门诊宫腔镜诊治子宫内膜息肉及宫颈息肉的临床价值

发布时间：2018-07-07 08:21

本文选题：宫腔镜 + 门诊　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:探讨门诊宫腔镜在子宫内膜息肉及宫颈息肉诊断与治疗中的临床价值,了解子宫内膜息肉及宫颈息肉的临床特点、病理类型及研究进展,提高门诊息肉患者的诊治率,改善患者的生活质量及临床预后。方法:对2015年1月?2016年6月于兰州大学第二医院妇产科门诊经宫腔镜诊断及治疗的子宫内膜息肉与宫颈息肉患者的病历资料进行回顾性分析。将同时期患者的宫腔镜检查及超声检查结果分别与病理结果进行比较,了解门诊宫腔镜诊断子宫内膜息肉及宫颈息肉的准确度,并分析门诊宫腔镜手术治疗子宫内膜息肉及宫颈息肉的安全性及可行性。应用SPSS19.0软件进行?2检验及Kappa检验。结果:1.宫腔镜诊断子宫内膜息肉384例、宫颈息肉342例、宫颈息肉合并内膜息肉46例,共计772例。其中主要以异常子宫出血行宫腔镜检查的患者有569例,占总数的73.70%,而绝经后出血、白带增多、不孕及腹痛者,分别占6.35%、4.66%、4.02%及3.63%,另有7.64%的患者无症状而在妇科检查时发现。2.排除无病理或超声结果的66例,其余706例经病理确诊为内膜息肉316例,宫颈息肉312例,宫颈息肉合并内膜息肉43例,另35例为非息肉患者。312例宫颈息肉与43例宫颈息肉合并内膜息肉均为良性病变。316例内膜息肉中有1例发生癌变,3例腺体出现不典型增生,内膜息肉的癌前病变及癌变率约占总数的1.3%。3.以病理结果为标准,宫腔镜诊断内膜息肉的灵敏度、符合率及正确指数分别为96.52%、93.77%与0.88,对宫颈息肉及宫颈息肉合并内膜息肉的上述指标分别为98.72%、97.45%与0.95及97.67%、99.29%与0.97。超声诊断内膜息肉的灵敏度、符合率及正确指数分别为58.23%、75.07%与0.47,对宫颈息肉及宫颈息肉合并内膜息肉的上述指标分别为23.40%、65.30%与0.22及2.33%、94.05%与0.02。将宫腔镜诊断与超声诊断的上述指标两两比较,以?=0.05的检验标准,结果均有显著性差异(P0.05)。4.将宫腔镜、超声分别与病理诊断结果进行Kappa检验,结果显示超声与病理在内膜息肉的诊断上具有中度一致性,而在宫颈息肉及宫颈息肉合并内膜息肉的诊断上只有低度一致性。宫腔镜与病理在内膜息肉、宫颈息肉、宫颈息肉合并内膜息肉的诊断上均具有高度一致性,两者差异有统计学意义(P0.05)。5.185例息肉患者在检查的同时成功进行了门诊宫腔镜手术治疗,其中宫颈息肉152例,内膜息肉21例,宫颈息肉合并内膜息肉12例。息肉多为单发、蒂部较细且平均直径≤2cm,平均手术时间未超过15min,除4例患者发生轻度头晕、恶心、低血压等迷走神经反应外,无一例严重并发症出现。结论:1.内膜息肉与宫颈息肉是常见的宫腔病变及宫颈病变之一,主要引起异常子宫出血、绝经后出血、白带增多及不孕等,且有恶变的风险,临床中应尽早明确诊断并予以针对性治疗。2.门诊宫腔镜对内膜息肉、宫颈息肉尤其是两者共存时诊断的准确度均高于超声,且与病理结果的符合率具有高度一致性,应作为理想的诊断选择。超声可用于息肉的初步筛查,但最终确诊仍需行宫腔镜检查并在其引导下进行活检。3.门诊宫腔镜手术在治疗单发、蒂部较细且直径不超过2cm的息肉时是一种安全、可行且患者耐受度良好的方法,应得到推广与应用。
[Abstract]:Objective: To explore the clinical value of hysteroscopy in the diagnosis and treatment of endometrial polyps and cervical polyps, to understand the clinical characteristics, pathological types and research progress of endometrial polyps and cervical polyps, to improve the diagnosis and treatment rate of polyps in outpatients, to improve the quality of life and the prognosis of the patients. Methods: in January 2015? June 2016 The clinical data of endometrial polyps and cervical polyps in the gynecology and obstetrics outpatient clinic of Second Hospital Affiliated to Lanzhou University were analyzed retrospectively. The diagnosis of endometrium polyps and cervix polyps by hysteroscopy in the same period was compared with the results of hysteroscopy and ultrasound examination. Accuracy, and analysis of the safety and feasibility of hysteroscopic surgery for endometrial polyps and cervical polyps. 2 tests and Kappa tests were performed by SPSS19.0 software. Results 1. hysteroscopic diagnosis of endometrial polyps, 342 cases of cervical polyps, 46 cases of cervical polyps with endometrial polyps, including 772 cases, mainly with abnormal uterus. There were 569 cases of bleeding with hysteroscopy, accounting for 73.70% of the total, and postmenopausal bleeding, increased leucorrhea, infertility and abdominal pain, accounting for 6.35%, 4.66%, 4.02% and 3.63% respectively, and 7.64% of the patients were asymptomatic and found in the gynecologic examination,.2. excluded pathological or ultrasound results in 66 cases, and the other 706 cases were diagnosed as intima polyps 316 cases, and the other 706 cases were diagnosed as endometrium. 312 cases of cervical polyp, 43 cases of cervical polyp and endometrial polyp, 35 cases of non polyp patients.312 cases of cervical polyp, 43 cases of cervical polyp and endometrial polyp, 1 cases of.316 endometrial polyp, 3 case of atypical hyperplasia, the precancerous lesion of endometrium and the cancer rate about the total number of 1.3%.3. The sensitivity, coincidence rate and correct index of endometrial polyp were 96.52%, 93.77% and 0.88 respectively. The above indexes of cervical polyps and cervical polyps with endometrial polyps were 98.72%, 97.45% and 0.95 and 97.67% respectively, and 99.29% and 0.97. ultrasound were sensitive to the diagnosis of internal membrane polyps, and the coincidence rate and the correct index were 58., respectively. 23%, 75.07% and 0.47, the above indexes of cervical polyp and polyp with endometrium polyp were 23.40%, 65.30% and 0.22 and 2.33%, 94.05% and 0.02. compared the above index of hysteroscopic diagnosis and ultrasonic diagnosis with the =0.05 test standard, the results were significant difference (P0.05).4. with hysteroscopy, ultrasound and pathological diagnosis. The results of Kappa test showed that ultrasound and pathology had moderate consistency in the diagnosis of endometrial polyps, while the diagnosis of cervical polyps and cervical polyps with endometrial polyps had only low consistency. The diagnosis of hysteroscopy and pathology in endometrial polyps, cervical polyps, cervical polyps and endometrium polyps was highly consistent, two The difference was statistically significant (P0.05).5.185 cases of polyp patients were successfully treated with hysteroscopy, including 152 cases of cervical polyps, 21 cases of endometrium polyp, 12 cases of endometrium polyp with endometrium polyp. Polyps were more single, the pedicle was smaller and the average diameter was less than 2cm, the average operation time was not more than 15min, except for 4 patients. Conclusion: 1. endometrium polyps and cervical polyps are one of the common uterine lesions and cervical lesions, which mainly cause abnormal uterine bleeding, postmenopausal bleeding, increased leukorrhea and infertility, and there is a risk of malignant change. It should be diagnosed as early as possible in the clinic. The diagnostic accuracy of the.2. clinic hysteroscopy for endometrial polyps and the coexistence of cervical polyps, especially both, is higher than ultrasound, and the coincidence with the pathological results is highly consistent. It should be used as an ideal diagnostic option. Ultrasound can be used for preliminary screening of polyps, but the final diagnosis still needs hysteroscopy and is guided by its guidance. Hysteroscopic surgery at.3. outpatient biopsy is a safe, feasible and well tolerated method for the treatment of single, thin pedicled polyps with a diameter of no more than 2cm, and should be popularized and applied.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711.74

【参考文献】