经阴道超声与宫腔镜对子宫内膜病变患者的诊断价值比较研究
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摘要
目的:探讨经阴道超声与宫腔镜检查诊断子宫内膜病变的临床价值,为临床诊断子宫内膜病变提供理论依据。方法:选取2011年3月-2014年3月间我院收治的158例疑似子宫内膜病变患者,分别采用经阴道超声和宫腔镜进行检查,并以病理诊断结果为"金标准",比较两种检查方法的诊断价值。结果:病理检查结果中,143例患者被确诊为子宫内膜病变,其中子宫内膜增生23例(16.08%),子宫内膜息肉31例(21.68%),子宫粘膜下肌瘤24例(16.78%),子宫内膜癌19例(13.29%),慢性非特异性子宫内膜炎46例(32.17%)。宫腔镜对子宫内膜病变诊断的准确率为94.41%,高于阴道超声的81.12%,差异有统计学意义(P<0.05),其中阴道超声和宫腔镜对子宫粘膜下肌瘤、子宫内膜癌诊断的准确率比较差异无统计学意义(P>0.05),阴道超声对子宫内膜增生、子宫内膜息肉及慢性非特异性子宫内膜炎的诊断准确率均较宫腔镜降低,差异有统计学意义(P<0.05)。阴道超声对子宫内膜病变诊断的特异度较宫腔镜更低(P<0.05),但两者灵敏度、AUC比较差异无统计学意义(P>0.05)。结论:经阴道超声诊断子宫内膜病变简单、有效,而宫腔镜诊断子宫内膜病变具有准确率以及特异度较高的特点。
Objective: To investigate the clinical value of transvaginal ultrasonography and hysteroscopy in the diagnosis of endometrial lesions, to provide a theoretical basis for the clinical diagnosis of endometrial lesions. Methods: A total of 158 cases of suspected endometrial lesions, who were treated in Beijing First Hospital of Integrated Chinese and Western Medicine from March 2011 to March2014, were selected and were detected by transvaginal sonography and hysteroscopy respectively. The diagnostic value of the two methods was compared with the results of pathological diagnosis as the gold standard. Results: In the results of pathological examination, 143 patients were diagnosed as endometrial lesions, including 23 cases of endometrial hyperplasia(16.08%), 31 cases of endometrial polyps(21.68%), 24 cases of uterine submucosal myoma(16.78%), 19 cases of endometrial carcinoma(13.29%), 46 cases of chronic nonspecific endometritis(32.17%). The accuracy rate(94.41%) of hysteroscopy in the diagnosis of endometrial lesions was higher than that(81.12%)of transvaginal ultrasound, and the difference was significant(P<0.05); there were no statistical differences in the accuracy rate of the diagnosis of submucosal myoma of uterus and endometrial carcinoma between transvaginal ultrasonography and hysteroscopy(P>0.05),and the accuracy rate of transvaginal ultrasound in endometrial hyperplasia, endometrial polyps and chronic nonspecific endometritis was lower than that of hysteroscopy, and the difference was statistically significant(P<0.05). The specificity of transvaginal ultrasonography in the diagnosis of endometrial lesions was lower than that of hysteroscopy(P<0.05), but there were no significant differences in sensitivity and AUC between the two methods(P>0.05). Conclusion: Transvaginal ultrasonography is a simple and effective method in diagnosis of endometrial diseases, and Hysteroscopy has higher accuracy and higher specificity in diagnosis of endometrial diseases.
Objective: To investigate the clinical value of transvaginal ultrasonography and hysteroscopy in the diagnosis of endometrial lesions, to provide a theoretical basis for the clinical diagnosis of endometrial lesions. Methods: A total of 158 cases of suspected endometrial lesions, who were treated in Beijing First Hospital of Integrated Chinese and Western Medicine from March 2011 to March2014, were selected and were detected by transvaginal sonography and hysteroscopy respectively. The diagnostic value of the two methods was compared with the results of pathological diagnosis as the gold standard. Results: In the results of pathological examination, 143 patients were diagnosed as endometrial lesions, including 23 cases of endometrial hyperplasia(16.08%), 31 cases of endometrial polyps(21.68%), 24 cases of uterine submucosal myoma(16.78%), 19 cases of endometrial carcinoma(13.29%), 46 cases of chronic nonspecific endometritis(32.17%). The accuracy rate(94.41%) of hysteroscopy in the diagnosis of endometrial lesions was higher than that(81.12%)of transvaginal ultrasound, and the difference was significant(P<0.05); there were no statistical differences in the accuracy rate of the diagnosis of submucosal myoma of uterus and endometrial carcinoma between transvaginal ultrasonography and hysteroscopy(P>0.05),and the accuracy rate of transvaginal ultrasound in endometrial hyperplasia, endometrial polyps and chronic nonspecific endometritis was lower than that of hysteroscopy, and the difference was statistically significant(P<0.05). The specificity of transvaginal ultrasonography in the diagnosis of endometrial lesions was lower than that of hysteroscopy(P<0.05), but there were no significant differences in sensitivity and AUC between the two methods(P>0.05). Conclusion: Transvaginal ultrasonography is a simple and effective method in diagnosis of endometrial diseases, and Hysteroscopy has higher accuracy and higher specificity in diagnosis of endometrial diseases.
引文
[1]Van der Putten LJM,Van Hoof R,Tops BBJ,et al.Molecular profiles of benign and(pre)malignant endometrial lesions[J].Carcinogenesis,2017,38(3):329-335
[2]Kierans AS,Doshi AM,Dunst D,et al.Retrospective Assessment of Histogram-Based Diffusion Metrics for Differentiating Benign and Malignant Endometrial Lesions[J].J Comput Assist Tomogr,2016,40(5):723-729
[3]陈明清.经阴道超声检查对子宫内膜病变初步诊断的临床价值[J].河北医学,2013,19(1):45-48Chen Ming-qing.The Diagnosis Value of Transvaginal Ultrasound for Endometrial Lesions[J].Hebei Medicine,2013,19(1):45-48
[4]于欣荣.阴道超声与宫腔镜诊断子宫内膜病变的效果比较[J].西南国防医药,2015,25(8):862-864Yu Xin-rong.Comparison of Transvaginal Ultrasonography and Hysteroscopy in the Diagnosis of Endometrial Lesions[J].Southwest National Defense Medicine,2015,25(8):862-864
[5]Grimbizis GF,Tsolakidis D,Mikos T,et al.A prospective comparison of transvaginal ultrasound,saline infusion sonohysterography,and diagnostic hysteroscopy in the evaluation of endometrial pathology[J].Fertil Steril,2010,94(7):2720-2725
[6]Ota H,Fukushi Y,Wada S,et al.Successful treatment of uterine artery pseudoaneurysm with laparoscopic temporary clamping of bilateral uterine arteries,followed by hysteroscopic surgery[J].J Obstet Gynaecol Res,2017,43(8):1356-1359
[7]DE Franciscis P,Grauso F,Messalli EM,et al.Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with"unfavorable"cervix[J].Minerva Ginecol,2017,69(3):239-244
[8]常才.经阴道超声诊断学[M].科学出版社,1999:73-94Chang Cai.Transvaginal Ultrasound Diagnosis[M].Science Press,1999:73-94
[9]夏恩兰,李自新.妇科内镜学[M].人民卫生出版社,2001:68-76,107-108Xia En-lan,Li Zi-xin.Gynecological Endoscopy[M].People's Medical Publishing House,2001:68-76,107-108
[10]刘旭明,何建方.现代诊断病理学[M].中山大学出版社,2006:181-186Liu Xu-ming,He Jian-fang.Modern diagnostic pathology[M].Zhongshan University Press,2006:181-186
[11]李巧香,原天香.绝经后妇女子宫内膜病变的特点及高危因素[J].中国妇幼保健,2015,30(8):1170-1172Li Qiao-xiang,Yuan Tian-xiang.Characteristics and Risk Factors of Endometrial Lesions in Postmenopausal Women[J].Chin Matern Child Health Care,2015,30(8):1170-1172
[12]Wang Q,Guo Q,Gao S,et al.Fertility-conservation combined therapy with hysteroscopic resection and oral progesterone for lo cal early stage endometrial carcinoma in young women[J].Int J Clin Exp Med,2015,8(8):13804-13810
[13]Laurelli G,Falcone F,Gallo MS,et al.Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated:A Prospective Study and Literature Update[J].Int J Gynecol Cancer,2016,26(9):1650-1657
[14]Austin RM.George Papanicolaou's Efforts to Develop Novel Cytologic Methods for the Early Diagnosis of Endometrial Carcinoma[J].Acta Cytol,2017,61(4-5):281-298
[15]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):7126-7129Cao Ying-jiu,Lv Bei,Wang Qian,et al.Clinical Value of Hysteroscopy and Transvaginal Ultrasound in the Diagnosis of Endometrial Diseases[J].Progress in Modern Biomedicine,2014,14(36):7126-7129
[16]Zhang Y,Luo L,Luo Q.Identification of benign and malignant endometrial cancer with transvaginal ultrasonography combined with elastography and tissue hardness analysis[J].J Biol Regul Homeost Agents,2015,29(4):905-912
[17]马钦风,张玉英,黎娉,等.青海地区经阴道超声联合宫腔镜检查对子宫内膜病变的应用价值[J].中国妇幼健康研究,2016,27(6):752-754Ma Qin-feng,Zhang Yu-ying,Li Pin,et al.The Value of Transvaginal Ultrasonography Combined with Hysteroscopy in the Treat ment of Endometrial Lesions in Qinghai[J].Maternal and Child Health Research in China,2016,27(6):752-754
[18]李琴,唐建华.经阴道超声在子宫内膜病变中的研究进展[J].医学综述,2015,21(2):299-300Li Qin,Tang Jian-hua.Research Progress of Transvaginal Ultrasound in Endometrial Lesions[J].Medical Review,2015,21(2):299-300
[19]吴学明.经阴道超声、宫腔镜对子宫内膜病变的诊断价值[J].长春中医药大学学报,2014,30(3):540-542Wu Xue-ming.Diagnostic Value of Transvaginal Ultrasound and Hysteroscopy in Endometrial Lesions[J].Journal of Changchun University of Traditional Chinese Medicine,2014,30(3):540-542
[20]Phelippeau J,Canlorbe G,Bendifallah S,et al.Preoperative diagnosis of tumor grade and type in endometrial cancer by pipelle sampling and hysteroscopy:Results of a French study[J].Surg Oncol,2016,25(4):370-377
[21]Spadoto-Dias D,Bueloni-Dias FN,Elias LV,et al.The value of hysteroscopic biopsy in the diagnosis of endometrial polyps[J].Womens Health(Lond),2016,12(4):412-419
[22]Martinelli F,Ditto A,Bogani G,et al.Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies[J].J Cancer Res Clin Oncol,2017,143(7):1275-1279
[23]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):1107-1108Xiao Zhong-kun.The Application and value of Hysteroscopy Combined with Transvaginal Ultrasound in the Diagnosis of Endometrial Diseases[J].Chinese Journal of Medicinal Guide,2016,18(11):1107-1108
[24]龙俊,冉素真,杨正春.经阴道超声对子宫内膜增生症与子宫内膜癌的鉴别诊断价值[J].重庆医学,2014,43(19):2426-2427,2431Long Jun,Ran Su-zhen,Yang Zheng-chun.Value of Transvaginal Ultrasonography in Differential Diagnosis of Endometrial Hyperplasia and Endometrial Carcinoma[J].Chongqing Medicine,2014,43(19):2426-2427,2431
[25]Loiacono RM,Trojano G,Del Gaudio N,et al.Hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium:hysteroscopic and histological results[J].Gynecol Obstet Invest,2015,79(3):210-216
[26]Wanderley MD,魣lvares MM,Vogt MF,et al.Accuracy of Transvaginal Ultrasonography,Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies[J].Rev Bras Ginecol Obstet,2016,38(10):506-511
[27]Zhu H,Fu J,Lei H,et al.Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women[J].Exp Ther Med,2016,12(2):1196-1200
[28]杨建华,郑云慧,马淑梅.经阴道和经腹部超声对子宫内膜病变诊断的临床价值比较[J].黑龙江医药,2015,28(3):630-632Yang Jian-hua,Zheng Yun-hui,Ma Shu-mei.Comparison of Clinical Value of Transvaginal and Transabdominal Ultrasound in the Diagnosis of Endometrial Diseases[J].Heilongjiang Medical Journal,2015,28(3):630-632
[29]郭津含,苏琛辉,林丽璇,等.经阴道超声、经阴道超声宫腔造影及宫腔镜诊断子宫内膜病变的对照分析[J].中国现代药物应用,2016,10(11):89-90Guo Jin-han,Su Chen-hui,Lin Li-xuan,et al.Comparative Analysis of Transvaginal Ultrasound,Transvaginal Sonography and Hysteroscopy in the Diagnosis of Endometrial Lesions[J].Chinese Journal of Modern Drug Application,2016,10(11):89-90
[30]于慧娟.子宫内膜病变患者经阴道超声和宫腔镜诊断分析[J].中国实用医刊,2017,44(9):87-89Yu Hui-juan.Transvaginal Ultrasonography and Hysteroscopy in the Diagnosis of Endometrial Lesions[J].Chinese Journal of Practical Medicine,2017,44(9):87-89
[2]Kierans AS,Doshi AM,Dunst D,et al.Retrospective Assessment of Histogram-Based Diffusion Metrics for Differentiating Benign and Malignant Endometrial Lesions[J].J Comput Assist Tomogr,2016,40(5):723-729
[3]陈明清.经阴道超声检查对子宫内膜病变初步诊断的临床价值[J].河北医学,2013,19(1):45-48Chen Ming-qing.The Diagnosis Value of Transvaginal Ultrasound for Endometrial Lesions[J].Hebei Medicine,2013,19(1):45-48
[4]于欣荣.阴道超声与宫腔镜诊断子宫内膜病变的效果比较[J].西南国防医药,2015,25(8):862-864Yu Xin-rong.Comparison of Transvaginal Ultrasonography and Hysteroscopy in the Diagnosis of Endometrial Lesions[J].Southwest National Defense Medicine,2015,25(8):862-864
[5]Grimbizis GF,Tsolakidis D,Mikos T,et al.A prospective comparison of transvaginal ultrasound,saline infusion sonohysterography,and diagnostic hysteroscopy in the evaluation of endometrial pathology[J].Fertil Steril,2010,94(7):2720-2725
[6]Ota H,Fukushi Y,Wada S,et al.Successful treatment of uterine artery pseudoaneurysm with laparoscopic temporary clamping of bilateral uterine arteries,followed by hysteroscopic surgery[J].J Obstet Gynaecol Res,2017,43(8):1356-1359
[7]DE Franciscis P,Grauso F,Messalli EM,et al.Resectoscope versus small diameter hysteroscopy for endometrial polypectomy in patients with"unfavorable"cervix[J].Minerva Ginecol,2017,69(3):239-244
[8]常才.经阴道超声诊断学[M].科学出版社,1999:73-94Chang Cai.Transvaginal Ultrasound Diagnosis[M].Science Press,1999:73-94
[9]夏恩兰,李自新.妇科内镜学[M].人民卫生出版社,2001:68-76,107-108Xia En-lan,Li Zi-xin.Gynecological Endoscopy[M].People's Medical Publishing House,2001:68-76,107-108
[10]刘旭明,何建方.现代诊断病理学[M].中山大学出版社,2006:181-186Liu Xu-ming,He Jian-fang.Modern diagnostic pathology[M].Zhongshan University Press,2006:181-186
[11]李巧香,原天香.绝经后妇女子宫内膜病变的特点及高危因素[J].中国妇幼保健,2015,30(8):1170-1172Li Qiao-xiang,Yuan Tian-xiang.Characteristics and Risk Factors of Endometrial Lesions in Postmenopausal Women[J].Chin Matern Child Health Care,2015,30(8):1170-1172
[12]Wang Q,Guo Q,Gao S,et al.Fertility-conservation combined therapy with hysteroscopic resection and oral progesterone for lo cal early stage endometrial carcinoma in young women[J].Int J Clin Exp Med,2015,8(8):13804-13810
[13]Laurelli G,Falcone F,Gallo MS,et al.Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated:A Prospective Study and Literature Update[J].Int J Gynecol Cancer,2016,26(9):1650-1657
[14]Austin RM.George Papanicolaou's Efforts to Develop Novel Cytologic Methods for the Early Diagnosis of Endometrial Carcinoma[J].Acta Cytol,2017,61(4-5):281-298
[15]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):7126-7129Cao Ying-jiu,Lv Bei,Wang Qian,et al.Clinical Value of Hysteroscopy and Transvaginal Ultrasound in the Diagnosis of Endometrial Diseases[J].Progress in Modern Biomedicine,2014,14(36):7126-7129
[16]Zhang Y,Luo L,Luo Q.Identification of benign and malignant endometrial cancer with transvaginal ultrasonography combined with elastography and tissue hardness analysis[J].J Biol Regul Homeost Agents,2015,29(4):905-912
[17]马钦风,张玉英,黎娉,等.青海地区经阴道超声联合宫腔镜检查对子宫内膜病变的应用价值[J].中国妇幼健康研究,2016,27(6):752-754Ma Qin-feng,Zhang Yu-ying,Li Pin,et al.The Value of Transvaginal Ultrasonography Combined with Hysteroscopy in the Treat ment of Endometrial Lesions in Qinghai[J].Maternal and Child Health Research in China,2016,27(6):752-754
[18]李琴,唐建华.经阴道超声在子宫内膜病变中的研究进展[J].医学综述,2015,21(2):299-300Li Qin,Tang Jian-hua.Research Progress of Transvaginal Ultrasound in Endometrial Lesions[J].Medical Review,2015,21(2):299-300
[19]吴学明.经阴道超声、宫腔镜对子宫内膜病变的诊断价值[J].长春中医药大学学报,2014,30(3):540-542Wu Xue-ming.Diagnostic Value of Transvaginal Ultrasound and Hysteroscopy in Endometrial Lesions[J].Journal of Changchun University of Traditional Chinese Medicine,2014,30(3):540-542
[20]Phelippeau J,Canlorbe G,Bendifallah S,et al.Preoperative diagnosis of tumor grade and type in endometrial cancer by pipelle sampling and hysteroscopy:Results of a French study[J].Surg Oncol,2016,25(4):370-377
[21]Spadoto-Dias D,Bueloni-Dias FN,Elias LV,et al.The value of hysteroscopic biopsy in the diagnosis of endometrial polyps[J].Womens Health(Lond),2016,12(4):412-419
[22]Martinelli F,Ditto A,Bogani G,et al.Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies[J].J Cancer Res Clin Oncol,2017,143(7):1275-1279
[23]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):1107-1108Xiao Zhong-kun.The Application and value of Hysteroscopy Combined with Transvaginal Ultrasound in the Diagnosis of Endometrial Diseases[J].Chinese Journal of Medicinal Guide,2016,18(11):1107-1108
[24]龙俊,冉素真,杨正春.经阴道超声对子宫内膜增生症与子宫内膜癌的鉴别诊断价值[J].重庆医学,2014,43(19):2426-2427,2431Long Jun,Ran Su-zhen,Yang Zheng-chun.Value of Transvaginal Ultrasonography in Differential Diagnosis of Endometrial Hyperplasia and Endometrial Carcinoma[J].Chongqing Medicine,2014,43(19):2426-2427,2431
[25]Loiacono RM,Trojano G,Del Gaudio N,et al.Hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium:hysteroscopic and histological results[J].Gynecol Obstet Invest,2015,79(3):210-216
[26]Wanderley MD,魣lvares MM,Vogt MF,et al.Accuracy of Transvaginal Ultrasonography,Hysteroscopy and Uterine Curettage in Evaluating Endometrial Pathologies[J].Rev Bras Ginecol Obstet,2016,38(10):506-511
[27]Zhu H,Fu J,Lei H,et al.Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women[J].Exp Ther Med,2016,12(2):1196-1200
[28]杨建华,郑云慧,马淑梅.经阴道和经腹部超声对子宫内膜病变诊断的临床价值比较[J].黑龙江医药,2015,28(3):630-632Yang Jian-hua,Zheng Yun-hui,Ma Shu-mei.Comparison of Clinical Value of Transvaginal and Transabdominal Ultrasound in the Diagnosis of Endometrial Diseases[J].Heilongjiang Medical Journal,2015,28(3):630-632
[29]郭津含,苏琛辉,林丽璇,等.经阴道超声、经阴道超声宫腔造影及宫腔镜诊断子宫内膜病变的对照分析[J].中国现代药物应用,2016,10(11):89-90Guo Jin-han,Su Chen-hui,Lin Li-xuan,et al.Comparative Analysis of Transvaginal Ultrasound,Transvaginal Sonography and Hysteroscopy in the Diagnosis of Endometrial Lesions[J].Chinese Journal of Modern Drug Application,2016,10(11):89-90
[30]于慧娟.子宫内膜病变患者经阴道超声和宫腔镜诊断分析[J].中国实用医刊,2017,44(9):87-89Yu Hui-juan.Transvaginal Ultrasonography and Hysteroscopy in the Diagnosis of Endometrial Lesions[J].Chinese Journal of Practical Medicine,2017,44(9):87-89