315例宫腔镜手术患者临床特点及手术热点问题

  目的  探讨宫腔镜手术患者的临床特点及宫腔镜手术的相关临床热点问题。  方法  回顾性分析2014年7月至12月在北京协和医院妇产科行宫腔镜手术的315例患者资料, 总结其临床及病理特点, 并对宫腔镜手术相关临床热点问题包括PALM-COEIN病因分类, 子宫内膜息肉的超声诊断, 以及特殊病例子宫腺肌瘤样息肉、乳腺癌辅助内分泌治疗后宫腔占位、子宫瘢痕憩室的特点进行分析。  结果  315例宫腔镜手术患者中, 有异常子宫出血(abnormal uterine bleeding, AUB)症状者172例, 无症状者143例, AUB患者恶性病变的检出率明显高于无症状者(15.7%比2.1%, P=0.000)。育龄期AUB患者128例, 进行PALM-COEIN病因分类, 最常见类型为子宫内膜息肉(AUB-P)(45.3%, 58/128)。子宫内膜息肉患者160例, 阴道超声用于诊断子宫内膜息肉的阳性预测值、阴性预测值、敏感性、特异性和准确性分别为80%、75%、71%、81%和76%。子宫腺肌瘤样息肉17例, 其中非典型腺肌瘤样息肉3例; 10例患者有乳腺癌手术史, 9例辅助内分泌治疗, 宫腔病理均为良性; 剖宫产术后子宫瘢痕憩室患者5例, 宫腔镜下均有特异表现。  结论  宫腔镜作为微创手术技术, 对于诊断和治疗AUB和宫腔占位具有重要价值, 对于子宫内膜息肉、乳腺癌术后的子宫内膜增厚、剖宫产术后的子宫瘢痕憩室等大多数良性病变, 宫腔镜检查明确诊断的同时可以达到治疗目的。对宫腔镜诊治诸多热点问题的探讨有助于改善临床处理策略。

Clinical Characteristics of 315 Hysteroscopic Patients and Relevant Inconclusive Questions in Hysteroscopy

  Objective  To investigate the clinical characteristics of hysteroscopic patients and to discuss some inconclusive questions in hysteroscopy.  Methods  A total of 315 patients who underwent hysteroscopy in Peking Union Medical College Hospital from July to December, 2014 were included in this retrospective study. Clinical and pathological features of these patients were summarized. Clinically relevant inconclusive questions including PALM-COEIN classification, ultrasonic diagnosis of endometrial polyp, case characteristics of adenomyomatous polyp, intrauterine space-occupying lesion induced by adjuvant endocrine therapy for breast cancer, and uterine scar diverticulum were analyzed based on the data of these patients.  Results  Among the 315 patients, 172 cases presented with abnormal uterine bleeding (AUB), and the other 143 were asymptomatic. Malignant lesions were more common in AUB patients compared with asymptomatic patients (15.7% vs. 2.1%, P=0.000). In the AUB patients, 128 were of reproductive age, in whom the most common condition was endometrial polyps (58 cases, 45.3%) according to PALM-COEIN classification system. All together 160 cases of endometrial polyps were identified. The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of transvaginal ultrasound in diagnosing endometrial polyps were 80%, 75%, 71%, 81%, and 76%, respectively. Seventeen patients had adenomyomatous polyp, including 3 with atypical pathological features; 10 patients had history of surgically treated breast cancer, 9 of whom received adjuvant endocrine therapy, and all had benign results of endometrial pathological examination; 5 patients had scar diverticulum after cesarean section, all with specific hysteroscopic demonstrations.  Conclusions  As a minimally invasive technique, hysteroscopy plays an important role in diagnosis and treatment of AUB and intrauterine space-occupying lesion. For most benign lesions, such as endometrial polyps, endometrial hyperplasia following postoperative endocrine therapy of breast cancer, and cesarean scare diverticulum, hysteroscopy allows therapeutic operation while confirming diagnosis. Investigation into hot topics in diagnosis and treatment with hysteroscopy could help to optimize clinical strategies.