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目的:比较宫腔镜检查及诊断性刮宫对绝经后子宫出血(PMB)的诊断价值。方法:回顾性分析177例PMB患者临床资料,按诊查方法分为宫腔镜检查组96例(先行宫腔镜下诊断,再行镜下定位活检)和诊断性刮宫组81例(先行分段诊断性刮宫,再行宫腔镜活检)。比较两者与最终病理结果的符合率。结果:绝经后子宫出血的原因依次为,萎缩性子宫内膜56例(31.6%),子宫内膜息肉36例(20.3%),子宫内膜增生症21例(11.9%),增生/分泌期子宫内膜18例(10.2%),子宫内膜癌17例(9.6%),子宫内膜炎15例(8.5%),子宫黏膜下肌瘤14例(7.9%)。宫腔镜检查组和分段诊断性刮宫组的诊断与病理结果的总符合率为89.6%(86/96)和67.9%(55/81),差异有统计学意义,P<0.05。结论:宫腔镜检查安全可靠,诊断宫腔内病变准确率高,结合镜下定位活检可早期发现子宫内膜癌,优于传统诊刮术,是绝经后子宫出血的首选检查方法。
Objective: To compare the value of hysteroscopy and diagnostic curettage in the diagnosis of postmenopausal uterine bleeding (PMB). Methods: The clinical data of 177 patients with PMB were retrospectively analyzed. According to the diagnostic methods, 96 cases were classified into hysteroscopy group (first hysteroscopy, microscopic location biopsy) and diagnostic curettage group (81 cases Section diagnostic curettage, hysteroscopic biopsy again). Comparing the two with the final pathological results of the coincidence rate. Results: The causes of uterine bleeding after menopause were as follows: atrophic endometrium 56 cases (31.6%), endometrial polyps 36 cases (20.3%), endometrial hyperplasia 21 cases (11.9%), proliferative / secretory phase 18 cases of endometrium (10.2%), 17 cases of endometrial carcinoma (9.6%), 15 cases of endometritis (8.5%) and 14 cases of uterine fibroids (7.9%). The total coincidence rate between the hysteroscopy group and the segmental diagnostic curettage group was 89.6% (86/96) and 67.9% (55/81), respectively, with significant difference (P <0.05). Conclusions: Hysteroscopy is safe and reliable, and the diagnostic accuracy of intrauterine lesions is high. Combined endoscopic biopsy can detect endometrial cancer earlier than traditional curettage. It is the first choice for postmenopausal uterine bleeding.