经阴道超声和宫腔镜检查对绝经后阴道出血的诊断价值

目的通过比较阴道超声(TVS)和宫腔镜对绝经后阴道出血(PMB)的诊断,分析其优缺点。方法取2006年1月～2008年10月在我院妇产科住院的112例PMB患者进行TVS检查,然后行宫腔镜检查并行内膜活检。将TVS和宫腔镜检查结果与病理检查结果进行分析比较。结果TVS的敏感度、特异度、阳性预测值、阴性预测值分别为95.0%、75.0%、90.5%、85.7%;以内膜厚度16mm作为阴超判断子宫内膜病变良恶性的临界值,其敏感度、特异度分别为91.7%、94.5%;宫腔镜的敏感度、特异度、阳性预测值、阴性预测值及准确度分别为98.8%、100.0%、100.0%、96.9%。结论TVS和宫腔镜对诊断PMB的敏感性都很高,但宫腔镜的特异性高于TVS。将内膜厚度16mm作为阴超判断子宫内膜病变良恶性的临界值比较适宜。PMB患者应常规进行TVS检查,异常者应行宫腔镜检查。

Diagnostic Value of Transvaginal Sonography and Hysteroscopy in Women with Postmenopausal Bleeding

Objective To compare transvaginal sonography and hysteroscopy in the diagnosis of postmenopausal bleeding. Methods One hundred and telve patients with postmenopausal bleeding were enrolled in this stady from Jan. 2006 to Oct. 2008. The endometrial thickness was meatured by TVS before hysteroscopy. The results were compared with pathologic findings. Results TVS showed 95.0% sensitivity,75.0% specificity,90.5% positive predictive value and 85.7% negative predictive value respectively,when the cutoff point of the endometrial thickness was set at 16 mm to detect the endomertrial lsions TVS showed 91.7% sensitivity,94.5% specificity. Hysteroscopy showed 98.8% sensitivity,100.0% specificity,100.0% positive predictive value and 96.9% negative predictive value respectively. Conclusion Both TVS and hysteroscopy were highly sensitive,but hysteroscopy was more specific than TVS. Endometrial thickness of 16 mm could be the threshold for the differentiation of benign from malignant endometrial lsions.TVS should be performed in women with postmenopausal bleeding and hysteroscopy should be performed if TVS showed abnormal.