發(fā)布時間：2018-07-07 08:21

  本文選題：宮腔鏡 + 門診�。� 參考：《蘭州大學》2017年碩士論文

【摘要】：目的:探討門診宮腔鏡在子宮內膜息肉及宮頸息肉診斷與治療中的臨床價值,了解子宮內膜息肉及宮頸息肉的臨床特點、病理類型及研究進展,提高門診息肉患者的診治率,改善患者的生活質量及臨床預后。方法:對2015年1月?2016年6月于蘭州大學第二醫(yī)院婦產科門診經宮腔鏡診斷及治療的子宮內膜息肉與宮頸息肉患者的病歷資料進行回顧性分析。將同時期患者的宮腔鏡檢查及超聲檢查結果分別與病理結果進行比較,了解門診宮腔鏡診斷子宮內膜息肉及宮頸息肉的準確度,并分析門診宮腔鏡手術治療子宮內膜息肉及宮頸息肉的安全性及可行性。應用SPSS19.0軟件進行?2檢驗及Kappa檢驗。結果:1.宮腔鏡診斷子宮內膜息肉384例、宮頸息肉342例、宮頸息肉合并內膜息肉46例,共計772例。其中主要以異常子宮出血行宮腔鏡檢查的患者有569例,占總數的73.70%,而絕經后出血、白帶增多、不孕及腹痛者,分別占6.35%、4.66%、4.02%及3.63%,另有7.64%的患者無癥狀而在婦科檢查時發(fā)現。2.排除無病理或超聲結果的66例,其余706例經病理確診為內膜息肉316例,宮頸息肉312例,宮頸息肉合并內膜息肉43例,另35例為非息肉患者。312例宮頸息肉與43例宮頸息肉合并內膜息肉均為良性病變。316例內膜息肉中有1例發(fā)生癌變,3例腺體出現不典型增生,內膜息肉的癌前病變及癌變率約占總數的1.3%。3.以病理結果為標準,宮腔鏡診斷內膜息肉的靈敏度、符合率及正確指數分別為96.52%、93.77%與0.88,對宮頸息肉及宮頸息肉合并內膜息肉的上述指標分別為98.72%、97.45%與0.95及97.67%、99.29%與0.97。超聲診斷內膜息肉的靈敏度、符合率及正確指數分別為58.23%、75.07%與0.47,對宮頸息肉及宮頸息肉合并內膜息肉的上述指標分別為23.40%、65.30%與0.22及2.33%、94.05%與0.02。將宮腔鏡診斷與超聲診斷的上述指標兩兩比較,以?=0.05的檢驗標準,結果均有顯著性差異(P0.05)。4.將宮腔鏡、超聲分別與病理診斷結果進行Kappa檢驗,結果顯示超聲與病理在內膜息肉的診斷上具有中度一致性,而在宮頸息肉及宮頸息肉合并內膜息肉的診斷上只有低度一致性。宮腔鏡與病理在內膜息肉、宮頸息肉、宮頸息肉合并內膜息肉的診斷上均具有高度一致性,兩者差異有統(tǒng)計學意義(P0.05)。5.185例息肉患者在檢查的同時成功進行了門診宮腔鏡手術治療,其中宮頸息肉152例,內膜息肉21例,宮頸息肉合并內膜息肉12例。息肉多為單發(fā)、蒂部較細且平均直徑≤2cm,平均手術時間未超過15min,除4例患者發(fā)生輕度頭暈、惡心、低血壓等迷走神經反應外,無一例嚴重并發(fā)癥出現。結論:1.內膜息肉與宮頸息肉是常見的宮腔病變及宮頸病變之一,主要引起異常子宮出血、絕經后出血、白帶增多及不孕等,且有惡變的風險,臨床中應盡早明確診斷并予以針對性治療。2.門診宮腔鏡對內膜息肉、宮頸息肉尤其是兩者共存時診斷的準確度均高于超聲,且與病理結果的符合率具有高度一致性,應作為理想的診斷選擇。超聲可用于息肉的初步篩查,但最終確診仍需行宮腔鏡檢查并在其引導下進行活檢。3.門診宮腔鏡手術在治療單發(fā)、蒂部較細且直徑不超過2cm的息肉時是一種安全、可行且患者耐受度良好的方法,應得到推廣與應用。
[Abstract]:Objective: To explore the clinical value of hysteroscopy in the diagnosis and treatment of endometrial polyps and cervical polyps, to understand the clinical characteristics, pathological types and research progress of endometrial polyps and cervical polyps, to improve the diagnosis and treatment rate of polyps in outpatients, to improve the quality of life and the prognosis of the patients. Methods: in January 2015? June 2016 The clinical data of endometrial polyps and cervical polyps in the gynecology and obstetrics outpatient clinic of Second Hospital Affiliated to Lanzhou University were analyzed retrospectively. The diagnosis of endometrium polyps and cervix polyps by hysteroscopy in the same period was compared with the results of hysteroscopy and ultrasound examination. Accuracy, and analysis of the safety and feasibility of hysteroscopic surgery for endometrial polyps and cervical polyps. 2 tests and Kappa tests were performed by SPSS19.0 software. Results 1. hysteroscopic diagnosis of endometrial polyps, 342 cases of cervical polyps, 46 cases of cervical polyps with endometrial polyps, including 772 cases, mainly with abnormal uterus. There were 569 cases of bleeding with hysteroscopy, accounting for 73.70% of the total, and postmenopausal bleeding, increased leucorrhea, infertility and abdominal pain, accounting for 6.35%, 4.66%, 4.02% and 3.63% respectively, and 7.64% of the patients were asymptomatic and found in the gynecologic examination,.2. excluded pathological or ultrasound results in 66 cases, and the other 706 cases were diagnosed as intima polyps 316 cases, and the other 706 cases were diagnosed as endometrium. 312 cases of cervical polyp, 43 cases of cervical polyp and endometrial polyp, 35 cases of non polyp patients.312 cases of cervical polyp, 43 cases of cervical polyp and endometrial polyp, 1 cases of.316 endometrial polyp, 3 case of atypical hyperplasia, the precancerous lesion of endometrium and the cancer rate about the total number of 1.3%.3. The sensitivity, coincidence rate and correct index of endometrial polyp were 96.52%, 93.77% and 0.88 respectively. The above indexes of cervical polyps and cervical polyps with endometrial polyps were 98.72%, 97.45% and 0.95 and 97.67% respectively, and 99.29% and 0.97. ultrasound were sensitive to the diagnosis of internal membrane polyps, and the coincidence rate and the correct index were 58., respectively. 23%, 75.07% and 0.47, the above indexes of cervical polyp and polyp with endometrium polyp were 23.40%, 65.30% and 0.22 and 2.33%, 94.05% and 0.02. compared the above index of hysteroscopic diagnosis and ultrasonic diagnosis with the =0.05 test standard, the results were significant difference (P0.05).4. with hysteroscopy, ultrasound and pathological diagnosis. The results of Kappa test showed that ultrasound and pathology had moderate consistency in the diagnosis of endometrial polyps, while the diagnosis of cervical polyps and cervical polyps with endometrial polyps had only low consistency. The diagnosis of hysteroscopy and pathology in endometrial polyps, cervical polyps, cervical polyps and endometrium polyps was highly consistent, two The difference was statistically significant (P0.05).5.185 cases of polyp patients were successfully treated with hysteroscopy, including 152 cases of cervical polyps, 21 cases of endometrium polyp, 12 cases of endometrium polyp with endometrium polyp. Polyps were more single, the pedicle was smaller and the average diameter was less than 2cm, the average operation time was not more than 15min, except for 4 patients. Conclusion: 1. endometrium polyps and cervical polyps are one of the common uterine lesions and cervical lesions, which mainly cause abnormal uterine bleeding, postmenopausal bleeding, increased leukorrhea and infertility, and there is a risk of malignant change. It should be diagnosed as early as possible in the clinic. The diagnostic accuracy of the.2. clinic hysteroscopy for endometrial polyps and the coexistence of cervical polyps, especially both, is higher than ultrasound, and the coincidence with the pathological results is highly consistent. It should be used as an ideal diagnostic option. Ultrasound can be used for preliminary screening of polyps, but the final diagnosis still needs hysteroscopy and is guided by its guidance. Hysteroscopic surgery at.3. outpatient biopsy is a safe, feasible and well tolerated method for the treatment of single, thin pedicled polyps with a diameter of no more than 2cm, and should be popularized and applied.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R711.74

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