阴道不规则流血2910例临床分析

目的 探讨诊断性刮宫术对阴道不规则流血明确诊断及治疗的临床意义.方法 选取2008年3月至2009年12月于本院妇科门诊因阴道不规则流血就诊,排除出血来源于阴道及官颈后行诊断性刮宫术的2910例患者的临床病历资料为研究对象.其年龄为20～71岁.按照年龄将其分为20～35岁组(n=1567)、36～50岁组(n=1162)和51～57岁组(n=181).对3组患者诊断性刮宫术后的刮出组织行病理学检查的结果及其发病年龄的关系进行网顾性分析(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准).3组患者阴道不规则流血的流血量及诊断性刮宫术式等比较,差异无统计学意义(P>0.05).结果 3组患者出现阴道不规则流血的发生率比较,差异有统计学意义(P<0.05).3组患者因功能失调性子宫出血(DUB)导致的阴道不规则流血发病率均最高,DUB总发病率为75.7%(2203/2910).诊断性刮宫术刮出物的病理学类型除子宫内膜息肉3组间比较,差异无统计学意义(P>0.05)外,其余类型3组间比较,差异均有统计学意义(P<0.05).阴道不规则流血还常与妊娠因素有关,其次为子宫内膜炎、子宫内膜不典型增生、子宫内膜癌及子宫内膜结核等.结论 诊断性刮宫术具有费用低、创伤小、无需住院等优势.排除出血来源部位为阴道及宫颈后,诊断性刮宫术即可对子宫内膜不规则流血明确诊断及治疗.

Clinical Analysis of 2910 Cases With Abnormal Vaginal Bleeding

Objective To investigate the significance of diagnostic curettage in the diagnosis and treatment of abnormal vaginal bleeding.Method From March 2008 to December 2009,a total of 2910 patients with vaginal bleeding caused from uterus cavity and diagnostic curettage surgery were included in the study.They were divided into 20-35 years old group(n=1567),36-50 years old group(n=1162)and 51-57 years old group(n=181)according to their ages.The pathology outcomes were analyzed in three groups.There was no significant differences among three groups in the volume of vaginal bleeding and diagnostic curettage surgery(P>0.05).The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Xiaogan Centre Hospital.Results There had significant differences in incidence rate of abnormal vaginal bleeding among three groups(P<0.05).Dysfunctional uterine bleeding(DUB) had the highest incidence rate(75.7%) in the pathology outcomes of abnormal vaginal bleeding in three groups.There also had significant differences in the pathology outcomes of abnormal vaginal bleeding except endometrial polyps among three groups(P<0.05).Conclusions Diagnostic curettage has the advantage of low cost,low trauma,no-hospitalization,which can confirm the diagnosis and treatment for abnormal endometrial bleeding except from vaginal and cervical bleeding.We should pay more attention to diagnostic curettage in the diagnosis and treatment of abnormal vaginal bleeding.