宫腔镜及超声检查在子宫内膜病变诊断中的价值
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摘要
目的:探究阴道超声检查(TVS)和宫腔镜检查(HS)在子宫内膜病变诊断中的价值。方法:回顾性分析医院收治的314例疑似子宫内膜病变患者资料,分别使用TVS和HS进行诊断检查,经术后病理学确认,或使用HS下进行组织活检,详细记录检查结果。比较子宫内膜病变中TVS和HS诊断的阳性预测值、阴性预测值、敏感度、准确率及符合率。结果:314例疑似子宫内膜病变患者术后病理检查结果无病变32例,子宫内膜病变282例;两种检查方法的子宫内膜炎、内膜癌、黏膜下肌瘤及内膜息肉诊断准确率比较,差异有统计学意义(x~2=30.721,x~2=6.252,x~2=11.109,x~2=5.710;P<0.05)。两种方法诊断灵敏度和阳性预测值比较,差异无统计学意义(x~2=2.646,x~2=0.848;P>0.05);HS检查的特异度、阴性预测值优于TVS检查,其差异有统计学意义(x~2=10.835,x~2=28.571;P<0.05)。结论:病理检查是子宫内膜病变诊断金标准,HS诊断具有较高的阴性预测值和特异性,而TVS则具有操作简单、诊断有效等优点。将TVS与HS两种诊断方法联合应用,可为子宫内膜病变诊断提供科学依据。
Objective: To investigate and compare the diagnostic values of transvaginal ultrasonography(TVS and hysteroscopy(HS) in endometrial lesions. Methods: A total of 314 patients with suspected endometrial lesions admitted to our hospital were enrolled in this retrospective analysis. And TVS and HS were respectively adopted to implement diagnostic examination for them. And these results were further confirmed by postoperative pathology,or they were implemented tissue biopsy under HS, and the inspection results were carefully recorded. And then, the diagnostic positive predictive rate, negative predictive rate, sensitivity, accuracy rate and coincidence rate of TVS and HS in endometrial lesions were compared. Results: The results of postoperative pathological examination of 314 patients with suspected endometrial lesions showed that there were 32 cases without lesions and 282 cases with endometrial lesions. The differences of diagnostic accuracies of endometritis, endometrial carcinoma, submucosal myoma of uterus and endometrial polyps between the two methods were significant(x~2=30.721, x~2=6.252, x~2=11.109,x~2=5.710, P<0.05). While the differences of diagnostic sensitivity and positive predictive value between the two methods were no significant(x~2=2.646, x~2=0.848, P>0.05). Besides, the specificity and negative predictive value of HS were significantly superior than those of TVS(x~2=10.835, x~2=28.571, P<0.05). Conclusion: Pathological examination is the gold standard for the diagnosis of endometrial diseases. HS diagnosis has higher negative predictive value and specificity, while TVS has the advantages of simple operation and effective diagnosis. Therefore, the combination of TVS and HS that is used in clinical practice can provide a scientific basis for the diagnosis of endometrial lesions.
Objective: To investigate and compare the diagnostic values of transvaginal ultrasonography(TVS and hysteroscopy(HS) in endometrial lesions. Methods: A total of 314 patients with suspected endometrial lesions admitted to our hospital were enrolled in this retrospective analysis. And TVS and HS were respectively adopted to implement diagnostic examination for them. And these results were further confirmed by postoperative pathology,or they were implemented tissue biopsy under HS, and the inspection results were carefully recorded. And then, the diagnostic positive predictive rate, negative predictive rate, sensitivity, accuracy rate and coincidence rate of TVS and HS in endometrial lesions were compared. Results: The results of postoperative pathological examination of 314 patients with suspected endometrial lesions showed that there were 32 cases without lesions and 282 cases with endometrial lesions. The differences of diagnostic accuracies of endometritis, endometrial carcinoma, submucosal myoma of uterus and endometrial polyps between the two methods were significant(x~2=30.721, x~2=6.252, x~2=11.109,x~2=5.710, P<0.05). While the differences of diagnostic sensitivity and positive predictive value between the two methods were no significant(x~2=2.646, x~2=0.848, P>0.05). Besides, the specificity and negative predictive value of HS were significantly superior than those of TVS(x~2=10.835, x~2=28.571, P<0.05). Conclusion: Pathological examination is the gold standard for the diagnosis of endometrial diseases. HS diagnosis has higher negative predictive value and specificity, while TVS has the advantages of simple operation and effective diagnosis. Therefore, the combination of TVS and HS that is used in clinical practice can provide a scientific basis for the diagnosis of endometrial lesions.
引文
[1]潘宁宁,马彩虹,宋雪凌,等.宫腔镜在子宫腺肌病合并不孕妇女子宫内膜病变诊断中的价值[J].中国微创外科杂志,2017,17(5):385-387.
[2]张颖,陈梅,郭银树,等.绝经后妇女子宫内膜息肉样癌及其癌前病变的临床特点及宫腔镜诊断价值[J].中华妇产科杂志,2016,51(5):366-370.
[3]张文燕,施晓波.经阴道超声诊断不孕症常见宫腔病变的分析——300例与宫腔镜检查结果的比较[J].生殖与避孕,2015,35(2):137-140.
[4]CepniI,OcalP,ErkanS,etal.Comparison oftransvaginalsonography,salineinfusion sonography and hysteroscopy in the evaluation ofuterinecavitypathologies[J].AustNZJ Obstet Gynaecol,2015,45(1):30-35.
[5]杨成梁,王春艳,黄德益.超声检查和宫腔镜检查对子宫内膜病变的诊断价值比较[J].中国妇幼健康研究,2015,26(4):783-784.
[6]曹迎九,吕蓓,王倩,等.宫腔镜与阴道超声用于诊断子宫内膜病变的临床价值探讨[J].现代生物医学进展,2014,14(36):7126-7129.
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[8]肖忠坤.宫腔镜联合经阴道超声在子宫内膜病变诊断中的应用与价值[J].中国医药导刊,2016,18(11):1107-1108.
[9]贾颍辉,谢馥穗.经阴道超声宫腔镜在子宫内膜病变中应用价值及意义[J].山西医药杂志,2017,46(6):659-661.
[10]刘新玉.经阴道三维超声和宫腔镜在绝经后子宫内膜良恶性病变诊断中的价值探讨[J].中南医学科学杂志,2016,44(3):251-254.
[11]张璐,周琦.宫腔镜与经阴道超声对子宫内膜病变诊断特异性、敏感度比较分析[J].中国妇幼健康研究,2017,28(4):453-455.
[12]Wang XW,Tian JW,Wang HK.Diagnostic value of transvaginal color Doppler ultrasound on endometrial lesions[J].Eur J Gynaecol Oncol,2016,37(6):842-845.
[13]朱丽红,张驰东,程昊,等.宫腔镜在诊断老年女性子宫内膜病变中的应用[J].老年医学与保健,2015,21(6):391-394.
[14]Giorda G,Crivellari D,Veronesi A,et al.Comparison of ultrasonography,hysteroscopy,and biopsy in the diagnosis of endometrial lesions in postmenopausal tamoxifen-treated patients[J].Acta Obstet Gynecol Scand,2015,81(10):975-980.
[15]张晓颖,徐程,叶青,等.阴道超声联合宫腔镜在诊断子宫内膜病变中的应用[J].江苏医药,2017,43(5):366-367.
[2]张颖,陈梅,郭银树,等.绝经后妇女子宫内膜息肉样癌及其癌前病变的临床特点及宫腔镜诊断价值[J].中华妇产科杂志,2016,51(5):366-370.
[3]张文燕,施晓波.经阴道超声诊断不孕症常见宫腔病变的分析——300例与宫腔镜检查结果的比较[J].生殖与避孕,2015,35(2):137-140.
[4]CepniI,OcalP,ErkanS,etal.Comparison oftransvaginalsonography,salineinfusion sonography and hysteroscopy in the evaluation ofuterinecavitypathologies[J].AustNZJ Obstet Gynaecol,2015,45(1):30-35.
[5]杨成梁,王春艳,黄德益.超声检查和宫腔镜检查对子宫内膜病变的诊断价值比较[J].中国妇幼健康研究,2015,26(4):783-784.
[6]曹迎九,吕蓓,王倩,等.宫腔镜与阴道超声用于诊断子宫内膜病变的临床价值探讨[J].现代生物医学进展,2014,14(36):7126-7129.
[7]贝政平,来佩琍,张斌.妇产科疾病诊断标准[M].2版.北京:人民文学出版社,2007:891-893.
[8]肖忠坤.宫腔镜联合经阴道超声在子宫内膜病变诊断中的应用与价值[J].中国医药导刊,2016,18(11):1107-1108.
[9]贾颍辉,谢馥穗.经阴道超声宫腔镜在子宫内膜病变中应用价值及意义[J].山西医药杂志,2017,46(6):659-661.
[10]刘新玉.经阴道三维超声和宫腔镜在绝经后子宫内膜良恶性病变诊断中的价值探讨[J].中南医学科学杂志,2016,44(3):251-254.
[11]张璐,周琦.宫腔镜与经阴道超声对子宫内膜病变诊断特异性、敏感度比较分析[J].中国妇幼健康研究,2017,28(4):453-455.
[12]Wang XW,Tian JW,Wang HK.Diagnostic value of transvaginal color Doppler ultrasound on endometrial lesions[J].Eur J Gynaecol Oncol,2016,37(6):842-845.
[13]朱丽红,张驰东,程昊,等.宫腔镜在诊断老年女性子宫内膜病变中的应用[J].老年医学与保健,2015,21(6):391-394.
[14]Giorda G,Crivellari D,Veronesi A,et al.Comparison of ultrasonography,hysteroscopy,and biopsy in the diagnosis of endometrial lesions in postmenopausal tamoxifen-treated patients[J].Acta Obstet Gynecol Scand,2015,81(10):975-980.
[15]张晓颖,徐程,叶青,等.阴道超声联合宫腔镜在诊断子宫内膜病变中的应用[J].江苏医药,2017,43(5):366-367.