超声、宫腔镜与病理学联合诊断异常子宫出血的价值

目的探讨阴道超声(transvaginal sonography,TVS)、宫腔镜及子宫内膜病理检查在异常子宫出血中的诊断价值. 方法 181例异常子宫出血患者,经腹部超声及盆腔检查除外卵巢囊肿、子宫肌瘤及与妊娠有关疾病后,依次行TVS、宫腔镜和子宫内膜病理检查,比较其诊断的敏感性、特异性和准确率. 结果 TVS、宫腔镜和病理学检查对诊断上述异常子宫出血的敏感性、特异性和准确率分别为52.3%、46.7%、51.4%,70.9%、70.0%、70.7%,59.5%、100%、64.7%.宫腔镜诊断的敏感性和准确率高于TVS(z=3.205,3.657;P＜0.05);而病理学诊断特异性高于宫腔镜(z=2.454,P=0.014). 结论宫腔镜对鉴别子宫异常出血宫腔内因素的敏感性和准确性均优于TVS,而对于子宫内膜的病变,病理学检查具有确诊作用.

Combined application of transvaginal sonography, hysteroscopy and pathologic examination for diagnosing abnormal uterine bleeding

Objective To estimate the clinical value of transvaginal sonography (TVS), hysteroscopy and endometrial pathologic examination for diagnosing abnormal uterine bleeding. Methods A total of 181 patients with abnormal uterine bleeding treated in this hospital entered the study. After abdominal ultrasonography and pelvic cavity examinations had been carried out to exclude ovarian cyst, hysteromyoma and diseases referable to the pregnancy, TVS, hysteroscopy and endometrial pathologic examination were performed in turn. The sensitivity, specificity and accuracy of the three methods in diagnosis were compared. Results The sensitivity, specificity and accuracy of TVS, hysteroscopy and endometrial pathologic examination for diagnosing abnormal uterine bleeding were 52 3%, 46 7%, 51 4%, 70 9%, 70 0%, 70 7%, 59 5%, 100% and 64 7%, respectively. Hysteroscopy showed a higher sensitivity and accuracy than TVS ( z =3 205 and 3 657, P <0 05) while pathology had a higher specificity than hysteroscopy ( z =2 454, P =0 014). Conclusions Hysteroscopy is more accurate and sensitive than TVS in the differential diagnosis of abnormal uterine bleeding whereas pathologic examination may provide valuable information in establishing the definitive diagnosis of endometrial lesions.