青海地区经阴道超声联合宫腔镜检查对子宫内膜病变的应用价值

目的：探讨经阴道超声（ TVS）、宫腔镜（ HS）及TVS联合HS检查在子宫内膜病变的应用价值。方法所有患者均接受阴道超声和宫腔镜检查，以子宫内膜病理检查为金标准，比较不同检查方法对于子宫内膜病变的诊断价值。结果306例患者的病理诊断包括内膜癌12例（3．92％），内膜增生59例（19．28％），内膜息肉73例（23．86％），粘膜下肌瘤44例（14．38％），正常118例（38．57％）。阴道超声联合宫腔镜检查灵敏度（96．28％）、特异度（88．98％）、阳性预测值（93．30％）、阴性预测值（93．75％）和诊断符合率（93．46％）均最高，其次为阴道超声，宫腔镜检查则最低。阴道超声、宫腔镜、阴道超声联合宫腔镜在诊断子宫内膜增生、子宫内膜息肉和正常周期性内膜方面有显著性差异（χ2值分别为9．791、10．489、14．902，均P＜0．05），其中阴道超声联合宫腔镜检测阳性率均最高，3种检查方法在子宫内膜癌和粘膜下肌瘤方面无显著性差异（χ2值分别为4．667、3．036，均P＞0．05）。非绝经组和绝经组子宫内膜病变构成不同，绝经组子宫内膜癌构成比显著高于非绝经组（χ2＝108．524，P＜0．05），而正常周期性内膜显著低于非绝经组（χ2＝5．337，P＜0．05），两组子宫内膜增生、子宫内膜息肉、粘膜下肌瘤构成比均无显著性差异（χ2值分别为0．485、0．420、0．538，均P＞0．05）。结论 TVS可作为诊断子宫内膜病变的首要检查方法，对于可疑子宫内膜癌或粘膜下肌瘤的患者可结合宫腔镜检查，二者联合应用可显著提高子宫内膜病变的诊断率。

Application value of transvaginal sonography combining hysteroscopy examination for endometrial lesions in Qinghai region

Objective To study the application value of transvaginal sonography (TVS), hysteroscopy (HS), and TVS combining HS inspection for endometrial lesions .Methods All cases underwent TVS and HS .Endometrial pathologic examination was taken as gold standard to compare the value of different methods for the diagnosis of endometrial lesions .Results The pathological diagnosis of 306 cases revealed 12 cases of endometrial carcinoma (3.92%), 59 cases of endometrial hyperplasia (19.28%), 73 cases of endometrial polyps (23.86%), 44 cases of submucous myoma (14.38%), and 118 normal cases (38.57%).The sensitivity (96.28%), specificity (88.98%), positive predictive value (93.30%), negative predictive value (93.75%) and the diagnosis coincidence rate (93.46%) of TVS combining HS examination were the highest , followed by TVS , and HS examination obtained the lowest ones .There was significant difference in the diagnosis of endometrial hyperplasia , endometrial polyps and normal endometrium among TVS , HS and TVS combining HS (χ2 value was 9.791, 10.489 and 14.902, respectively, all P<0.05).The test positive rate of TVS combining HS was highest .The difference in diagnosis of endometrial cancer and submucous myoma was not significant among three methods (χ2 value was 4.667 and 3.036, respectively, both P>0.05).The constitution of endometrial lesions was different between menopause group and non -menopause group, and menopause group had higher constituent ratio of endometrial cancer (χ2 =108.524,P<0.05) but lower constituent ratio of normal cyclical endomembrane (χ2 =5.337,P<0.05).Two groups were not significantly different in constituent ratio of endometrial hyperplasia, endometrial polyps and submucous myoma (χ2 value was 0.485, 0.420 and 0.538, respectively, all P>0.05).Conclusion TVS can be considered as a first-choice method to detect endometrial lesions .For patients suspected of endometrial cancer or submucous myoma, HS needs to be combined , and combining two methods can significantly improve the diagnostic rate of endometrial lesions .