宫腔镜及B超在异常子宫出血中的诊断价值

目的:分析宫腔镜检查与B超检查对异常子宫出血病因的诊断价值。方法:对220例异常子宫出血患者病历资料进行回顾性分析,对病历中B超、宫腔镜和病理检查结果进行对照研究。结果:①在异常子宫出血病因诊断中,宫腔镜对宫内残留、子宫内膜炎及子宫内膜息肉的敏感度高,对子宫内膜癌、子宫粘膜下肌瘤和宫内残留的特异度高;②B超对子宫粘膜下肌瘤的敏感度高,对宫内残留的特异度高;③对子宫内膜息肉和子宫内膜增生的诊断,B超与病理检查的符合率和宫腔镜与病理检查的符合率之间存在极显著性差异(P<0.01),对子宫粘膜下肌瘤和宫内残留的诊断,上述两组符合率之间差异无显著性意义(P>0.05)。结论:①宫腔镜对异常子宫出血的病因有很高的诊断价值,与B超之间存在互补关系;②提倡将B超、宫腔镜及定位活检合理地综合应用,使异常子宫出血的病因从影像学、形态学和组织学三方面得以准确诊断。

Diagnostic Value of B Ultrasound and Hysteroscopy to the Etiological Factors of Abnormal Uterine Bleeding

Objective:To analyze the diagnostic value of B ultrasound and hysteroscopy to the etiological factors of abnormal uterine bleeding. Methods: Retrospective analysis was carried out to the 220 case files of abnormal uterine bleeding and comparative study was made to the results of B ultrasound, hysteroscopy and pathological examination. Results: In the diagnosis of abnormal uterine bleeding by hysteroscopy, high sensitivity was showed to diagnose endometrial polyps, endometritis and remains of embryo in the uterus, and high specificity was showed to diagnose endometrial cancer, submucous myoma of uterus and remains of embryo in the uterus. High sensitivity and high specificity were showed by B ultrasound to diagnose submucous myoma of uterus and remains of embryo in the uterus, respectively. To the diagnosis of endometrial hyperplasia and endometrial polyps, it was showed significant difference between the degree of coincidence of B ultrasound with pathological examination and that of coincidence of hysteroscopy with pathological examination (P<0.01), however, to the diagnosis of submucous myoma of uterus and remains of embryo in the uterus, the difference of the coincidence degree of the two conditions mentioned above was not significant(P>0.05). Conclusion: It appears very high diagnostic value of hysteroscopy to the diagnosis of the etiological factors of abnormal uterine bleeding, which can be a complement to B ultrasound. It is recommended to integrated application of combining B ultrasound with hysteroscopy and localized biopsy rationally to diagnose abnormal uterine bleeding validly from the views of imageology, morphology and histology.