本文關(guān)鍵詞： 絕經(jīng)后宮腔占位 出血 宮腔鏡檢查 超聲 診斷　出處：《寧夏醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的1.分析絕經(jīng)后宮腔占位的疾病分布及其與年齡、絕經(jīng)年限及出血的關(guān)系。 2.探討宮腔鏡在診斷絕經(jīng)后宮腔占位中的臨床應(yīng)用價(jià)值。 方法對(duì)2009年09月-2013年08月在寧夏醫(yī)科大學(xué)總醫(yī)院就診的320例絕經(jīng)后超聲診斷為宮腔占位的患者行宮腔鏡檢查，鏡下定位取材，并行病理檢查。以年齡是否大于60歲、絕經(jīng)年限是否超過(guò)10年、是否有出血癥狀，分別分為兩組，分別比較兩組患者的疾病類(lèi)型。分析宮腔鏡操作情況、診斷結(jié)果、比較宮腔鏡與超聲的診斷結(jié)果，探討宮腔鏡在診斷絕經(jīng)后宮腔占位的優(yōu)勢(shì)。 結(jié)果1.絕經(jīng)后宮腔占位的疾病分布：本研究中320例絕經(jīng)后宮腔占位，其中子宮內(nèi)膜息肉占60.0%（192/320），子宮黏膜下肌瘤18.4%（59/320），子宮內(nèi)膜增生10.3%（33/320）,子宮內(nèi)膜炎5.6%（18/320），子宮內(nèi)膜癌占5.6%（18/320）。 2.≤60歲組年齡組惡性病變患者占3.29%（7/213），60組占10.28%（11/107）,（P0.05）；絕經(jīng)年限≤10年組惡性病變患者占3.37%（7/208），〉10年組占9.82%（11/112）,（P0.05）；出血組子宮內(nèi)膜息肉占55.4%（117/211）,非出血組子宮內(nèi)膜息肉68.8%（75/109），（P0.05）；出血組子宮內(nèi)膜癌占8.1%（17/211），非出血組子宮內(nèi)膜癌1.0%(1/109),（P0.05）。 3.宮腔鏡觀察子宮良性病變，可見(jiàn)血管例數(shù)為222例，占73.51%（222/302），子宮內(nèi)膜癌可見(jiàn)血管例數(shù)為17例，占94.44%（17/18），其中16例子宮內(nèi)膜癌在宮腔鏡下觀察到異型血管，占子宮內(nèi)膜癌總數(shù)的88.89%。 4.宮腔鏡診斷子宮內(nèi)膜息肉的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確率分別為93.75％、89.89％、93.26％、90.55％、92.19％，宮腔鏡診斷子宮粘膜下肌瘤的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確率分別為91.53％、98.47％、93.10％、98.09％、97.19％，宮腔鏡診斷子宮內(nèi)膜炎的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確率分別為94.44％、99.01％、85.00％、99.67％、98.75％，宮腔鏡診斷子宮內(nèi)膜增生的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確率分別為51.52％、96.52％、62.96％、94.54％、91.88％，宮腔診斷子宮內(nèi)膜癌的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值、準(zhǔn)確率分別為89.89％、98.01％、72.73％、99.33％、97.50％。 5.宮腔鏡與超聲診斷子宮內(nèi)膜息肉的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及準(zhǔn)確度差異有統(tǒng)計(jì)學(xué)意義（P0.05）；宮腔鏡與超聲診斷子宮粘膜下肌瘤的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及準(zhǔn)確度差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；宮腔鏡與超聲診斷子宮內(nèi)膜增生的特異度、陽(yáng)性預(yù)測(cè)值及準(zhǔn)確度差異有統(tǒng)計(jì)學(xué)意義（P0.05）；敏感度、陰性預(yù)測(cè)值差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；宮腔鏡與超聲診斷子宮內(nèi)膜癌的敏感度、陰性預(yù)測(cè)值差異有統(tǒng)計(jì)學(xué)意義（P0.05）；特異度、陽(yáng)性預(yù)測(cè)值及準(zhǔn)確度差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。 6.本研究中行宮腔鏡檢查的320例患者，給予宮腔鏡治療的占47.50%（152/320）。 結(jié)論1.絕經(jīng)后宮腔占位性疾病以良性病變?yōu)橹鳎訉m內(nèi)膜息肉多見(jiàn)。 2.絕經(jīng)后宮腔占位患者，年齡越大、絕經(jīng)后時(shí)間越長(zhǎng)，越需警惕惡性病變。 3.絕經(jīng)后宮腔占位，合并出血者高度警惕子宮內(nèi)膜癌可能，無(wú)出血的患者不能完全排除惡性病變。 4.宮腔鏡檢查絕經(jīng)后宮腔占位具有直觀性、全面性及準(zhǔn)確性。并在診斷的同時(shí)治療，，是診斷絕經(jīng)后宮腔占位的最佳方法。
[Abstract]:Objective 1. to analyze the distribution of the disease in the postmenopausal uterine cavity space and its relationship with age, menopause and bleeding.
2. to explore the clinical value of hysteroscopy in the diagnosis of postmenopausal uterine cavity occupying.
Methods from 2009 09 months -2013 years 08 months in the General Hospital of Ningxia Medical University, 320 cases of ultrasound diagnosis of postmenopausal uterine cavity for patients by hysteroscopy of endoscopic positioning specimens for pathological examination. The age is more than 60 years of age, menopausal period is more than 10 years, whether there is bleeding symptoms, respectively. For the two group, the type of disease in two groups were compared respectively. Analysis of hysteroscopic operation, diagnosis, diagnostic results of hysteroscopy and ultrasound, hysteroscopy occupying the advantage in the diagnosis of postmenopausal uterine cavity.
Results 1. postmenopausal uterine occupying disease distribution: in this study, 320 cases of postmenopausal uterine cavity lesions, including endometrial polyps accounted for 60% (192/320), submucous myoma of uterus 18.4% (59/320), endometrial hyperplasia in 10.3% (33/320), 5.6% (18/320), endometritis and endometrial cancer accounted for 5.6% (18/320).
2. = 60 age group age group of patients with malignant lesions accounted for 3.29% (7/213), the 60 groups accounted for 10.28% (11/107), (P0.05); menopause less than 10 years group of malignant lesions accounted for 3.37% (7/208), "10 years group accounted for 9.82% (11/112), (P0.05); hemorrhage group endometrial polyps accounted for 55.4% (117/211), non bleeding group endometrial polyps (75/109), 68.8% (P0.05); hemorrhage group endometrial carcinoma accounted for 8.1% (17/211), non bleeding group endometrial carcinoma (1/109), 1% (P0.05).
3. hysteroscopy in the observation of benign uterine lesions, the number of vessels was 222 cases, accounting for 73.51% (222/302). The number of blood vessels in endometrial carcinoma was 17 cases, accounting for 94.44% (17/18). 16 cases of endometrial carcinoma observed abnormal blood vessels under hysteroscopy, accounting for 88.89%. of total endometrial cancer.
4. hysteroscopic diagnosis of endometrial polyps sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 93.75%, 89.89%, 93.26%, 90.55%, 92.19%, hysteroscopic diagnosis of submucosal myoma of uterus of sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 91.53%, 98.47%. 93.10%, 98.09%, 97.19%, hysteroscopic diagnosis of endometritis sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 94.44%, 99.01%, 85%, 99.67%, 98.75%, hysteroscopy endometrial hyperplasia of the sensitivity, specificity, positive predictive value, negative predictive value, accuracy was 51.52% 96.52%, 62.96%, 94.54%, 91.88%, and uterine endometrial cancer diagnosis sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate were 89.89%, 98.01%, 72.73%, 99.33%, 97.50 %.
5. hysteroscopy and ultrasound in the diagnosis of uterine endometrial polyps sensitivity, specificity, positive predictive value, negative predictive value and accuracy was statistically significant difference (P0.05); hysteroscopy and ultrasound diagnosis of uterine submucous myoma of the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the difference was not statistically significant (P0.05); hysteroscopy and ultrasound diagnosis of endometrial hyperplasia was statistically significant specificity, positive predictive value and accuracy difference (P0.05); sensitivity, negative predictive value of the difference was not statistically significant (P0.05); hysteroscopy and ultrasound in the diagnosis of endometrial cancer sensitivity, negative predictive value was statistically significant difference (P0.05); the specificity, positive predictive value and accuracy of the difference was not statistically significant (P0.05).
6. of the 320 patients who underwent hysteroscopy in this study, 47.50% (152/320) were given hysteroscopy.
Conclusion 1. postmenopausal uterine cavity occupying diseases are mainly benign lesions, and endometrium polyps are common.
2. the greater the age, the longer the postmenopause, the more vigilant the malignant lesion is, the longer the menopause.
3. postmenopausal uterine cavity occupying, combined bleeding with high vigilance for endometrial cancer, patients with no bleeding can not completely exclude malignant lesions.
4. hysteroscopy is an intuitive, comprehensive and accurate method for detecting postmenopausal uterine cavity occupancy. It is the best way to diagnose postmenopausal uterine cavity occupying.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R737.33

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