宫腔镜与经阴道超声检查对绝经后子宫出血的诊断价值

目的比较宫腔镜与经阴道超声检查诊断绝经后子宫出血患者宫腔内病变的准确性。方法对有绝经后子宫出血病史的67例患者行阴道超声检查后,进行宫腔镜检查,记录检查结果,所有病例均行病理组织检查,最后将两种检查结果与病理组织检查结果进行比较,分别计算出敏感性、特异性、阳性预测率及阴性预测率。结果67例患者中29例经阴道超声检查为正常,其中16例(55.17%)病理证实子宫内膜无异常。38例经阴道超声检查诊断为宫腔病变的患者中有35例(92.11%)经病理组织检查证实。经阴道超声检查宫腔病变的敏感性、特异性、阳性预测率、阴性预测率分别为72.92%、84.21%、92.11%和55.17%。67例患者中18例宫腔镜检查为正常,其中1例(5.56%)病理组织检查证实有宫腔病变。49例宫腔镜检查诊断宫腔病变的患者中,46例(93.88%)经病理组织检查证实。宫腔镜检查的敏感性、特异性、阳性预测率、阴性预测率分别为97.87%、85.00%、93.88%和94.44%,其敏感性及阴性预测率显著高于阴道超声检查。结论经阴道超声检查是诊断绝经后子宫出血的首选检查方法;子宫内膜厚度大于4mm,宫腔镜直视下活检或诊断性刮宫是绝经后子宫出血的最佳诊断手段。

Diagnostic value of hysteroscopy and transvaginal ultrasonography in women with postmenopausal uterine bleeding

Objective To compare the accuracy of hysteroscopy and transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of postmenopausal uterine bleeding. Methods A total of 67 patients presenting with a history of postmenopausal uterine bleeding were included into the study. Hysteroscopy was carried out by the gynecologist, on the same settting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathological findings were compared with the results obtained from transvaginal ultrasonography and hysteroscopy. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure. Results The surgical-pathologic examination confirmed normal physiologic endometrium in 16 (55.17%) of 29 women who were said to have normal endometrium on transvaginal sonography. 35 (92.11%) of 38 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 72.92%, 84.21%, 92.11%, and 55.17%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 1 (5.56%) of 18 women who were said to have normal endometrium on hysteroscopy. Among 49 women diagnosed of intracavitary pathologies on hysteroscopy, 46 (93.88%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hysteroscopy in the detection of intracavitary pathology were 97.87%, 85.00%, 93.88%, and 94.44%, respectively. Sensitivity and negative predictive value were significantly higher with hysteroscopy. Conclusions Transvaginal ultrasonography is the first line diagnostic procedure in postmenopausal women with uterine bleeding;With an endometrial more than 4mm, hysteroscopy with biopsy or dilatation and curettage is the most appropriate procedure in postmenopausal women with uterine bleeding.