经阴道B超和宫腔镜对异常子宫出血诊断价值的研究

发布时间：2018-08-19 11:57

【摘要】：目的：探讨经阴道B超、宫腔镜对异常子宫出血诊断的临床价值。方法：选择2012年1月－2013年12月上海市第六人民医院因异常子宫出血就诊的1032例患者纳入本研究，所有患者均行阴道B超（TVS）及宫腔镜检查（HS），并在宫腔镜直视下取可疑部位活检，术后送病理并记录检查结果。分析阴道B超子宫内膜的声像图改变、宫腔镜检查的镜下特征。将阴道B超、宫腔镜两种检查结果与病理结果对照，计算两种方法预测子宫内膜正常或异常的敏感性、特异性、阳性预测值和阴性预测值并分析其对异常子宫出血的确诊率、误诊率和漏诊率。结果：1032例患者，967(93.70%)例经阴道B超诊断为异常，其中病理证实940(91.09%)例，65(6.30%)例经阴道B超诊断无异常，其中病理证实35(3.39%)例；982(95.16%)例经宫腔镜诊断为异常，其中病理证实964(93.41%)例，50(4.84%)例经宫腔镜诊断无异常，其中病理证实44(4.26%)例。宫腔镜预测子宫内膜正常或异常的敏感性、特异性、阳性预测值、阴性预测值(99.38%、70.97%、98.17%、88.00%)均高于阴道B超（96.91%、56.45%、97.21%、53.85%)。与病理诊断相比较，宫腔镜对粘膜下肌瘤、内膜增生、萎缩性内膜、内膜炎、正常内膜和其它（子宫畸形、妊娠相关、IUD）造成的异常子宫出血诊断符合率（81.46%、58.25%、73.53%、76.92%、70.97%、100%）均高于阴道B超（75.50%、45.63%、61.76%、69.23%、56.45%、94.59%），二者比较，差异无显著性（P0.05）；对子宫内膜息肉、内膜癌（85.92%、82.69%）的诊断符合率亦高于阴道B超（62.27%、63.46%），但二者比较，，差异有显著性（P0.05）。结论：宫腔镜可直视宫腔，具有较高的特异性及阴性预测值，尤其在诊断子宫内膜息肉和内膜癌方面。阴道B超诊断异常子宫出血无创、简单、经济，但特异性及阴性预测值较低。临床可将阴道B超作为初筛，结合宫腔镜，提高异常子宫出血的诊断符合率。
[Abstract]:Objective: to investigate the clinical value of transvaginal ultrasonography and hysteroscopy in the diagnosis of abnormal uterine bleeding. Methods: 1032 patients with abnormal uterine bleeding in Shanghai sixth people's Hospital from January 2012 to December 2013 were included in this study. All patients were examined by (TVS) and hysteroscopy, and biopsy of suspected sites was performed under hysteroscopy. Postoperative pathology was sent and the results were recorded. The sonographic changes of the endometrium were analyzed and the hysteroscopy features were analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of the two methods for predicting normal or abnormal endometrium were calculated and the diagnostic rate of abnormal uterine bleeding was analyzed by comparing the results of two kinds of vaginal ultrasonography and hysteroscopy with pathological results, and calculated the sensitivity, specificity, positive predictive value and negative predictive value of the two methods for the prediction of normal or abnormal endometrium. Misdiagnosis rate and missed diagnosis rate. Results 967 (93.70%) of 1 032 patients were diagnosed as abnormal by transvaginal ultrasonography, of which 940 (91.09%) cases (91.09%) were diagnosed by pathology, 65 (6.30%) by transvaginal B-ultrasound, and 982 (95.16%) by hysteroscopy were diagnosed as abnormal by pathology. Among them 964 cases (93.41%) were confirmed by pathology, 50 cases (4.84%) were diagnosed by hysteroscopy, and 44 cases (4.26%) were confirmed by pathology. The sensitivity, specificity, positive predictive value and negative predictive value (99.38%) of hysteroscopy in predicting normal or abnormal endometrium were higher than that of vaginal ultrasound (96.91%). Compared with pathological diagnosis, hysteroscopy is associated with submucous myoma, endometrial hyperplasia, atrophic endometrium, endometritis, normal endometrium, and other abnormalities. The diagnostic coincidence rate of abnormal uterine bleeding caused by pregnancy related IUD (81.4658.25 and 73.53 and 76.92U 70.97g / 100%) was higher than that of vaginal B-mode ultrasound (75.505055.630.63cm) (69.2356.459.59%). There was no significant difference between the two groups (P0.05); for endometrial polyps, endometrial carcinoma (85.922 / 82.69%) was also higher than vaginal B ultrasound (62.2763.46%), but compared with vaginal ultrasound (62.2763.46%), the diagnostic accuracy of endometrial carcinoma (85.922%) was higher than that of vaginal ultrasound (62.2763.46%). The difference was significant (P0.05). Conclusion: hysteroscopy has high specificity and negative predictive value, especially in the diagnosis of endometrial polyps and endometrial carcinoma. The diagnosis of abnormal uterine bleeding by vagina B ultrasound is noninvasive, simple and economical, but its specificity and negative predictive value are low. Vaginal ultrasound can be used as primary screen and hysteroscopy to improve the diagnostic accuracy of abnormal uterine bleeding.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.52;R445.1

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