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。     

经阴道超声结合宫腔镜检查对绝经后子宫出血的诊断价值

目的探讨经阴道超声(TVS)结合宫腔镜(HSC)检查在绝经后子宫出血中的诊断价值。方法回顾性分析2007年6月至2010年6月应用TVS结合HSC检查绝经后子宫出血230例,术中行定位取材或诊断性刮宫。结果 TVS诊断绝经后子宫出血病人宫腔内病变的符合率为71.74%,TVS结合HSC的诊断符合率为88.26%。结论 TVS结合HSC对发现绝经后子宫出血病人宫腔内病变具有一定的价值。     

阴式超声和宫腔镜对异常子宫出血的诊断价值及比较

目的讨论阴式超声及宫腔镜对异常子宫出血的诊断价值并对二者进行比较。方法对90例异常子宫出血患者进行阴式超声及宫腔镜检查。宫腔镜检查后常规行诊刮或定位活检。结果阴式超声结果与宫腔镜检查结合病理诊断结果差异具有显著性。结论对于异常子宫出血的诊断,宫腔镜检查明显优于阴式超声。     

宫腔镜检查在子宫异常出血中的诊断价值

目的研究官腔镜检查术在子宫异常出血中的诊断价值。方法应用官腔镜检查子宫异常出血病人218例。术中行定位取材并送病理检查，并将两者进行比较。结果官腔镜诊断子宫内膜息肉的敏感性为85．00％，子宫内膜增生过长为80．65％，黏膜下子宫肌瘤为100％，子宫内膜癌为70．00％，子宫内膜萎缩为100％，子宫内膜炎为87．50％。结论官腔镜检查在子宫异常出血的诊断中具有重要临床价值。官腔镜检查可以观察到更详细的宫内形态学的变化，提高对各种宫内疾病的诊断率。     

阴道超声和宫腔镜在诊断绝经后子宫出血中的应用

目的 比较阴道超声和宫腔镜检查在诊断绝经后子宫出血中的应用。方法 回顾性分析2030年1月至2003年12月来我院行阴道超声和宫腔镜检查的绝经后阴道出血妇女63例。全部在宫腔镜检查后刮取子宫内膜送病理检查。结果 组织取样不足2例(3.1％)；萎缩子宫内膜18例(28.57％)；正常子宫内膜4例(14.29％)；子宫内膜炎1例(1.59％)；子宫内膜息肉11例(17.46％)；子宫粘膜下肌瘤9例(14.29％)；子宫内膜单纯增生3例(4.76％)；子宫内膜非典型增生2例(3.17％)；子宫内膜癌13例(20.63％)。阴道超声诊断子宫内膜癌的敏感性为69.23％，特异性为88％，阳性预测值为60％，阴性预测值为91.67％；宫腔镜诊断子宫内膜癌的敏感性为76.92％，特异性为98％，阳性预测值为90.91％，阴性预测值为94.23％；二者联合诊断子宫内膜癌的敏感性为100％，特异性为89.7％，阳性预测值为92.3％，阴性预测值为100％。阴道超声诊断子宫内膜病变的敏感性为94.29％，特异性为39.28％，阳性预测值为66％，阴性预测值为84.62％；官腔镜诊断子宫内膜病变的敏感性为94.29％，特异性为92.86％，阳性预测值为94.29％，阴性预测值为92.86％；二者联合诊断子宫内膜病变的敏感性为96.5％，特异性为93.4％，阳性预测值为91.86％，阴性预测值为95.62％。结论 绝经后子宫出血是子宫内膜癌的一个危险信号。子宫内膜厚度大于4mm，宫腔镜直视下活检或诊断性刮宫，是最佳诊断手段。     

宫腔镜诊断异常子宫出血的临床价值

目的探讨宫腔镜检查对异常子宫出血的诊断价值。方法对150例异常子宫出血患者行宫腔镜检查，在宫腔内定位摘取病变组织或诊断性刮取内膜。结果宫腔镜检查异常子宫出血与病理结果对照150例宫腔检查总符合率为92．o％，与南道B超检查总符合率为50．7％比较差异有显著性（u=10．87，P〈0．01）。结论宫腔镜检查能直视宫腔内病变，定位取材，诊断准确率高，宫贮镜检查结合定位病变活组织检查是诊断异常子宫出血可靠和理想的手段。     

阴道超声和宫腔镜联合诊断宫腔赘生物的临床价值

目的探讨阴道超声和宫腔镜联合诊断宫腔赘生物的临床价值。方法回顾分析684例在我院进行过阴道超声和宫腔镜两种检查的患者,比较分析两种检查方法的优缺点。结果阴道超声检查宫腔赘生物的敏感性为94．17％,特异性为70．83％;宫腔镜检查宫腔赘生物的敏感性为100％,特异性为95．83％。阴道超声检查阳性的病例,宫腔镜检查的阳性率为78．76％;而阴道超声检查阴性的病例,宫腔镜检查的阳性率仅1．23％。二者的差异有显著性意义。结论阴道超声联合宫腔镜检查是目前诊断宫腔赘生物较理想的方法。     

Definition of anatomical planes for use in transvaginal sonography

Planes frequently used to identify radiologic and abdominal ultrasonographic images such as transverse, coronal, and sagittal are generally not anatomically correct when applied to transvaginal ultrasonographic planes and images. More appropriate terminology specific for the planes imaged during transvaginal ultrasonography, such as TRANS-pelvic and AP-pelvic planes, are suggested. A TRANS-pelvic plane refers to a plane imaged when the sound beam is directed across or from side to side in the pelvis. An AP-pelvic plane refers to an image obtained when the sound beam is directed anteriorly and posteriorly.     

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。     

围绝经期及绝经后阴道出血患者诊断性刮宫结果分析及护理

目的 通过对6 868例围绝经期及绝经后阴道不规则出血患者的诊断性刮宫的结果分析,探讨其出血的病因及年龄特征,提出合理的护理对策.方法 对1999年6月至2009年6月,在我院行诊断性刮宫的6 868例患者的病理资料进行回顾性分析.结果 本资料中,出血原因依次为功能性子宫出血4 702例,炎性病变1 322例、非典型增生404例、复杂性增生220例、恶性肿瘤220例.功能性子宫出血、炎性病变和非典型增生的发生率随着年龄的增长而降低,但复杂性增生和恶性肿瘤随着年龄的增长而增高,65～74岁年龄组恶性肿瘤发生率为59.1%.结论 对于围绝经期和绝经后妇女一旦发现阴道异常出血,应立即到医院进行常规妇科检查,必要时应行分段诊刮取子宫内膜作病理检查,早期发现、早期治疗,提高中老年妇女的健康水平.     

宫腔镜检查结合定点活检诊断异常子宫出血患者455例分析

目的 探讨宫腔镜检查结合子宫内膜定点活检诊断异常子宫出血患者的临床价值.方法 对该院收治的455例异常子宫出血患者进行宫腔镜检查及宫腔镜下定点子宫内膜活检,并对病检结果进行回顾性分析.结果 455例患者均成功完成宫腔镜检查,其中功能失调性子宫出血患者200例;IUD所致出血68例;子宫内膜炎52例;子宫内膜增生症13例;其中单纯性增生7例;复杂性增生2例,不典型增生4例;萎缩性子宫内膜19例;子宫内膜息肉22例;子宫黏膜下肌瘤15例;子宫内膜癌66例.生育年龄(20～39岁)的异常子宫出血患者以功能失调性子宫出血及子宫内膜炎等功能性病变为主,围绝经期及绝经后10年内(40～59岁)异常子宫出血患者子宫内膜器质性病变大幅上升.结论 对异常子宫出血患者要及时了解子宫内膜病变情况,根据病检结果因病施治.     

经阴道超声对绝经后子宫内膜变化与肥胖相关性研究

目的经阴道超声探讨与分析绝经后子宫内膜变化与肥胖的相关性。方法绝经和肥胖组80例．绝经和正常体重组80例,分别应用彩色多普勒阴道超声技术检测子宫内膜厚度。结合测量血雌二醇（E2）与内膜诊刮病理结果进行分析对照。结果绝经后肥胖组：子宫内膜厚度6－18mm。病理显示子宫内膜呈增生反映。部分腺上皮不典型增生。绝经后正常体重组子宫内膜厚度2—4mm。结论绝经后肥胖组子宫内膜均有不同程度增生。     

Less abnormal uterine bleeding with dabigatran than warfarin in women treated for acute venous thromboembolism

Essentials

• Factor Xa inhibitors cause more abnormal menstrual bleeding (AUB) than vitamin‐K antagonists (VKA).
• We analyzed data of AUB in women, evaluating dabigatran versus VKA.
• We observed a 41% lower risk of AUB in women on dabigatran compared to those on VKA.
• Our findings of lower AUB risk on dabigatran should be corroborated in future studies.

Summary

Introduction

Although direct oral anticoagulants (DOACs) are associated with a better safety profile than warfarin in patients with acute venous thromboembolism (VTE), direct factor Xa inhibitors involve a higher risk of abnormal uterine bleeding (AUB). We aimed to determine the risk of AUB during anticoagulation with dabigatran compared with warfarin.

Methods

Post‐hoc analysis of the pooled RE‐COVER studies and the RE‐MEDY trial. Incidences of AUB, based on a defined preferred terms search for adverse events, in female patients aged 18–50 years treated with dabigatran, were compared with those in women treated with warfarin.

Results

Of the 2964 women included in the above‐mentioned trials, 1280 women were in the relevant age category (18–50 years) and included in the current analysis. A total of 643 patients were randomized to treatment with dabigatran and 637 to treatment with warfarin. The overall rate of AUB was 8.1%, 5.9% for the women treated with dabigatran and 9.6% in those treated with warfarin, for an odds ratio for dabigatran‐treated patients of 0.59 (95% confidence interval [CI], 0.39–0.90; P = 0.015). In the dabigatran‐treated patients, three (0.5%) suffered major bleeding (MB) vs. five (0.8%) in the warfarin‐treated patients (HR, 0.65; 95% CI, 0.15–2.72). MB or non‐major relevant bleeding occurred in 30 (4.7%) patients randomized to receive dabigatran and 57 (8.9%) randomized to receive warfarin (HR, 0.53; 95% CI, 0.34–0.83). None of the bleeding events was fatal.

Conclusion

Dabigatran treatment was associated with a significantly (41%) lower risk of AUB than warfarin. Future studies in daily practice are needed to corroborate these findings.

     

The added value of transvaginal sonohysterography over transvaginal sonography alone in women with known or suspected leiomyoma.

OBJECTIVE: To assess whether sonohysterography provides added diagnostic value over transvaginal sonography in patients with suspected or known myomas by comparing diagnostic confidence, interobserver agreement, accuracy, and change in diagnoses when 2 independent observers interpreted transvaginal sonography alone and later interpreted transvaginal sonography and sonohysterography together. METHODS: Hard copy images from 72 women were interpreted independently by 2 sonologists on separate occasions, rating parameters (abnormal uterus, myoma in any location, submucous myoma, classification of location of a submucous myoma with respect to the uterine cavity, myoma remote from the cavity, adenomyosis, and focal and diffuse endometrial lesions) on a scale of 1 to 5 (1 indicated definitely no; 2, probably no; 3, uncertain; 4, probably yes; and 5, definitely yes). Correlation was made with clinical and imaging follow-up, surgery, and pathologic examination. RESULTS: The added information provided by sonohysterography resulted in improved diagnostic confidence for most parameters. Interobserver agreement was markedly improved for the diagnosis and location of submucous myomas and focal endometrial lesions. Sensitivity values for submucous myomas and focal endometrial lesions were 100% and 90% for transvaginal sonography and sonohysterography together and 100% and 70% for transvaginal sonography alone. CONCLUSIONS: We found that sonohysterography does provide additional information over transvaginal sonography alone and is an important adjunct to transvaginal sonography in symptomatic women with known or suspected myomas, particularly before surgical or medical therapy.     

腔内三维超声联合临床指标对剖宫产术后子宫切口憩室致子宫异常出血的价值

目的  探讨腔内三维超声联合临床指标在剖宫产术后子宫切口憩室致子宫异常出血的价值。方法  收集2017年1月~2023年4月在石河子市人民医院行阴道超声检查的126例剖宫产术后合并子宫切口憩室的患者资料。根据患者剖宫产术后出血情况分为组1（无异常出血,n=72）、组2（异常出血,n=54）,所有患者均行阴道超声（二维超声及三维超声）检查。分析比较两组间临床特征（子宫位置、剖宫产次数以及剖宫产缝线方式等）以及子宫切口憩室超声特征（憩室形态、憩室容积、憩室长度、憩室深度以及残余肌层厚度等）的差异,建立基于临床及超声特征的预测模型,探索剖宫产术后合并子宫切口憩室患者子宫异常出血的独立危险因素,并评价此模型的预测价值。结果  两组间剖宫产次数、子宫位置、子宫内膜厚度、憩室深度、憩室长度、憩室容积、憩室比以及残余肌层厚度的差异均有统计学意义（P < 0.05）;多因素回归分析显示,子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是子宫异常出血的独立危险因素（OR=0.087、10.385、4.658、12.892、0.001,P < 0.05）,与各单因素相比,此模型预测子宫异常出血的AUC为0.936,高于各单因素（AUC=0.567、0.705、0.836、0.895、0.870,P < 0.05）,该联合预测模型以-6.28为截断值时,敏感度为87.04%,特异性为91.67%,准确度为89.68%,且与临床诊断结果有良好一致性（Kappa=0.789,P < 0.001）。结论  子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是剖宫产术后子宫切口憩室合并子宫异常出血的独立危险因素,超声及临床特征对预测剖宫产术后子宫切口憩室致子宫异常出血有重要预测价值。     

经阴道超声筛查子宫内膜良性病变的价值探讨

目的以宫腔镜联合病理检查结果（H＆B）为金标准,探讨经阴道超声（TVS）筛查子宫内膜良性病变的价值。方法回顾性分析我院150例子宫内膜良性病变患者的TVS检查结果,与同期的H＆B进行对比。结果TVS诊断子宫内膜良性病变的敏感性为97．9％,特异性为80．0％,阳性预测值为96．6％,阴性预测值为72．7％。结论TVS检查可作为诊断子宫内膜良性病变经济、实用、敏感的检查手段,与H＆B高度一致。     

阴道超声辅助行腹腔镜剔除术在治疗多发性子宫肌瘤中的临床疗效

目的：研究分析阴道超声辅助行腹腔镜剔除术在治疗多发性子宫肌瘤中的临床疗效。方法：随机选取2015年1月~2016年1月于我院就诊的多发性子宫肌瘤患者82例,随机均分为观察组与对照组,各41例。对照组行腹腔镜子宫肌瘤剔除术,观察组使用阴道超声辅助行腹腔镜子宫剔除剔除术,观察并对比两组患者的临床疗效与预后。结果：两组患者手术时间、术中出血量、肠胃功能恢复时间、住院时间等对比差异不显著,无统计学意义(P>0.05);且两组患者术后并发症发生率对比差异不显著,无统计学意义(P>0.05);观察组患者的术后肌瘤残留率显著低于对照组(P<0.05),肌瘤直径显著小于对照组(P<0.05);观察组患者的术后1年复发率显著低于对照组(P<0.05);结论：在多发性子宫肌瘤治疗中采用阴道超声辅助行腹腔镜子宫肌瘤剔除术,能够有效降低子宫肌瘤残留率,并显著降低术后1年的复发率,预后效果较好,具有较高的临床应用价值,值得推广使用。     

Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding

PURPOSE: Saline infusion sonography (SIS) is a relatively new technique in the evaluation of abnormal uterine bleeding. We compared the diagnostic accuracy of SIS with that of transvaginal sonography (TVS) in the detection of intracavitary abnormalities in premenopausal women with abnormal uterine bleeding. METHODS: In this prospective study, consecutive premenopausal women who underwent a hysteroscopy for abnormal uterine bleeding also underwent TVS and SIS. The findings at TVS and SIS were compared with the hysteroscopic and histologic findings. Sensitivity, specificity, and likelihood ratios were calculated. Receiver operating characteristic curves were constructed to assess the performance of endometrial thickness measured using TVS. RESULTS: Sixty-two patients were included in the study. TVS demonstrated 60% sensitivity in directly visualizing intracavitary abnormalities and 93% specificity. The likelihood ratio of the presence of an intracavitary abnormality was 8, and the likelihood ratio of the absence of an intracavitary abnormality was 0.43. Defining an abnormality at TVS as direct visualization of an intracavitary abnormality or an endometrial thickness greater than 5 mm, TVS had an 85% sensitivity and a 21% specificity, with corresponding likelihood ratios of 1.1 and 0.71, respectively. For SIS, the sensitivity, specificity, and likelihood ratios of the presence and absence of intracavitary abnormalities were 88%, 95%, 10, and 0.13, respectively. CONCLUSIONS: SIS is more accurate in the diagnosis of intracavitary abnormalities in premenopausal women than is TVS. An approach using endometrial thickness measurement by TVS and reserving SIS for patients who have an endometrial thickness greater than 5 mm or an intracavitary abnormality visualized by TVS would be the most effective method to reduce the number of hysteroscopies.