阴道彩超与宫腔镜在围绝经期及绝经后期子宫出血中的应用分析

目的探讨阴道彩超与宫腔镜在围绝经期及绝经后期子宫出血中诊治的临床应用价值。方法回顾性分析2014年1月至2015年12月间收治的围绝经期及绝经后期子宫出血患者232例。所有患者完成阴道彩超检查和宫腔镜检查并取活检,并将检查结果与病理学诊断对照对比分析。结果宫腔镜对各个疾病诊断的阳性预测率和真阳性率(敏感度)均较阴道彩超高。其中宫腔镜对宫内膜增生、子宫内膜癌、子宫内膜炎诊断的阳性预测率、敏感度与阴道彩超比较,差异均有统计学意义(P0.05)。宫腔镜对子宫内膜息肉诊断的敏感度为87.8%,高于阴道彩超的60.6%,差异有统计学意义(P0.05)。宫腔镜对子宫内膜生理性改变的诊断中阳性预测率高于阴道彩超,差异有统计学意义(P0.05)。阴道彩超显示,厚度为≥4~10mm组的子宫内膜癌检出率低于厚度10mm组,差异有统计学意义(χ~2=6.523,P=0.011)。子宫内膜厚度4mm组子宫内膜生理性改变的检出率高于厚度≥4~10mm和厚度10mm组,差异有统计学意义(χ~2=6.116,P=0.013和χ~2=22.428,P=0.001)。子宫内膜生理性改变≤10mm组中的检出率高于厚度10mm组,差异有统计学意义(χ~2=9.13,P=0.003)。结论围绝经期及绝经后期子宫出血可采用阴道彩超常规筛查,宫腔镜较阴道彩超在明确诊断上更有优势,值得临床推广。

The application of transvaginal color Doppler ultrasonography and hysteroscopy in perimenopausal and postmenopausal patients with uterine bleeding

Objective To investigate the clinical value of transvaginal color Doppler ultrasonography and hysteroscopy in perim‐enopausal and postmenopausal patients with uterine bleeding .Methods A total of 232 cases of patients with uterine bleeding from January 2014 to December 2015 were selected and analyzed retrospectively in the hospital .All patients underwent transvaginal color Doppler ultrasound examination and hysteroscopy and biopsy ,and the results were compared with pathological diagnosis results .Re‐sults The positive predictive rate and true positive rate (sensitivity) of hysteroscopy in all diseases were higher than those of the transvaginal color Doppler ultrasonography .The positive predictive rates and true positive rates of endometrial hyperplasia ,uterine endometrial carcinoma and endometritis detected by hysteroscopy were all significantly higher than that detected by transvaginal color Doppler ultrasound(P<0 .05) .The sensitivity of hysteroscopy in the diagnosis of endometrial polyps (87 .8% ) was signifi‐cantly higher than that of transvaginal color Doppler ultrasound(P<0 .05) .The positive predictive rate of hysteroscopy in the diag‐nosis of endometrial physiological changes was significantly higher than that of the transvaginal color Doppler ultrasound(P<0 .05) .The detective rate of endometrial carcinoma in the group of endometrial thickness from 4 to 10 mm was significantly lower than that of the thickness higher than 10 mm(χ2 =6 .523 ,P=0 .011) .And the detective rate of physiological changes in the group of endometrial thickness lower than 4 mm was significantly higher that of the thickness from 4 to 10 mm group(χ2 =6 .116 ,P=0 .013) and the thickness higher than 10 mm group(χ2 =22 .428 ,P=0 .001) .In addition ,the detective rate of physiological changes in the group of endometrial thickness lower than 10 mm was significantly higher than that of thickness higher than 10 mm (χ2 =9 .13 ,P=0 .003) .Conclusion Transvaginal color Doppler ultrasound could be used in screening the perimenopausal and postmeno‐pausal patients with uterine .And hysteroscopy has more advantages in the diagnosis of gynecological disease compared with trans‐vaginal color Doppler ultrasound ,which is worthy of clinical value .