B超及宫腔镜对未绝经子宫内膜癌的诊断价值

目的 :评价 B超、宫腔镜和诊刮在未绝经的子宫内膜癌的诊断作用。方法 :10 3例原发性子宫内膜癌 ,2 3～5 5岁 ,未绝经。超声诊断后 ,宫腔镜检查并取内膜活检。结果 :不规则阴道出血 84例 (81.6 % ) ,所有病例内膜厚度≥ 5mm,平均内膜厚度 (9.3± 5 .6 ) mm。多数患者被按良性病变治疗 2～ 9个月后 ,才进行诊刮或宫腔镜检查。诊刮、宫腔镜阳性率分别为 86 .5 %、10 0 %。症状出现后 ,3个月内确诊比例为 35 .9% ,3～ 9个月、9个月以后的比例分别为 2 5 .2 %、38.8%。结论 :绝经前子宫内膜癌的主要症状是不规则阴道出血、年轻的患者 ,出现症状后到确诊的时间较长 ;B超不能代替诊刮和宫腔镜。     

测量子宫内膜厚度对HRT中不规则出血的监测作用

目的 :评价采用阴道B超测量子宫内膜厚度能否作为绝经后妇女使用雌激素连续联合疗法及周期序贯疗法中出现不规则出血的监测方法。方法 :对 186例使用激素替代治疗 (HRT)至少 1年以上绝经后妇女 (其中13 4例使用周期序贯疗法 ,5 2例使用连续联合疗法 ) ,采用阴道B超测量其子宫内膜厚度 ,用药中出现不规则出血者或内膜厚度超过 5mm者进行宫腔镜检查。结果 :不规则出血者与其他患者的内膜厚度之间无显著性差异 ,2 3例子宫内膜厚度 <5mm的不规则出血患者 ,其内膜病检全部是萎缩性子宫内膜 ,如以内膜厚度 5mm为界限 ,阴道B超对不规则出血诊断的敏感性、特异性、阳性预测值及阴性预测值分别为 10 0 %、77 4%、3 0 %、10 0 %。结论 :在使用HRT中出现不规则出血时 ,阴道B超测量内膜厚度是一种较安全的监测方法 ,可作为内膜活检前的筛选 ,当内膜厚度 <5mm时 ,可不必行宫腔镜检查或活检 ,如子宫内膜厚度超过 5mm ,应行宫腔镜检查及内膜活检     

宫腔镜检查术在绝经后出血中的诊断价值

目的:探讨宫腔镜检查术在绝经后出血中的诊断价值。方法:应用宫腔镜检查绝经后出血患者151例,术中行定位取材或诊断性刮宫;刮出物送病理检查。结果:宫腔镜诊断子宫内膜萎缩、黏膜下子宫肌瘤、子宫内膜增生、子宫内膜癌的敏感性分别为94.91%、85.71%、75%、60%。结论:宫腔镜检查绝经后出血,可提高对子宫内膜萎缩及黏膜下子宫肌瘤的诊断率;尽管对子宫内膜癌的诊断敏感性与单纯诊刮相似,但可观察到更详细的形态学变化。     

超声检测绝经后阴道出血子宫内膜病变

目的 :探讨绝经后阴道出血妇女应用超声检测子宫内膜病变的价值。方法 :对 132例绝经后阴道出血妇女行阴道超声检查 ,测量其子宫大小及内膜厚度 ,然后行分段诊刮术 ,标本送病理检查。结果 :5 3例子宫内膜厚度≤ 4mm ,其中 5 2例 (98.1% )内膜属生理性改变 ,1例为内膜癌 (1.9% ) ;79例为内膜厚度≥ 5mm ,其中 6 5例 (82 .35 % )内膜病理性改变 ,2 3例为内膜癌 (2 9.1% )。结论 :子宫内膜厚度≤ 4mm者 ,可免于诊刮。高分辩阴道超声检查可作为绝经后阴道出血妇女的常规检查方法和子宫内膜癌高发群的筛查手段     

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。     

阴道B超及宫腔镜在诊断绝经后阴道出血的价值

目的 :评价阴道B超 (TVS)及宫腔镜在诊断绝经后出血的准确性。方法 :对 1 98例绝经后出血患者进行TVS检查 ,测量其子宫内膜厚度 ,随后进行宫腔镜检查并在宫腔镜下进行内膜活检 ,将TVS和宫腔镜检查结果与病理检查进行分析、比较。结果 :病理检查结果为 :1 7例未能刮出内膜组织或内膜组织过少不足以作出病理诊断 ,萎缩性子宫内膜 1 0 2例、内膜息肉 2 0例、内膜增殖症 1 7例、子宫内膜癌 1 6例、内膜炎 8例、正常内膜 1 8例。TV显示 1 0 8例内膜厚度≤ 5mm ,90例 >5mm ,所有子宫内膜癌的内膜厚度均 >5mm ,宫腔镜诊断1 4 1例内膜正常 ,57例异常。TVS的敏感性、特异性、阳性预测值及阴性预测值分别为 1 0 0 %、40 %、69.8%、1 0 0 % ,宫腔镜的敏感性、特异性、阳性预测值及阴性预测值分别为 1 0 0 %、89%、93 %、1 0 0 %。结论 :TVS及宫腔镜对诊断绝经后出血敏感性都很高 ,但宫腔镜的特异性高于TVS ,绝经后出血的患者应常规行TVS检查 ,如子宫内膜厚度超过 5mm ,应行宫腔镜检查     

子宫异常出血的病理与B超宫腔镜检查对照分析

目的：探讨B超与宫腔镜检查在子宫异常出血中的应用价值。方法回顾性分析2012－06～2013－06住院的子宫异常出血患者345例,均B超检查后再做宫腔镜检查,并进行诊刮做病理诊断,病理诊断结果作为标准,对B超检查、宫腔镜检查资料进行统计学分析。结果 B超诊断子宫内膜增殖症与病理符合率大于宫腔镜的符合率;宫腔镜检查诊断子宫内膜息肉、子宫黏膜下肌瘤、子宫内膜癌与病理符合率大于B超检查诊断,二者差异均有统计学意义（P＜0．05）。结论内膜增殖症宜B超结合诊刮进行诊断。子宫内膜癌及区分黏膜下肌瘤及息肉宜宫腔镜结合诊制进行诊断。     

宫腔镜辅助诊断绝经后阴道出血临床观察

目的研究宫腔镜协助诊断绝经后阴道处血的原因和临床诊断结果。方法回顾性分析接收的绝经后阴道流血患者70例,所有患者均行宫腔镜检查,并将宫腔镜切片标本进行组织病理学检查,将宫腔镜检查结果与病理学结果进行对比。结果 70例绝经后阴道处血患者宫腔镜检查结果分别为:子宫内膜癌7例、子宫内膜炎17例、子宫息肉25例、子宫内膜增生12例、子宫肌瘤9例;病理学检查结果为子宫内膜癌8例、子宫内膜炎17例、子宫息肉23例、子宫内膜增生12例、子宫肌瘤10例。宫腔镜检查子宫内膜癌准确率为87.5%、子宫内膜炎准确率为100.0%、子宫息肉准确率为92.0%、子宫内膜增生准确率为100.0%、子宫肌瘤准确率为90.0%。结论宫腔镜协助诊断绝经后阴道出血疾病具有较高的准确性,能快速准确地诊断子宫病变情况,降低误诊和漏诊的发生,具有临床推广价值。     

子宫内膜癌术前漏诊临床病理分析

目的分析子宫内膜癌的漏诊原因。方法回顾性分析1999年5月~2009年4月间子宫内膜癌术前漏诊病例。结果10年间共收治子宫内膜癌患者146例,其中术前漏诊子宫内膜癌患者28例,漏诊患者术前仅有6例作诊刮术,漏诊患者术前均未做宫腔镜检查。结论要避免子宫内膜癌的漏诊:①术前B超检查必须报告子宫内膜的厚度;②对有子宫内膜癌高危因素者、不规则阴道出血者和子宫内膜异常者,子宫切除前均应行诊刮术;③术中及时剖检子宫标本,有怀疑时应及时行快速冰冻切片,对子宫内膜上皮内瘤变者,术中常规快速冰冻切片,以免漏诊导致第2次手术。     

子宫内膜癌的宫腔镜下诊断

目的探讨子宫内膜癌的有效快捷诊断方法。方法对1999年6月￣2002年6月宫腔镜检查、内膜活检805例及确诊子宫内膜23例的宫腔镜下图像进行回顾性分析。结果宫腔镜诊断子宫内膜癌的敏感性为100%。23例子宫内膜癌中,5例为弥漫型,表现病灶凹凸不平,表面有曲张异型血管。16例为局限型,镜下表现:病灶形态不规则,有曲张异型血管的子宫赘生物。有2例表现宫腔点状出血灶,追踪检查,病理确诊子宫内膜癌。结论宫腔镜检查并行内膜组织活检、病理检查是诊断子宫内膜癌的有效快捷的方法。宫腔镜下对子宫内膜炎的诊断要慎重,对宫腔镜下的出血病灶必须追踪检查,以防子宫内膜癌的漏诊。     

Diagnostic laparoscopy

The value of surgical laparoscopy for various therapeutic interventions has been well established. In recent years, the interest of gastroenterologists in this method has revived, since laparoscopy can provide additional information for the staging of oncological and liver diseases. The introduction of miniature lenses may have contributed to this process, and an increasing number of physicians are using minilaparoscopy due to its safety and easy handling. Surgical studies have mainly focused on the evaluation of laparoscopic ultrasound for the detection of liver and lymph-node metastases. In specialized centers, laparoscopic ultrasound is also used for the estimation of locoregional pancreatic tumor spread, but the diagnostic impact of the method, particularly in colorectal carcinoma, still remains to be determined. Remarkably, the number of publications from gastroenterology departments has tended to increase in comparison with last year's review.     

Diagnostic laparoscopy

Diagnostic laparoscopy continues to play an important role in the accurate evaluation of patients with abdominal disorders. Combined with laparoscopic ultrasound, it is highly accurate in the staging of intra-abdominal malignancies, and it is superior to transcutaneous ultrasonography and computed tomography. Other important applications include the evaluation of patients with acute and chronic abdominal pain, acute abdomen, peritonitis, and blunt and penetrating abdominal trauma. Laparoscopy now rests firmly in the hands of surgeons. The majority of last year's papers originated from departments of surgery; papers on laparoscopy in hepatic disorders are sorely missing in this year's review.     

Diagnostic thoracoscopy

Since the introduction of video-imaging and endoscopic surgical interventions, there is a worldwide renewed interest in thoracoscopy. However, thoracoscopy for diagnosis of pleural and pulmonary disease has been performed for more than 30 years. An overview is presented here of the results and experiences in the past 3 decades of thoracoscopy for diagnosis of pulmonary and pleural disease. Thoracoscopy is a simple and safe method to obtain a diagnosis in case of pleural effusion, pleural mass, or interstitial lung disease. In most cases, it can be performed under local anaesthesia.     

Diagnostic Ultrasound

When ‘Fat Sam’ waddled into Pip Millard's practice, Pip saw only a very fat Jack Russell terrier needing to lose weight, and perhaps a chance for a little local publicity for the practice. Pip rang a local paper to suggest that it run a story on the dangers of overindulging pets, with no inkling that she might end up enjoying more than just 15 minutes of fame…     

Diagnostic virology

Diagnostic virology services are increasingly available and pertinent as the number of useful antiviral agents grows. In this article, current methods of diagnosis are reviewed with special emphasis on rapid procedures. Guidelines for interpretation of cultures and other tests are provided.     

Diagnostic testing

The results of cardiac tests must always be interpreted through the lens of pretest probabilities created by the history and the physical examination. Tests should be chosen with a clear diagnostic and prognostic purpose in mind. A clear understanding of the relationship between the history and physical examination and more technologic diagnostic testing improves the primary care physician's ability to evaluate potential cardiac disease in an efficient and cost-effective manner.     

Diagnostic cholangiopancreatography

As in recent years, the articles on diagnostic endoscopic retrograde cholangiopancreatography (ERCP) published between July 2001 and June 2002 again reflect a defensive attitude and are mainly concerned with magnetic resonance cholangiopancreatography (MRCP) and the complications associated with the new imaging method. Diagnostic ERCP is declining in importance and has held its position mainly due to new advances in tissue sampling, pressure measurement, and the use of echo probes and miniature endoscopes. Problems of training in ERCP have still not yet been resolved, due to the contradictions inherent in low case loads, the desire to offer a wide spectrum of training, and issues of quality assurance.