宫腔镜检查对内膜厚度≥4mm的绝经后子宫出血的诊断价值

目的探讨宫腔镜检查对阴道超声下内膜厚度≥4 mm的绝经后子宫出血的诊断价值。方法绝经后子宫出血的患者经阴道超声初筛后选取内膜厚度≥4 mm的病例,行宫腔镜检查,术中行定位取材送活检。并对宫腔镜诊断与病理结果进行比较。结果宫腔镜诊断子宫腔内异常病变71例,正常31例,病理检查异常73例,正常29例。与病理结果比较,宫腔镜检查诊断的敏感性为98.6%,特异性为90.3%,阳性预测值为95.9%,阴性预测值为90.3%。病理检查正常组的内膜厚度为5.42±0.52 mm,异常组的内膜厚度14.56±2.91 mm,子宫内膜癌及癌前病变的内膜厚度17.19±2.77 mm,每两组两两相比差异有显著性（P〈0.05）。结论宫腔镜检查联合病理检查是诊断绝经后子宫出血的主要方法之一,但为合理使用医疗资源,可经阴道超声初筛后选择子宫内膜厚度≥4 mm的病例。

The clinical role of hysteroscopy in diagnosing postmenopausal uterine bleeding in cases with at least 4 mm of endometrial lining in thickness

Objective The study attempted to determine the value of hysteroscopy in diagnosing postmenopausal uterine bleeding in cases with sonographic thickness of endometrial lining of at least 4 mm. Method A group of women with sonographic endometrial thickness of at least 4 mm and were experiencing postmenopausal uterine bleeding were selected as subjects. All patients underwent hysteroscopic diagnosis and biopsy. Hystcroscopic diagnosis and biopsy results were compared and analyzed among all patients. Findings Hysteroscopic diagnosis identified 71 cases of uterine cavity abnormality and 31 normal cases, while pathological diagnosis identified 73 abnormal cases and 28 normal cases. Compared with histology, the sensitivity thereby was 98.6% , specificity 90.3% , positive predictive value 95.9% , negative predictive value 90.3%.Conclusion Hysteroscopy combined with pathological analysis can serve as the best procedure for diagnosing postmenopausal uterine bleeding,but hysteroscopy is preferable for cases with sonographic endometrial thickness of at least 4 mm.