绝经后宫腔积液的临床探讨

目的探讨宫腔镜在诊断和治疗绝经后宫腔积液方面的作用。方法收集经彩色阴道多普勒超声（transvaginal ultrasonography）提示为宫腔积液而无阴道流血的302例患者,同期另17例因绝经后取环等原因而超声未提示宫腔积液的患者的临床资料,比较超声检查及宫腔镜检查结果与术后病理诊断,分析宫腔积液、内膜厚度与宫腔疾病的关系。结果 TVS对宫腔积液检查的敏感性为97.69%（296/303）,特异性为62.5%（10/16）。阳性预测值98.01%（296/302）,阴性预测值58.82%（10/17）,漏诊率为41.18%（7/17）;宫腔积液量的多少与病理的良恶性无关（P=0.53）;子宫内膜的厚度与病理的良恶性有关,子宫内膜越厚,病理为恶性的几率就越高（P〈0.001）。结论绝经后宫腔积液,主要是子宫内膜炎造成。应该根据患者临床症状,结合超声检查,根据内膜厚度全面综合考虑,必要时宫腔镜检查,排除子宫内膜病变,提高早期子宫内膜癌的诊断率。

Clinical implication of hydrohystera in postmenopausal women

Objective To analyze the clinical implication of hydrohystera in postmenopausal women. Methods Hysteroscopy was performed in 319 women without colporrhagia who underwent transvaginal ultrasonography（ TVS） examination,including 302 cases diagnosed as hydrohystera and 17 cases w ithout hydrohystera. The results of TVS,hysteroscopy and pathological diagnosis w ere compared, and the correlation of hydrohystera w ith endometrial thickness and intrauterine diseases w as analyzed. Results The sensitivity,specificity,positive predictive value,negative predictive value and missed diagnosis rate of TVS for hydrohystera w as 97. 69%（ 296 /303）,62. 5%（ 10 /16）,98. 01%（ 296 / 302）,58. 82%（ 10 /17） and 41. 18%（ 7 /17）,respectively. The volume of hydrohystera w as not correlated w ith benignancy or malignancy of pathologic diagnosis（ P = 0. 53）. How ever,endometrial thickness w as related to the pathological diagnosis,the thicker endometrium w as likely to be malignant lesions（ P ＆lt; 0. 001）. Conclusion Endometritis is the leading cause for postmenopausal hydrohystera, hemorrhage and empyema. Hysteroscopy should be performed if necessary,to exclude malignant lesion in endometrium.