宫腔镜对绝经后出血宫腔病因的诊断价值探讨

目的探讨宫腔镜对绝经后子宫出血(PMB)诊断效果。方法对我院2004年1月至2006年12月门诊收治绝经后子宫出血患者,妇科检查局部阴道及宫颈未发现明显异常,考虑出血来自宫腔的共125例,宫腔镜检查后常规刮宫,未能刮出组织者在直视下取活检。所有刮出物或活检组织均送病理检查。结果宫腔镜诊断宫腔异常病变的敏感性为97.8%(90/92),特异性为81.8%(27/33),阳性预测值为93.8%(90/96),阴性预测值为93.1%(27/29)。其中子宫黏膜下肌瘤100%,子宫内膜息肉90.0%,子宫内膜炎87.0%,子宫内膜癌73.3%,子宫内膜增生70.6%。结论对于绝经后阴道出血患者,行宫腔镜检查,全面观察宫腔情况,全面诊刮,必要时在直视下取活检,可以大大提高宫腔病变确诊率。     

Pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or thickened endometrium

BACKGROUNDPostmenopausal bleeding and an endometrial thickness ≥ 5 mm on sonograms of menopausal women can indicate the presence of endometrial lesions. Diagnostic hysteroscopy is a powerful method for endometrial diseases.AIMTo investigate the pathological pattern of endometrial abnormalities in postmenopausal women with bleeding or asymptomatic thickened endometrium diagnosed by hysteroscopy.METHODSA total of 187 postmenopausal women with bleeding or asymptomatic thickened endometrium underwent diagnostic hysteroscopy. The women were subsequently divided into three groups: Postmenopausal bleeding (PMB) group (n = 84), asymptomatic group (n = 94), and additional group (n = 9). Women in the additional group manifested abdominal pain and leukorrhagia.RESULTSAmong the 187 patients examined, 84 (44.9%) were diagnosed with PMB and 94 (50.3%) with asymptomatic thickened endometrium. Endometrial polyp was the most common endometrial abnormality, which was detected in 51.2%, 76.6% and 77.8% of the PMB, asymptomatic, and additional groups, respectively. In the PMB group, 7 (8.3%) women had hyperplasia with atypia and 14 (16.7%) had endometrial adenocarcinoma. Fewer malignant lesions were detected in the asymptomatic group. Endometrial hyperplasia without atypia was found in 8.3% of the PMB group and 7.4% of the asymptomatic group.CONCLUSIONEndometrial polyp was the most common pathology in the PMB group. Diagnostic hysteroscopy is recommended for women with PMB and asymptomatic thickened endometrium.     

Diagnostic accuracy of endometrial thickness to exclude polyps in women with postmenopausal bleeding

PURPOSE: To determine the accuracy of endometrial thickness measurement with transvaginal ultrasonography (TVUS) to diagnose endometrial polyps in women with postmenopausal bleeding in whom a carcinoma has been ruled out. METHODS: In women with postmenopausal bleeding, endometrial thickness was measured with TVUS. If endometrial thickness was >4 mm, office hysteroscopy was performed. At hysteroscopy, the uterine cavity was assessed for the presence of polyps. Patients with malignancy were excluded. We used receiver operating characteristics (ROC) analysis to assess the capacity of TVUS endometrial thickness measurement to diagnose endometrial polyps. Findings at hysteroscopy were considered to be the reference standard. RESULTS: We included 178 patients with postmenopausal bleeding and endometrial thickness >4 mm. Hysteroscopy showed an endometrial polyp in 90 patients (50%). The ROC analysis revealed that endometrial thickness had an area under the curve of 0.64 in the diagnosis of endometrial polyps. CONCLUSION: In women with postmenopausal bleeding in whom carcinoma has been ruled out, measurement of endometrial thickness with TVUS is not useful in the diagnosis of endometrial polyps.     

经阴道超声测量对绝经后子宫内膜癌的诊断价值

目的:评价经阴道超声测量对绝经后子宫内膜癌的诊断价值。方法:选择因经阴道超声提示宫腔占位行宫腔镜检查术绝经后妇女520例,分析绝经后子宫内膜癌患者的相关特征。以病理诊断结果为金标准,评价经阴道超声和宫腔镜诊断子宫内膜癌的灵敏度和特异度。以ROC曲线下面积确定经阴道超声测量宫腔占位大小诊断绝经后子宫内膜癌的最佳临界值。结果:绝经后阴道流血(postmenopausal bleeding,PMB)、宫腔占位大及宫腔积液多与绝经后子宫内膜癌相关,而年龄、绝经年龄、绝经时间、内膜厚度与绝经后子宫内膜癌无关。伴PMB妇女的子宫内膜癌发生率是无PMB妇女的6.4倍。宫腔镜诊断绝经后子宫内膜癌的准确性高于经阴道超声。超声测量宫腔占位大小诊断无PMB子宫内膜癌的最佳临界值为14.5mm,此时阳性预测值为10.75%、阴性预测值为99.14%。超声测量宫腔占位大小诊断伴PMB绝经后子宫内膜癌的最佳临界值为18.5mm,此时阳性预测值为55.56%、阴性预测值为91.94%。结论:对于无PMB的妇女,经阴道超声测量宫腔占位大于14.5mm作为行宫腔镜检查的指征较合理;而对于经阴道超声发现宫腔占位且伴PMB的妇女,子宫内膜癌发生率较高,建议均行宫腔镜检查。     

宫腔镜与经阴道超声检查对绝经后子宫出血的诊断价值

目的比较宫腔镜与经阴道超声检查诊断绝经后子宫出血患者宫腔内病变的准确性。方法对有绝经后子宫出血病史的67例患者行阴道超声检查后,进行宫腔镜检查,记录检查结果,所有病例均行病理组织检查,最后将两种检查结果与病理组织检查结果进行比较,分别计算出敏感性、特异性、阳性预测率及阴性预测率。结果67例患者中29例经阴道超声检查为正常,其中16例(55.17%)病理证实子宫内膜无异常。38例经阴道超声检查诊断为宫腔病变的患者中有35例(92.11%)经病理组织检查证实。经阴道超声检查宫腔病变的敏感性、特异性、阳性预测率、阴性预测率分别为72.92%、84.21%、92.11%和55.17%。67例患者中18例宫腔镜检查为正常,其中1例(5.56%)病理组织检查证实有宫腔病变。49例宫腔镜检查诊断宫腔病变的患者中,46例(93.88%)经病理组织检查证实。宫腔镜检查的敏感性、特异性、阳性预测率、阴性预测率分别为97.87%、85.00%、93.88%和94.44%,其敏感性及阴性预测率显著高于阴道超声检查。结论经阴道超声检查是诊断绝经后子宫出血的首选检查方法;子宫内膜厚度大于4mm,宫腔镜直视下活检或诊断性刮宫是绝经后子宫出血的最佳诊断手段。     

315例宫腔镜手术患者临床特点及手术热点问题

  目的  探讨宫腔镜手术患者的临床特点及宫腔镜手术的相关临床热点问题。  方法  回顾性分析2014年7月至12月在北京协和医院妇产科行宫腔镜手术的315例患者资料, 总结其临床及病理特点, 并对宫腔镜手术相关临床热点问题包括PALM-COEIN病因分类, 子宫内膜息肉的超声诊断, 以及特殊病例子宫腺肌瘤样息肉、乳腺癌辅助内分泌治疗后宫腔占位、子宫瘢痕憩室的特点进行分析。  结果  315例宫腔镜手术患者中, 有异常子宫出血(abnormal uterine bleeding, AUB)症状者172例, 无症状者143例, AUB患者恶性病变的检出率明显高于无症状者(15.7%比2.1%, P=0.000)。育龄期AUB患者128例, 进行PALM-COEIN病因分类, 最常见类型为子宫内膜息肉(AUB-P)(45.3%, 58/128)。子宫内膜息肉患者160例, 阴道超声用于诊断子宫内膜息肉的阳性预测值、阴性预测值、敏感性、特异性和准确性分别为80%、75%、71%、81%和76%。子宫腺肌瘤样息肉17例, 其中非典型腺肌瘤样息肉3例; 10例患者有乳腺癌手术史, 9例辅助内分泌治疗, 宫腔病理均为良性; 剖宫产术后子宫瘢痕憩室患者5例, 宫腔镜下均有特异表现。  结论  宫腔镜作为微创手术技术, 对于诊断和治疗AUB和宫腔占位具有重要价值, 对于子宫内膜息肉、乳腺癌术后的子宫内膜增厚、剖宫产术后的子宫瘢痕憩室等大多数良性病变, 宫腔镜检查明确诊断的同时可以达到治疗目的。对宫腔镜诊治诸多热点问题的探讨有助于改善临床处理策略。     

绝经后阴道流血的相关因素分析

目的探讨绝经后阴道流血的病因和诊断.方法对183例绝经后阴道流血患者的临床资料进行回顾性分析.结果非器质性病变、良性疾病及恶性肿瘤引起的出血分别占38.8%、35.5%、25.7%.子宫内膜病变引起的出血占73.2%,其中以功能性出血为主,内膜癌次之.恶性肿瘤以子宫内膜癌及宫颈癌为主;年龄大,绝经时间长的患者恶性肿瘤发生率高;一些非器质性及良性病变可能发展为恶性肿瘤.结论近年来非器质性及良性疾病成为绝经后出血的主要原因,但恶性肿瘤仍占一定比例.因此,对绝经后阴道流血者除注重常规的妇科检查外还应采取综合的检查手段,如B超、分段诊刮及宫腔镜等检查,配合活检尽早明确病因,早治疗可以减少肿瘤的发生率.     

宫腔镜在协助诊断异常子宫出血中的价值

【目的】探讨宫腔镜协助诊断异常子宫出血的价值和优势。【方法】应用宫腔镜检查262例异常子宫出血患者,并在宫腔镜下定位取材或诊断性刮宫。【结果】宫腔镜诊断手宫黏膜下肌瘤、子宫内膜息肉、萎缩型子宫内膜、子宫内膜炎的敏感性高,宫腔镜检查与病理检查结果总符合率93．35％。萎缩型子宫内膜、子宫内膜炎是本组患者绝经后出血的主要原因,子宫内膜增生症、子宫内膜息肉是绝经前异常子宫出血的主要原因。【结论】宫腔镜检查能直视宫腔内病变,定位取材送病理检查可提高诊断准确率,对部分病人可达到诊断和治疗一体化的作用。     

宫腔镜联合B超检查对异常子宫出血的病因诊断价值

目的:探讨联合应用宫腔镜与B超对异常子宫出血(AUB)的病因诊断价值.方法:对103例初诊为AUB者进行宫腔镜联合B超检查及定位活检,回顾分析其临床资料.结果:103例均行盆腔B超检查、官腔镜直视下活检或宫腔镜检查后B超引导下的定位活检,最后经组织病理学检查证实诊断.官腔镜诊断子宫内病变的符合率为90.3%,B超诊断符合率为62.1%,两者联合诊断符合率为95.1%.103例均无并发症发生.结论:宫腔镜检查对AUB的病因诊断具有较高价值,联合B超检查可提高操作安全性.值得临床推广应用.     

Comparative study of transvaginal sonography and hysteroscopy for the detection of pathologic endometrial lesions in women with postmenopausal bleeding.

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.     

绝经后出血与妇科良性疾病125例临床分析

目的探讨绝经后出血（PMB）与妇科良性疾病的关系，以减少临床上过度诊断，过度治疗。方法128例患者均进行常规查体及妇科检查、经阴道彩色多普勒超声（TVCDS），部分行宫颈癌筛查和／或分段诊断性刮宫或手术治疗，内膜病理检查，行病因学分析。结果良性疾病125例，占PMB97．66％，而良性病变中依次是炎症91例（72．8％），内分泌变化28例（22.4％），良性肿瘤6例（4．8％）。结论绝经后出血大部分是妇科良性疾病，以炎症居多。TVCDS是PMB的首选辅助检查方法，必要时诊刮术或宫腔镜检查。PMB患者不能忽视宫颈癌筛查，必要时行宫颈液基细胞学检查及人乳头瘤病毒（HPV）DNA检测。     

Sonohysterographic endometrial sampling and hysteroscopic endometrial biopsy: a comparative study.

OBJECTIVES: To compare the quantity and quality of endometrial tissue sampled at saline contrast sonohysterography (SCSH) with that obtained by directed endometrial biopsy by operative hysteroscopy in patients with diffusely thickened and/or inhomogeneous endometrium at SCSH. A secondary aim was a comparison of the extent of procedure-related pain. METHODS: One hundred and twenty-eight patients with diffusely thickened (> 4 mm) and/or inhomogeneous endometrium at SCSH were prospectively recruited. Endometrial sampling was performed at the end of SCSH using the same 4.7-mm intrauterine catheter that had been used for saline instillation. These samples were compared to directed endometrial biopsies obtained with the guidance of an office 5-mm hysteroscope. After hysteroscopy, an extended guided curettage was performed under general anesthesia, providing specimens that were considered the gold standard for histological diagnosis. Endometrial specimen area (mm(2)), histologic concordance and procedure related pain (10-cm VAS) were compared for the two techniques. RESULTS: The median age of 88 pre- and of 40 post-menopausal patients was 41 (interquartile range, 34-48) years and 57 (interquartile range, 52-67) years, respectively. The median area of endometrial specimen obtained by SCSH was 25.1 (interquartile range, 12.4-52.3) mm(2) and was not significantly different from that obtained by hysteroscopy (16.9 (interquartile range, 10.0-52.7) mm(2)). The K values of the two different techniques for typical hyperplasia (n = 61) and for premalignant and malignant lesions (n = 26) were 0.91 and 0.94, respectively. Procedure-related pain was not significantly different between pre- and postmenopausal patients for both sampling techniques. CONCLUSIONS: SCSH with sampling proved to be as good as and as tolerable as hysteroscopic biopsy in cases with diffusely thickened and/or inhomogeneous endometrium. Both these imaging and biopsy techniques should be considered a reliable outpatient procedure in the management of patients with abnormal uterine bleeding. Published by John Wiley & Sons, Ltd.     

宫腔镜联合B超定位活检与诊断性刮宫对绝经后子宫出血的诊断价值比较

目的　探讨绝经后子宫出血的原因 ,比较宫腔镜与B超联合定位活组织检查 (联合定位活检 )与传统的诊断性刮宫 (诊刮 )对绝经后子宫出血的诊断价值。方法　 10 5例绝经后子宫出血患者 ,5 4例联合定位活检、5 1例诊刮 ,术后比较病理检查结果。结果　萎缩性子宫内膜炎是引起绝经后子宫出血的主要原因 ,子宫黏膜下肌瘤、子宫内膜息肉、子宫内膜增生样病变、子宫内膜癌亦是绝经后子宫出血的常见原因 ,联合定位活检病理检查的符合率 (88. 89% ) ,诊刮病理检查的符合率 (6 2 .75 % ) ,差异有显著性意义 (P <0 . 0 5 )。结论　宫腔镜与B超联合定位活检具有安全、可靠、准确的优点 ,是绝经后子宫出血的最佳诊断手段 ,值得推广应用。     

围绝经期异常子宫出血诊断和治疗专家共识

围绝经期异常子宫出血(abnormal uterine bleeding, AUB)主要与卵巢功能衰退有关。卵巢衰退后常处于无排卵状态, 可能引起月经异常, 同时也是子宫内膜良、恶性病变的诱发因素。多数AUB会使患者不适, 并对其生活质量产生重大影响, 需要及时干预。随着诊断手段的不断丰富和规范化, 越来越多的AUB在门诊即得到了快速诊断。围绝经期异常子宫出血需针对病因进行规范化、个体化治疗。AUB的病因包括结构性改变和无结构性改变。无结构性改变者常需进行药物干预, 如孕激素、口服避孕药(尤其是短效口服避孕药)、放置左炔诺孕酮宫内缓释系统以及抗纤维蛋白溶解药物, 还可辅以微创治疗如宫腔镜手术和子宫内膜消融术等, 这使得很多AUB患者避免或推迟了子宫切除手术。     

Gray-scale ultrasound morphology in the presence or absence of intrauterine fluid and vascularity as assessed by color Doppler for discrimination between benign and malignant endometrium in women with postmenopausal bleeding.

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.     

Endometrial thickness and histological abnormalities in women on hormonal replacement therapy: a transvaginal ultrasound/hysteroscopic study.

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.     

Saline contrast sonohysterography and directed extraction, resection and biopsy of intrauterine pathology using a Uterine Explora Curette.

OBJECTIVE: To assess the utility of an endometrial sampling device, the Uterine Explora Curette, with concomitant saline contrast sonohysterography (SCSH) for ultrasound-directed extraction, resection and biopsy of endometrial pathology. METHODS: Use of the Uterine Explora Curette was prospectively evaluated in 20 women with either infertility (n = 14), recurrent miscarriage (n = 2) or peri-/postmenopausal bleeding (n = 4). Findings on SCSH were compared with those on pathological analysis. RESULTS: In all 20 cases the Uterine Explora Curette was used successfully during SCSH to treat endometrial filling defects. The procedure was well tolerated, with an average time from start to finish of 10 (range, 2-23) min. It was without complications, and appeared to remove or biopsy adequately endometrial filling defects in most patients, obviating the need for hysteroscopy. CONCLUSIONS: In properly selected patients, directed extraction, resection and biopsy using the Uterine Explora Curette during SCSH appears to be an effective and easy method for treating intrauterine pathology and provides a cost-effective alternative to operative hysteroscopy.     

Sonohysterography for distinguishing endometrial thickening from endometrial polyps in postmenopausal bleeding.

Sonohysterography, or sonographic uterine cavity visualization by uterine cavity distension, may help to distinguish true endometrial thickening from other intracavitary pathological conditions, assuming the same sonographic appearance. We examined 1.5 women with a thickened endometrium (range 10-25 mm) in sonography performed for postmenopausal bleeding. Sonohysterography revealed a polypoid structure in seven women, a normal uterine cavity in four women, and a thickened endometrium in four women. All the women underwent hysteroscopic evaluation of the uterine cavity. Hysteroscopy confirmed the sonohysterographic findings in 14 women (93.3%). Hysteroscopic resection of the polypoid structure was performed while the other patients underwent diagnostic curettage. Histological examination of the seven polypoid structures revealed benign endometrial polyps in six patients, and one pedunculated submucous fibroid. In the patients undergoing diagnostic curettage, histological examination revealed three cases of glandular hyperplasia, one of cystic (atrophic) hyperplasia, and one of papillary endometrial adenocarcinoma. Two cases were inadequate for diagnosis. The advantage of sonohysterography in distinguishing endometrial thickening from intracavitary polyps or fibroids was clearly demonstrated. This technique can help in tailoring the correct treatment in various conditions presenting as postmenopausal bleeding.     

阴道彩超与宫腔镜在围绝经期及绝经后期子宫出血中的应用分析

目的探讨阴道彩超与宫腔镜在围绝经期及绝经后期子宫出血中诊治的临床应用价值。方法回顾性分析2014年1月至2015年12月间收治的围绝经期及绝经后期子宫出血患者232例。所有患者完成阴道彩超检查和宫腔镜检查并取活检,并将检查结果与病理学诊断对照对比分析。结果宫腔镜对各个疾病诊断的阳性预测率和真阳性率(敏感度)均较阴道彩超高。其中宫腔镜对宫内膜增生、子宫内膜癌、子宫内膜炎诊断的阳性预测率、敏感度与阴道彩超比较,差异均有统计学意义(P0.05)。宫腔镜对子宫内膜息肉诊断的敏感度为87.8%,高于阴道彩超的60.6%,差异有统计学意义(P0.05)。宫腔镜对子宫内膜生理性改变的诊断中阳性预测率高于阴道彩超,差异有统计学意义(P0.05)。阴道彩超显示,厚度为≥4~10mm组的子宫内膜癌检出率低于厚度10mm组,差异有统计学意义(χ~2=6.523,P=0.011)。子宫内膜厚度4mm组子宫内膜生理性改变的检出率高于厚度≥4~10mm和厚度10mm组,差异有统计学意义(χ~2=6.116,P=0.013和χ~2=22.428,P=0.001)。子宫内膜生理性改变≤10mm组中的检出率高于厚度10mm组,差异有统计学意义(χ~2=9.13,P=0.003)。结论围绝经期及绝经后期子宫出血可采用阴道彩超常规筛查,宫腔镜较阴道彩超在明确诊断上更有优势,值得临床推广。     

两种术前检查方式对子宫内膜恶性肿瘤患者腹腔细胞学检出率及随访生存率的影响

目的探讨术前宫腔诊刮术与宫腔镜检查对子宫内膜恶性肿瘤患者腹腔细胞学检出率及随访生存率的影响。方法研究对象选取该院2011年3月-2013年12月收治的子宫内膜恶性肿瘤患者120例,根据术前检查方式差异分为诊刮组(64例)和宫腔镜组(56例),分别在术前采用宫腔诊刮术与宫腔镜检查;比较两组患者标本合格率、病理诊断一致率、腹水细胞学检出率、随访3年总生存率和无进展生存率等。结果两组患者标本合格率和病理诊断一致率比较差异无统计学意义(P0.05);宫腔镜组患者腹水细胞学检出率明显高于诊刮组(P0.05);同时两组患者随访3年总生存率和无进展生存率比较差异无统计学意义(P0.05)。结论宫腔诊刮术与宫腔镜检查用于子宫内膜恶性肿瘤诊断价值相当,但宫腔镜检查可能增加腹腔转移风险,但对远期生存并无影响,有待更大规模随机对照证实。