:1  
目的探讨阴道B超和宫腔镜检对异常子宫出血病因诊断的临床价值。方法对247例异常子宫出血患者,进行阴道B超和宫腔镜检查,并同时进行病理活检检查。结果最常见病因为子宫内膜息肉,其次为子宫内膜增生过长和子宫黏膜下肌瘤;绝经后妇女子宫异常出血病因与子宫内膜增生过长和子宫内膜息肉、子宫内膜癌及子宫内膜炎有关;阴道B超联合宫腔镜检联合镜检检出率较高,3组间检出率差异具有统计学意义(P<0.01)。阴道B超与宫腔镜检检出率间差异具有统计学意义(P<0.01)。对于子宫内膜息肉、子宫内膜增生过长及宫颈管息肉,宫腔镜检检出率显著高于阴道B超(P<0.05)。阴道B超无法检测出子宫内膜炎。而对于黏膜下肌瘤、宫腔妊娠物残留、子宫内膜癌和宫内节育环嵌顿等其他病例,两者检出率差异不具有统计学意义(P>0.05)。结论阴道B超联合宫腔镜检可以提高异常子宫出血检出率。  相似文献   

2.
目的:评价经阴道彩色多普勒血流显像(TVCDFI)对预测围绝经期异常子宫出血妇女子宫内膜性质的价值.材料与方法:对临床拟诊子宫内膜病变需做诊刮或宫腔镜检查的512例围绝经期异常子宫出血妇女行常规经阴道超声检查(TVS)及TVS+CDFI,并与病理检查对照,比较两者的诊断符合率.结果:TVS与TVS+CDFI两者比较:内膜生理性改变、内膜增生、内膜炎的诊断符合率差异不大,无统计学意义;内膜息肉、内膜癌TVS与TVS+CDFI诊断符合率分别为:61.54%(32/52),61.54%(8/13);88.47%(46/52),92.86%(13/14),结果差异具有极显著性意义(P<0.01).结论:TVS+CDFI对围绝经期异常子宫出血妇女子宫内膜性质有较高的预测价值.阴超检查子宫内膜时,常规应用CDFI观察内膜区血流信号,能有效提高子宫内膜微小病变及早期子宫内膜癌的检出率.  相似文献   

3.
目的对比经阴道超声与宫腔镜对绝经后子宫内膜良恶性病变中的诊断符合率,为临床预测和评估子宫内膜良恶性病变提供依据。方法回顾性研究自2017年6月至2018年6月在沧州市人民医院接受治疗的疑似子宫内膜良恶性病变90例患者作为观察对象,以病理检测结果为准,在患者自愿的前提下对患者先进行经阴道超声检查(阴道超声),后进行宫腔镜检查(宫腔镜),比较患者两次检查的临床检出率、诊断准确率。结果宫腔镜检查对绝经后子宫内膜病变的阳性检出率(86. 67%)、阴性检出率(58. 33%)、诊断符合率(91. 67%)明显优于对经阴道超声检查的阳性检出率(84. 44%)、阴性检出率(42. 86%)、诊断符合率(87. 78%),差异具有统计学意义(P 0. 05)。经阴道超声检查在对绝经后子宫内膜增生的诊断检出率(39例,43. 33%)显著高于宫腔镜检查的诊断检出率(28例,31. 11%),且两者差异均具有统计学意义(P=0. 002);宫腔镜检查在对绝经后子宫内膜癌的诊断检出率(7例,7. 78%)、子宫内膜息肉的诊断检出率(16例,17. 78%)、子宫内膜萎缩的诊断检出率(39例,43. 33%)显著高于经阴道超声检查在对绝经后子宫内膜癌的诊断检出率(5例,5. 55%)、子宫内膜息肉的诊断检出率(13例,14. 44%)、子宫内膜萎缩的诊断检出率(33例,36. 67%),且两者差异均具有统计学意义(P 0. 05)。宫腔镜检查在对绝经后子宫内膜病变的诊断效果方面[灵敏度(95. 05%)、特异度(86. 34%)、阳性预测率(93. 34%)、约登指数(0. 85)]更优于阴道超声组的诊断效果方面[灵敏度(87. 72%)、特异度(65. 58%)、阳性预测率(89. 62%)、约登指数(0. 67)],且两者差异均具有统计学意义(P 0. 05)。结论采取经阴道超声和宫腔镜对绝经后子宫内膜良恶性病变的检查均具有较高的诊断符合率,采取宫腔镜对于子宫内膜良恶性病变的诊断具有检出率高、灵敏度高、特异性好及精准度的临床效果,具有十分重要的临床推广价值。  相似文献   

4.
目的:探讨绝经后无症状子宫内膜增厚的临床情况、相关因素和病理分类。方法回顾性分析2010年1月至2013年3月136例绝经后无明确症状(阴道出血、腹痛等)子宫内膜增厚妇女的临床资料。结果136例绝经后无症状子宫内膜增厚的患者按各因素分组子宫内膜厚度行统计学比较,差异无显著性(P>0.05)。诊断性刮宫病理为正常子宫内膜43例,子宫内膜良性病变81例,包括子宫内膜息肉79例、子宫黏膜下肌瘤2例;子宫内膜不典型增生11例,子宫内膜癌1例。按子宫内膜厚度5~10mm、10~15mm及内膜厚度>15mm分组,比较各种不同病理的分布情况,差异均有统计学意义(P<0.05)。结论绝经后内膜厚度与合并高血压、糖尿病、肥胖、生育无明显相关性;内膜厚度与子宫内膜病理分类有显著相关性。常规宫腔镜应用,可以提高绝经后子宫内膜病变的检出率。  相似文献   

5.
目的探讨宫腔镜窄带成像技术(NBI)诊断不同类型子宫内膜增生性病变的价值。方法选取148例异常子宫出血患者行宫腔镜检查,分别于白光和NBI模式下观察子宫内膜,对可疑病灶行靶向活检,送病理组织学检查。以病理诊断为金标准,比较白光与NBI模式对不同分类子宫内膜增生性病变的诊断价值。结果低危型子宫内膜增生性病变表现以Ⅱ型微血管为主,高危型子宫内膜增生性病变以Ⅲ~Ⅳ型微血管为主。宫腔镜白光及NBI模式诊断低危型子宫内膜增生性病变的敏感性分别为65.52%及86.21%,差异有统计学意义(χ~2=6.78,P=0.009);NBI模式诊断低危型子宫内膜增生性病变与病理学诊断一致性中等(Kappa值为0.617)。宫腔镜白光、NBI模式诊断高危型子宫内膜增生性病变的准确率分别为81.08%及89.86%(χ~2=4.60,P=0.032),敏感性分别为57.14%及92.86%(χ~2=14.29,P=0.000),阴性预测值分别为84.21%及96.91%(χ~2=9.43,P=0.002),差异均有统计学意义;特异性分别为90.57%及88.68%(χ~2=0.20,P=0.652),阳性预测值分别为70.59%及76.47%(χ~2=0.37,P=0.544),差异均无统计学意义;NBI模式诊断高危型子宫内膜增生性病变与病理学诊断有较好的一致性(Kappa值为0.766)。结论宫腔镜NBI可清晰地观察子宫内膜表面及深层的微血管形态变化,有助于减少低危型子宫内膜增生性病变的漏诊,提高诊断高危型子宫内膜增生性病变的准确率。NBI在诊断不同分类子宫内膜病变中具有一定临床应用价值。  相似文献   

6.
目的探讨阴道彩色多普勒超声对围绝经期妇女子宫内膜病变的预测价值.方法对164例绝经前不规则阴道出血的患者行阴道彩色多普勒超声检查,重点观察内膜厚度及内膜血流,与当日或次日诊刮的内膜组织病理诊断对照.结果子宫内膜厚度在生理改变,良性病变,癌及癌前病变三组比较,具有极显著性差异(P<0.01).以内膜厚度12 mm为预测绝经前妇女子宫内膜病变的临界值,其敏感性、特异性、阳性预测值、阴性预测值分别为96.2%、65.5%、83.6%、86.4%.生理改变组58例(58/164)内膜区未检测到血流信号,良性病变组2例(2/98),癌前病变组中有癌3例(3/8).结论阴道彩超可把内膜厚度12 mm做为围绝经期子宫内膜病变的临界值,但内膜形态、内部回声、边缘及内膜内血流对预测病变亦有诊断意义.  相似文献   

7.
经阴道彩色超声对绝经后子宫内膜病变的诊断   总被引:1,自引:0,他引:1  
目的:探讨经阴道彩色超声对绝经后子宫内膜病变的诊断价值。方法:采用经阴道彩色超声回顾性观察200例绝经后子宫出血患者的超声图像特征、子宫内膜厚度及血流阻力指数。结果:子宫内膜癌的内膜厚度明显高于子宫良性病变的内膜厚度,且子宫内膜癌的内膜厚度均〉5 mm;子宫内膜癌的血流阻力指数明显低于良性病变,两项均有统计学差异(P〈0.05)。结论:经阴道彩色超声检查是诊断子宫内膜疾病的常规首选方法。  相似文献   

8.
目的探讨宫腔镜应用于绝经后子宫内膜病变诊断的临床价值。方法选取2016年4月-2018年4月该院100例绝经后子宫内膜病变患者,根据随机数字法,将其分为对照组(诊断性刮宫)和观察组(宫腔镜),每组各50例,比较两组患者子宫腔病变检出率,以及诊断各种子宫内膜病变的敏感度、特异度、阳性预测值和阴性预测值。结果观察组子宫内膜病变检出率明显高于对照组(P 0.05);观察组患者子宫内膜息肉、子宫黏膜下肌瘤检出率明显高于对照组(P 0.05);观察组患者子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜增生和子宫内膜癌等病变诊断的敏感度、特异度、阳性预测值和阴性预测值均高于对照组。结论宫腔镜能够有效、准确地诊断绝经后子宫内膜病变,其简单、快速、损伤小,值得临床推广。  相似文献   

9.
目的分析阴道超声检查诊断子宫内膜增厚的准确率、灵敏度、特异度。方法回顾性分析我院2015年1月~2017年9月在我院行阴道超声检查的104例子宫内膜增厚患者临床资料。根据患者子宫内膜厚度分为3组,A组(子宫内膜厚度15mm)57例,B组(15mm≤子宫内膜厚度20mm)34例,C组(子宫内膜厚度≥20mm)13例。以病理检查结果为金标准,分析三组超声检查准确率、灵敏度、特异度。结果本组超声检查结果检出阳性94例,阴性10例,其中假阳性5例,假阴性2例,超声诊断准确率为93.27%,敏感度为97.70%,特异度为70.59%。结论子宫内膜增厚阴道超声检查对于子宫内膜病变有良好的初筛效果,但子宫内膜厚度不同,检查结果会有存在一定差异,需结合诊刮术和宫腔镜等方法提高诊断准确性和灵敏性。  相似文献   

10.
病例资料来源于我院妇科近年来收治围绝经期功能障碍性子宫出血患者180例,以随机抽样方法分为对照组和试验组各90例;对照组采用20mg/d米非司酮常规周期治疗,试验组采用15mg/d米非司酮优化周期治疗;比较两组患者临床疗效,治疗前后子宫大小和内膜厚度及随访复发率等。结果试验组患者临床疗效显著优于对照组,差异有统计学意义(P0.05);两组患者治疗前后子宫大小比较差异无统计学意义(P0.05);两组患者治疗后内膜厚度较治疗前均显著减少,且试验组患者治疗后内膜厚度小于对照组,差异有统计学意义(P0.05);同时试验组患者随访复发率显著低于对照组,差异有统计学意义(P0.05)。优化米非司酮周期治疗方案用于围绝经期功能障碍性子宫出血患者可有效减少阴道不规则流血,降低子宫内膜厚度,并降低复发风险。  相似文献   

11.
OBJECTIVE: To determine if gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and endometrial vascular morphology as assessed by color Doppler ultrasonography can discriminate between benign and malignant endometrium in women with postmenopausal bleeding. METHODS: In a prospective study 95 consecutive women with postmenopausal bleeding and endometrial thickness > or = 4.5 mm as measured by transvaginal ultrasound were included. Gray-scale and color Doppler ultrasound examination of the endometrium was performed. The ultrasound examiner characterized the morphology of the endometrium before and during saline infusion and assessed the endometrial vascular tree using a predetermined classification protocol without suggesting a diagnosis. A histopathological diagnosis was obtained by operative hysteroscopy, dilatation and curettage or hysterectomy. RESULTS: There were no statistically significant differences in ultrasound findings between benign and malignant endometria of uterine cavities without fluid. Heterogeneous echogenicity, irregular surface, and both heterogeneous echogenicity and irregular surface of a focal lesion (or of the endometrium in the absence of focal lesions) in a uterine cavity filled with fluid (spontaneous or infused) were significantly more common in malignant than in benign endometrium. The sensitivity, false positive rate, positive and negative likelihood ratios of these findings were as follows: heterogeneous echogenicity, 80%, 29%, 2.74, 0.28, P = 0.003; irregular surface, 89%, 33%, 2.70, 0.17, P = 0.002; and both, 78%, 12%, 6.59, 0.25, P < 0.001. Two or more vessels were found in 67% (8/12) of the malignant endometria vs. 51% (40/79) of the benign endometria (non-significant difference). Vascular branching tended to be more common in malignant endometria (10/11; 91%) than in benign endometria (39/61; 64%), P = 0.09. CONCLUSION: Heterogeneous echogenicity and an irregular surface of a focal lesion or of the endometrium in a fluid-filled uterine cavity are useful ultrasound criteria for predicting endometrial malignancy. Assessment of vascular morphology using color Doppler ultrasound is of limited--if any--value for discrimination between benign and malignant endometrium.  相似文献   

12.
经阴道彩色多普勒对子宫内膜良性病变的观察   总被引:7,自引:2,他引:7  
目的 经阴道彩色多普勒技术准确、有效地诊断及鉴别诊断子宫内膜良性病变。方法 运用高分辨率探头观察经宫腔镜或手术证实的 5 4例患者的子宫内膜形态及血流状态 ,并测量内膜厚度及病变处的阻力指数。结果 有效地诊断了内膜息肉、黏膜下小肌瘤和内膜增生过长。结论 经阴道彩色多普勒所提供的二维及血流信息能较为准确地鉴别子宫内膜良性病变  相似文献   

13.
BACKGROUNDEndometrial lesions include endometrial cancer and inferior fibroids. Among them, endometrial cancer as a malignant tumor seriously endangers the life and health of patients. Ultrasonography is an important means of diagnosing female reproductive system diseases, and it is of critical value for the early diagnosis of endometrial cancer. However, different ultrasound inspection programs have achieved different results. It is of great significance to choose a suitable inspection program.AIMTo explore the diagnostic efficacy of different ultrasonic examination methods in clinical endometrial lesions.METHODSThe 140 patients with endometrial lesions who were treated in our hospital from April 2018 to October 2019 were used as the research subjects. All patients underwent transvaginal color ultrasound and transabdominal color ultrasound. We compared the diagnostic coincidence and image display effects of the two different examination methods, and the endometrial thickness, blood flow, uterine effusion and resistance index of different diseases were observed by transvaginal color ultrasound.RESULTSThe diagnostic coincidence rate of all types of diseases of transvaginal color ultrasound was significantly higher than that of transabdominal color ultrasound (P = 0.001, 0.005, 0.001 and 0.001). In addition, the excellent and good rate of image display of transvaginal color ultrasound was higher than that of transabdominal color ultrasound (P = 0.001). There were significant differences in endometrial thickness in patients with different types of endometrial lesions through the transvaginal color examination (P = 0.001). The incidence rate of uterine effusion in patients with endometrial carcinoma was significantly higher than that in patients with other types of endometrial lesions (P = 0.001), and the rate of the blood flow was the highest (P = 0.001). The comparison of blood flow resistance index indicated that the blood flow resistance index in endometrial cancer patients was the lowest, which shows that the difference was statistically significant (P = 0.001).CONCLUSIONThe overall diagnostic efficacy of transvaginal color ultrasound in the clinical diagnosis of endometrial lesions is better than that of transabdominal color ultrasound, which held higher diagnostic coincidence rate and image display effect. There were significant differences in the thickness of the endometrium and the blood flow in different types of lesions.  相似文献   

14.
Dilatation and curettage is used as the "gold standard" for diagnosing pathologic endometrial lesions in women with postmenopausal bleeding. In this group of women, about 10% have an endometrial cancer and an additional 20% have some other endometrial abnormality. However, some abnormalities, such as endometrial polyps and submucous fibroids, are difficult to diagnose by dilatation and curettage. In such cases, combining transvaginal sonography with hysteroscopy may be of value. This study compared the use of transvaginal sonography and hysteroscopy for evaluation of the uterine cavity in women with postmenopausal bleeding. The study included 51 women, 39 of whom had an abnormally thick ( > 4 mm) endometrium as measured by transvaginal sonography, and 35 of 39 had an abnormal appearance at hysteroscopy. The sensitivity and specificity for the measurement of endometrial thickness using transvaginal sonography to diagnose an endometrial abnormality were 100% and 75%, respectively. The corresponding figures for hysteroscopy were 97% and 88%. In all women with an endometrial thickness of 8 mm as measured by transvaginal sonography, hysteroscopy is identified as an abnormality. The study indicates that transvaginal sonography reveals an endometrial thickness of > or = 8 mm and the histopathologic diagnosis after dilatation and curettage is atrophic endometrial polyp or submucous myoma.  相似文献   

15.
目的 该研究比较了经阴道超声(transvaginal ultrasonography,TVS)与宫腔镜检查(hysteroscopy,HS)在诊断绝经后服用他莫昔芬(tamoxifen,TAM)对子宫内膜病变的价值,以探讨与其相关的监测方法.方法 随诊了46例绝经后因乳腺癌服用TAM(20mg/d)超过6个月的妇女.所有患者均施行了TVS、HS以及内膜组织病理学检查.TVS以子宫内膜厚度≥5mm为阳性判断标准.结果 TVS检查结果阳性21例(45.7%)中,经HS及病理诊断证实内膜息肉14例,单纯增殖型内膜2例,萎缩型内膜5例;TVS检查结果阴性25例(54.3%)中,内膜息肉8例,单纯增殖型内膜3例,萎缩型内膜14例.TVS检查的特异性为70.8%,敏感性为63.6%,阳性预测值为66.7%,阴性预测值为68.0%.而HS分别为100%、96.0%、95.7%和95.7%.息肉病人的TVS结果与非息肉病人比较差异有显著性(P=0.019).结论 由于TAM对绝经后的子宫内膜具有雌激素样作用,能够引起内膜基质水肿,产生类似增生内膜的超声影像,导致TVS的检查结果与HS下所见以及内膜病检不相符.服用TAM的绝经后乳腺癌患者,单纯以TVS作为其内膜病变的筛选方法具有一定诊断价值,但存在较高的假阳性率且特异性较差.在确诊子宫内膜息肉方面HS具有特殊优势.  相似文献   

16.
目的:探析经阴道彩色多普勒联合肿瘤标记物检测对子宫内膜癌的诊断价值。方法对67例子宫内膜癌患者行经阴道彩色多普勒超声检查及肿瘤标记物糖链抗原125、糖链抗原199检测,比较单用一种方法及两种方法联合检测的检出率。结果联合检测检出率显著高于单独经阴道多普勒超声诊断与肿瘤标记物检测(P<0.01)。3种方法早期检出率比较差异有极显著性(P<0.01),中晚期检出率比较差异无显著性(P>0.05);3种方法对中晚期患者的检出率均显著高于早期患者(P<0.01)。结论经阴道彩色多普勒超声检查联合肿瘤标记物检测可显著提高子宫内膜癌的早期诊断检出率,有利于早期发现、早期治疗。  相似文献   

17.
The objectives of the study were to establish color and pulsed Doppler sonographic characteristics of uterine vascularity in postmenopausal patients with pathologic endometrium in order to reduce the number of unnecessary diagnostic dilatation and curettage procedures. The prospective study involved 42 postmenopausal patients who were examined, prior to dilatation and curettage operation, with transvaginal color and pulsed Doppler sonography. Twenty patients had symptoms such as vaginal bleeding or clinically enlarged uterus and 22 postmenopausal women, from our screening group, were asymptomatic. Endometrial thickness (cut-off value of 8 mm), rates of visualization, and the density of uterine, myometrial (peritumoral) and endometrial (intratumoral) vessels were used, along with pulsatility and resistive indices of these vessels, to assess and correlate with endometrium pathology. Endometrial thickness was greater than 8 mm in all cases of endometrial carcinoma (14 of 14 cases), endometrial hyperplasia (eight of eight cases), and one endometrial polyp. In all cases of uterine myoma (nine cases) and in asymptomatic controls (11 subjects) the endometrium thickness was below 8 mm. Percentage of visualization of myometrial and endometrial vessels in cases of endometrial carcinoma was 93% and 43% respectively, which was significantly higher than for cases with benign endometrium (P < 0.05). RI and PI values of these studied vessels of endometrial carcinoma were significantly lower than those for endometrial hyperplasia (P < 0.05). In 80% of cases of endometrial carcinoma, dense vascularity was found in the myometrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

18.
OBJECTIVES: The aim of this study was to assess if endometrial thickness could be used to select postmenopausal women on hormonal replacement therapy (HRT) at increased risk for endometrial abnormalities. The secondary aim was to assess if endometrial abnormalities were more likely to occur in patients with increased endometrial thickness or in patients with unexpected bleeding. METHODS: Bi-endometrial thickness was measured by transvaginal ultrasound (TVS) in postmenopausal patients on sequential or combined HRT regimens. Women following a sequential regimen underwent TVS examination immediately after their withdrawal bleed, always between 5 and 10 days after the last progesterone tablet. A hysteroscopy with endometrial biopsy was performed within 5 days after the TVS examination, when endometrial thickness was > or = 4 mm, or when unscheduled bleeding was observed. RESULTS: A total of 190 women were recruited. In 138 women on sequential regimens, the mean value of endometrial thickness was 3.6 mm +/- 1.5, and in 52 women on combined regimens it was 3.2 mm +/- 1.8 (P = n.s.) Twenty-eight patients (15%) had an endometrial thickness > 4 mm, 35 patients (18.4%) reported unexpected bleeding. The percentage of abnormal endometrial findings (9%; three of 35) in patients selected for unscheduled bleeding was significantly lower than the percentage of abnormal findings in patients selected for hysteroscopy for endometrial thickness > 4 mm (36%; 10 of 28) (P < 0.01). All patients with unexpected bleeding and endometrial thickness < or = 4 mm (24 cases) were found to have an atrophic endometrium. CONCLUSIONS: Endometrial thickness in patients on sequential HRT, measured soon after withdrawal bleeding, is not significantly different from thickness measured in patients on combined HRT. Patients on HRT with an endometrial thickness of > 4 mm could be considered for histological sampling. The prevalence of abnormal endometrial findings in patients with a thick endometrium is significantly higher than the prevalence observed in patients with unexpected bleeding.  相似文献   

19.
李东 《检验医学与临床》2014,(15):2128-2130
目的:探讨经阴道彩色多普勒超声(T VCDS )结合诊断性刮宫对早期子宫内膜癌的诊断价值。方法选择2007~2013年经手术后病理证实的早期子宫内膜癌患者50例,所有患者均经阴道彩色多普勒超声和诊断性刮宫检查,(1)分析TVCDS结合诊断性刮宫检查诊断子宫内膜癌的准确性、特异性和敏感性;(2)分析TVCDS对子宫内膜癌分期的准确性;(3)分析TVCDS检查各期子宫内膜癌子宫内膜厚度与彩色多普勒血流成像(CDFI)差异。结果(1)TVCDS结合诊断性刮宫诊断早期子宫内膜癌的敏感度、特异度、准确性分别为94.00%、95.00%、94.44%;(2)分析TVCDS对子宫内膜癌分期的准确性为94%;(3)TVCDS检查,随肿瘤分期增高子宫内膜平均厚度增厚,血流显示率、阻力指数(RI)增高,比较Ⅲ期子宫内膜厚度、血流显示率、RI指数差异有统计学意义( P<0.05)。结论经阴道彩色多普勒超声结合诊断性刮宫对子宫内膜癌的早期诊断具有较高临床应用价值。  相似文献   

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