摘要
目的 绝经后出血是一种常见的临床主诉 ,造成绝经后出血的原因可能为子宫内膜癌、内膜息肉、黏膜下肌瘤和炎症等。及时地对绝经后出血的患者进行诊断是很重要的。本研究旨在通过比较阴道B超、针吸、诊刮和宫腔镜检查对绝经后出血的诊断 ,分析其各自的优缺点。方法 本试验取 2 0 0 1年 1月～ 2 0 0 3年 8月在我院就诊的绝经后出血的患者共 1 0 9例 ,每位患者均行阴道超声检查和分段诊刮术 ,其中 31名患者在行分段诊刮前行针吸术 ,74名在诊刮的同时行宫腔镜检查。结果 阴道B超提示子宫内膜厚度≤ 4mm ,无内膜癌和增生性疾病发生。针吸给患者带来的痛苦小 ,对子宫内膜癌的检出率与分段诊刮相似 ,均为 6 6 7%。分段诊刮的病理和宫腔镜下诊断完全一致者占 71 6 2 % ,有近 30 %漏诊。宫腔镜诊断子宫内膜癌的敏感性为 1 0 0 % ,特异性为 85 71 %。分段诊刮和宫腔镜结合对子宫内膜的病变检出率最高。结论 对于绝经后出血的患者 ,可先行阴道B超 ,如超声提示内膜厚度≤ 4mm ,在没有高危因素的情况下 ,可免于分段诊刮 ,但应密切随诊。在子宫内膜厚度 >4mm无高危因素下 ,可行针吸术代替分段诊刮。如阴道B超示有异常回声或存在高危因素 ,则应行分段诊刮和 或宫腔镜检查。
Objective Postmenopausal bleeding is a common chief complaint. Since many diseases, such as endometrial carcinoma, endometrial polps, submucous leiomyoma, inflammation, can cause postmenopausal bleeding, it is very important to make a timely diagnosis. The purpose of this study is to compare transvaginal sonography, pipelle endometrial biopsy, dilatation and curettage (D&C) and hysteroscopy in the diagnosis of postmenopausal bleeding. Methods One hundred and nine patients with postmenopausal bleeding were enrolled in this study from Jan. 2001 to Aug. 2003. Routine transvaginal sonography was used to measure the endometrial thickness. All the patients underwent D&C, 31 of whom underwent pipelle before D&C and 74 underwent hysteroscopy at the same time. The endometrial sample was examined histologically. Results When endometrial thickness≤4 mm, there was no endometrial carcinoma and hyperplasia. Pipelle and D&C showed no statistical difference in diagnosis of endometrial cancer both with 66 7% sensitivity, and pipelle incurred less pain for patients. The consistence of pathologic diagnosis of D&C and hysteroscopy was about 71 62%, and less than 30% of them failed to be diagnosed by D&C. The sensitivity of hysteroscopy was 100%, and the specificity was 85 71%. The combination of D&C and hysteroscopy achieved the highest accuracy in diagnosis of the endometrial abnormity. Conclusions For women with postmenopausal bleeding, if endometrial thickness≤ 4mm and without high risk factors, observation for a period of time can be carried out; if endometrial thickness>4mm without high risk factors, pipelle endometrial biopsy can be applied, otherwise, D&C and/or hysteroscopy should be chosen.
出处
《中国妇产科临床杂志》
2004年第3期177-179,207,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
绝经后出血
针吸术
分段诊刮
宫腔镜检查
诊断
阴道B超
Postmenopausal bleeding
Dilatation and Curettage
Transvaginal sonography
Pipelle endometrial biopsy
hysteroscopy
