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目的:讨论宫腔镜与B超联合检查在诊断异常子宫出血中的临床价值。方法:应用宫腔镜联合B超检查异常子宫出血115例术中行定位取材或直视下活检。结果:B超报告子宫内膜正常者63例,宫腔镜诊断子宫内膜息肉3例,增殖期子宫内膜4例,宫颈管息肉2例,病理报告与宫腔镜诊断相符,B超发现异常情况52例,经宫腔镜检查活检、诊刮的病理报告异常的有35例。宫腔镜诊断子宫内膜息肉、子宫肌瘤、子宫内膜癌的准确性较高分别为100.0%、85.9%、100.0%,宫腔镜诊断子宫内膜增生、子宫内膜萎缩的准确性分别达59.1%、60.0%、宫腔镜诊断异常子宫出血的漏诊率为零,B超检查的漏诊率为8.7%。结论:宫腔镜检查结合B超定位活检、诊刮相结合才能提高对异常子宫出血诊断的准确性,宫腔镜检查对诊断宫腔及宫颈管内疾病有重要价值,若联合B超检查可以使宫腔镜检查更加安全、准确并同时诊断宫腔外的盆腔疾病。
Objective: To discuss the clinical value of hysteroscopy combined with ultrasound in the diagnosis of abnormal uterine bleeding. Methods: Hysteroscopy combined with B-ultrasound to detect abnormal uterine bleeding in 115 cases underwent surgery or direct vision under biopsy. Results: There were 63 cases with normal endometrium, 3 cases with endometrial polyps diagnosed by hysteroscopy, 4 cases with proliferative endometrium and 2 cases with cervical polyp. The pathological findings were consistent with the diagnosis of hysteroscopy. Abnormalities in 52 cases, the hysteroscopy biopsy, curettage pathology reported in 35 cases. Hysteroscopy diagnosis of endometrial polyps, uterine fibroids, endometrial cancer were higher accuracy of 100.0%, 85.9%, 100.0%, hysteroscopy diagnosis of endometrial hyperplasia, endometrial atrophy accuracy respectively Up to 59.1% and 60.0% respectively. The misdiagnosis rate of hysteroscopy in diagnosing abnormal uterine bleeding was zero, and the rate of misdiagnosis in B-ultrasound was 8.7%. Conclusion: Hysteroscopy in combination with B-site biopsy and curettage can improve the accuracy of diagnosis of abnormal uterine bleeding. Hysteroscopy is valuable for the diagnosis of intrauterine and endocervical diseases. Combined with B-mode ultrasonography, Hysteroscopy more secure, accurate and at the same time the diagnosis of extrauterine pelvic disease.