宫腔镜诊断绝经后宫腔占位的临床分析

发布时间：2018-01-30 20:31

本文关键词： 绝经后宫腔占位出血宫腔镜检查超声诊断　出处：《宁夏医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的1.分析绝经后宫腔占位的疾病分布及其与年龄、绝经年限及出血的关系。 2.探讨宫腔镜在诊断绝经后宫腔占位中的临床应用价值。方法对2009年09月-2013年08月在宁夏医科大学总医院就诊的320例绝经后超声诊断为宫腔占位的患者行宫腔镜检查，镜下定位取材，并行病理检查。以年龄是否大于60岁、绝经年限是否超过10年、是否有出血症状，分别分为两组，分别比较两组患者的疾病类型。分析宫腔镜操作情况、诊断结果、比较宫腔镜与超声的诊断结果，探讨宫腔镜在诊断绝经后宫腔占位的优势。结果1.绝经后宫腔占位的疾病分布：本研究中320例绝经后宫腔占位，其中子宫内膜息肉占60.0%（192/320），子宫黏膜下肌瘤18.4%（59/320），子宫内膜增生10.3%（33/320）,子宫内膜炎5.6%（18/320），子宫内膜癌占5.6%（18/320）。 2.≤60岁组年龄组恶性病变患者占3.29%（7/213），60组占10.28%（11/107）,（P0.05）；绝经年限≤10年组恶性病变患者占3.37%（7/208），〉10年组占9.82%（11/112）,（P0.05）；出血组子宫内膜息肉占55.4%（117/211）,非出血组子宫内膜息肉68.8%（75/109），（P0.05）；出血组子宫内膜癌占8.1%（17/211），非出血组子宫内膜癌1.0%(1/109),（P0.05）。 3.宫腔镜观察子宫良性病变，可见血管例数为222例，占73.51%（222/302），子宫内膜癌可见血管例数为17例，占94.44%（17/18），其中16例子宫内膜癌在宫腔镜下观察到异型血管，占子宫内膜癌总数的88.89%。 4.宫腔镜诊断子宫内膜息肉的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为93.75％、89.89％、93.26％、90.55％、92.19％，宫腔镜诊断子宫粘膜下肌瘤的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为91.53％、98.47％、93.10％、98.09％、97.19％，宫腔镜诊断子宫内膜炎的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为94.44％、99.01％、85.00％、99.67％、98.75％，宫腔镜诊断子宫内膜增生的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为51.52％、96.52％、62.96％、94.54％、91.88％，宫腔诊断子宫内膜癌的敏感度、特异度、阳性预测值、阴性预测值、准确率分别为89.89％、98.01％、72.73％、99.33％、97.50％。 5.宫腔镜与超声诊断子宫内膜息肉的敏感度、特异度、阳性预测值、阴性预测值及准确度差异有统计学意义（P0.05）；宫腔镜与超声诊断子宫粘膜下肌瘤的敏感度、特异度、阳性预测值、阴性预测值及准确度差异无统计学意义（P0.05）；宫腔镜与超声诊断子宫内膜增生的特异度、阳性预测值及准确度差异有统计学意义（P0.05）；敏感度、阴性预测值差异无统计学意义（P0.05）；宫腔镜与超声诊断子宫内膜癌的敏感度、阴性预测值差异有统计学意义（P0.05）；特异度、阳性预测值及准确度差异无统计学意义（P0.05）。 6.本研究中行宫腔镜检查的320例患者，给予宫腔镜治疗的占47.50%（152/320）。结论1.绝经后宫腔占位性疾病以良性病变为主，子宫内膜息肉多见。 2.绝经后宫腔占位患者，年龄越大、绝经后时间越长，越需警惕恶性病变。 3.绝经后宫腔占位，合并出血者高度警惕子宫内膜癌可能，无出血的患者不能完全排除恶性病变。 4.宫腔镜检查绝经后宫腔占位具有直观性、全面性及准确性。并在诊断的同时治疗，，是诊断绝经后宫腔占位的最佳方法。
[Abstract]:Objective 1. to analyze the distribution of the disease in the postmenopausal uterine cavity space and its relationship with age, menopause and bleeding.
2. to explore the clinical value of hysteroscopy in the diagnosis of postmenopausal uterine cavity occupying.
Methods from 2009 09 months -2013 years 08 months in the General Hospital of Ningxia Medical University, 320 cases of ultrasound diagnosis of postmenopausal uterine cavity for patients by hysteroscopy of endoscopic positioning specimens for pathological examination. The age is more than 60 years of age, menopausal period is more than 10 years, whether there is bleeding symptoms, respectively. For the two group, the type of disease in two groups were compared respectively. Analysis of hysteroscopic operation, diagnosis, diagnostic results of hysteroscopy and ultrasound, hysteroscopy occupying the advantage in the diagnosis of postmenopausal uterine cavity.
Results 1. postmenopausal uterine occupying disease distribution: in this study, 320 cases of postmenopausal uterine cavity lesions, including endometrial polyps accounted for 60% (192/320), submucous myoma of uterus 18.4% (59/320), endometrial hyperplasia in 10.3% (33/320), 5.6% (18/320), endometritis and endometrial cancer accounted for 5.6% (18/320).
2. = 60 age group age group of patients with malignant lesions accounted for 3.29% (7/213), the 60 groups accounted for 10.28% (11/107), (P0.05); menopause less than 10 years group of malignant lesions accounted for 3.37% (7/208), "10 years group accounted for 9.82% (11/112), (P0.05); hemorrhage group endometrial polyps accounted for 55.4% (117/211), non bleeding group endometrial polyps (75/109), 68.8% (P0.05); hemorrhage group endometrial carcinoma accounted for 8.1% (17/211), non bleeding group endometrial carcinoma (1/109), 1% (P0.05).
3. hysteroscopy in the observation of benign uterine lesions, the number of vessels was 222 cases, accounting for 73.51% (222/302). The number of blood vessels in endometrial carcinoma was 17 cases, accounting for 94.44% (17/18). 16 cases of endometrial carcinoma observed abnormal blood vessels under hysteroscopy, accounting for 88.89%. of total endometrial cancer.
4. hysteroscopic diagnosis of endometrial polyps sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 93.75%, 89.89%, 93.26%, 90.55%, 92.19%, hysteroscopic diagnosis of submucosal myoma of uterus of sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 91.53%, 98.47%. 93.10%, 98.09%, 97.19%, hysteroscopic diagnosis of endometritis sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 94.44%, 99.01%, 85%, 99.67%, 98.75%, hysteroscopy endometrial hyperplasia of the sensitivity, specificity, positive predictive value, negative predictive value, accuracy was 51.52% 96.52%, 62.96%, 94.54%, 91.88%, and uterine endometrial cancer diagnosis sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 89.89%, 98.01%, 72.73%, 99.33%, 97.50 %.
5. hysteroscopy and ultrasound in the diagnosis of uterine endometrial polyps sensitivity, specificity, positive predictive value, negative predictive value and accuracy was statistically significant difference (P0.05); hysteroscopy and ultrasound diagnosis of uterine submucous myoma of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the difference was not statistically significant (P0.05); hysteroscopy and ultrasound diagnosis of endometrial hyperplasia was statistically significant specificity, positive predictive value and accuracy difference (P0.05); sensitivity, negative predictive value of the difference was not statistically significant (P0.05); hysteroscopy and ultrasound in the diagnosis of endometrial cancer sensitivity, negative predictive value was statistically significant difference (P0.05); the specificity, positive predictive value and accuracy of the difference was not statistically significant (P0.05).
6. of the 320 patients who underwent hysteroscopy in this study, 47.50% (152/320) were given hysteroscopy.
Conclusion 1. postmenopausal uterine cavity occupying diseases are mainly benign lesions, and endometrium polyps are common.
2. the greater the age, the longer the postmenopause, the more vigilant the malignant lesion is, the longer the menopause.
3. postmenopausal uterine cavity occupying, combined bleeding with high vigilance for endometrial cancer, patients with no bleeding can not completely exclude malignant lesions.
4. hysteroscopy is an intuitive, comprehensive and accurate method for detecting postmenopausal uterine cavity occupancy. It is the best way to diagnose postmenopausal uterine cavity occupying.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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