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目的探讨宫腔镜窄带成像下诊治子宫内膜增生性病变的临床应用价值。方法选取118例异常子宫出血患者行宫腔镜检查,分别使用白光和窄带成像技术(NBI)模式对子宫内膜进行PLAM-COEIN分类和病灶性质的判断,以病理诊断作为金标准,比较两种检查模式对子宫内膜病变诊治的作用。结果 NBI在显示病灶轮廓、微血管清晰度方面明显优于白光模式(χ~2=48.020,P=0.000);白光与NBI模式下诊断与病理诊断Kappa值分别为0.605和0.911,NBI诊断与病理诊断一致性较好;病理阳性病灶(子宫内膜增生性病变)88例阴性病灶(非结构异常COEIN病例)30例。根据高于周边内膜的不规则突起或明显赘生物,质地坚韧或糟脆,新生异型血管丰富,白光和NBI模式诊断子宫内膜增生性病变的准确率分别为83.05%和96.61%(χ~2=11.874,P=0.001),敏感性分别为81.82%和97.73%(χ~2=12.129,P=0.000),特异性分别为86.67%和93.33%(χ~2=0.671,P=0.335)。结论 NBI可清晰地观察子宫内膜病变的轮廓及微血管形态变化,有助于其性质及程度的判断,减少漏诊,NBI引导下子宫内膜病变的定位活检具有良好的临床应用价值。
Objective To investigate the clinical value of hysteroscopic narrow-band imaging in the diagnosis and treatment of endometrial hyperplasia. Methods One hundred and eighty patients with abnormal uterine bleeding were examined by hysteroscopy. The classification of the endometrium by PLM-COEIN and the nature of the lesion were evaluated by white light and narrow band imaging (NBI) respectively. The pathological diagnosis was taken as the gold standard. Mode of diagnosis and treatment of endometrial lesions. Results NBI was better than white light in displaying the contour of the lesion and the microvessel clarity (χ ~ 2 = 48.020, P = 0.000). The diagnostic and pathological diagnostic Kappa values of white light and NBI were 0.605 and 0.911 respectively. The diagnostic and pathological diagnosis of NBI Consistency is good; Pathological positive lesions (endometrial hyperplastic lesions) 88 cases of negative lesions (non-structural abnormal COEIN cases) 30 cases. The accuracy rate of diagnosis of endometrial hyperplastic lesions by white light and NBI patterns were 83.05% and 96.61% (χ ~ 2, respectively) according to irregular or obvious neoplasms higher than peripheral intima, The sensitivity was 81.82% and 97.73% respectively (χ ~ 2 = 12.129, P = 0.000) with specificity of 86.67% and 93.33% (χ ~ 2 = 0.671, P = 0.335) . Conclusion NBI can clearly observe the contour of endometrial lesions and the changes of microvascular morphology, which is helpful to judge the nature and degree of NBM, reduce the misdiagnosis and localization biopsy of NBI-guided endometrial lesions with good clinical value.