宫腔镜窄带成像下诊治子宫内膜增生性病变的临床价值

发布时间：2019-02-15 15:39

【摘要】：目的探讨宫腔镜窄带成像下诊治子宫内膜增生性病变的临床应用价值。方法选取118例异常子宫出血患者行宫腔镜检查,分别使用白光和窄带成像技术(NBI)模式对子宫内膜进行PLAM-COEIN分类和病灶性质的判断,以病理诊断作为金标准,比较两种检查模式对子宫内膜病变诊治的作用。结果 NBI在显示病灶轮廓、微血管清晰度方面明显优于白光模式(χ~2=48.020,P=0.000);白光与NBI模式下诊断与病理诊断Kappa值分别为0.605和0.911,NBI诊断与病理诊断一致性较好;病理阳性病灶(子宫内膜增生性病变)88例阴性病灶(非结构异常COEIN病例)30例。根据高于周边内膜的不规则突起或明显赘生物,质地坚韧或糟脆,新生异型血管丰富,白光和NBI模式诊断子宫内膜增生性病变的准确率分别为83.05%和96.61%(χ~2=11.874,P=0.001),敏感性分别为81.82%和97.73%(χ~2=12.129,P=0.000),特异性分别为86.67%和93.33%(χ~2=0.671,P=0.335)。结论 NBI可清晰地观察子宫内膜病变的轮廓及微血管形态变化,有助于其性质及程度的判断,减少漏诊,NBI引导下子宫内膜病变的定位活检具有良好的临床应用价值。
[Abstract]:Objective to evaluate the clinical value of narrow-band hysteroscopy in the diagnosis and treatment of endometrial hyperplasia. Methods 118 patients with abnormal uterine hemorrhage were examined by hysteroscopy. The PLAM-COEIN classification and the nature of endometrium were determined by (NBI) mode of white light and narrow band imaging respectively. The pathological diagnosis was taken as the golden standard. To compare the role of two examination modes in the diagnosis and treatment of endometrial lesions. Results NBI was superior to the white light mode in displaying the shape of lesion and the definition of microvessel (蠂 ~ 2 ~ (48.020) P ~ (0.000). The diagnostic and pathological Kappa values of white light and NBI were 0.605 and 0.911 respectively, and the pathological positive lesions (endometrial proliferative lesions) in 88 negative lesions (non-structural abnormal COEIN cases) in 30 cases. According to irregular processes or obvious vegetations higher than the peripheral endometrium, the texture was tough or brittle, and the neovascularization was abundant. The accuracy of diagnosis of endometrial hyperplasia by white light and NBI was 83.05% and 96.61%, respectively (蠂 ~ 2 ~ (11.874), P < 0.05). The sensitivity and specificity were 81.82% and 97.73% respectively (蠂 ~ 2 ~ (12.129) P ~ (0.000), and the specificity were 86.67% and 93.33% (蠂 ~ (2), respectively (蠂 ~ (2) 0.671P ~ (0.335). Conclusion NBI can clearly observe the contour and microvascular morphology of endometrial lesions, which is helpful to judge the nature and degree of endometrial lesions and reduce missed diagnosis. NBI guided localization biopsy of endometrial lesions has a good clinical value.
【作者单位】：大连医科大学附属大连市妇产医院暨大连市妇幼保健院妇科;
【分类号】：R711.74

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