经阴道彩色多普勒超声诊断围绝经期妇女子宫内膜病变的价值

目的探讨阴道彩色多普勒超声对围绝经期妇女子宫内膜病变的预测价值.方法对164例绝经前不规则阴道出血的患者行阴道彩色多普勒超声检查,重点观察内膜厚度及内膜血流,与当日或次日诊刮的内膜组织病理诊断对照.结果子宫内膜厚度在生理改变,良性病变,癌及癌前病变三组比较,具有极显著性差异(P＜0.01).以内膜厚度12 mm为预测绝经前妇女子宫内膜病变的临界值,其敏感性、特异性、阳性预测值、阴性预测值分别为96.2%、65.5%、83.6%、86.4%.生理改变组58例(58/164)内膜区未检测到血流信号,良性病变组2例(2/98),癌前病变组中有癌3例(3/8).结论阴道彩超可把内膜厚度12 mm做为围绝经期子宫内膜病变的临界值,但内膜形态、内部回声、边缘及内膜内血流对预测病变亦有诊断意义.

Transvaginal color Doppler sonography in diagnosing endometrial disorders of perimenopausal women

Objective To evaluate the value of transvaginal color Doppler sonography in assessing endometrial disorders in perimenopausal women. Methods We prospectively studied 164 premenopausal women with irregular uterine bleeding. Transvaginal color Doppler sonography was used to measure the endometrial thickness and assess blood flow in endometrium before fractional dilatation and curettage (D&C). The histopathologic diagnosis of specimens was compared with findings on ultrasound. Results A significant difference was found among normal group and groups of endometrial malignancy and premalignancy (P<0.01). Using the cut off value of 12 mm of the endometrial thickness as abnormal endometrium, the sensitivity,specificity,positive predictive value and negative predictive value were 96.2%,65.5%,83.6%,86.4% respectively. Blood flow was not detected in normal group and only two cases were detected in benign endometrial disorders. Blood flow was detected in all cases with endometrial carcinoma. Conclusion Endometrial thickness of 12 mm may serve as the cut off point to identify the endometrial abnormality in premenopausal women. The shape, internal echoes, border and the blood flow of the endometrium should also be considered in detecting endometrial disorders.[Key words] Ultrasonography,color Doppler,transvaginal; Perimenopause bleeding; Endometrium