【摘要】：目的：探討經(jīng)陰道B超、宮腔鏡對異常子宮出血診斷的臨床價值。 方法：選擇2012年1月－2013年12月上海市第六人民醫(yī)院因異常子宮出血就診的1032例患者納入本研究，所有患者均行陰道B超（TVS）及宮腔鏡檢查（HS），并在宮腔鏡直視下取可疑部位活檢，術(shù)后送病理并記錄檢查結(jié)果。分析陰道B超子宮內(nèi)膜的聲像圖改變、宮腔鏡檢查的鏡下特征。將陰道B超、宮腔鏡兩種檢查結(jié)果與病理結(jié)果對照，計算兩種方法預(yù)測子宮內(nèi)膜正�；虍惓５拿舾行�、特異性、陽性預(yù)測值和陰性預(yù)測值并分析其對異常子宮出血的確診率、誤診率和漏診率。 結(jié)果：1032例患者，967(93.70%)例經(jīng)陰道B超診斷為異常，其中病理證實940(91.09%)例，65(6.30%)例經(jīng)陰道B超診斷無異常，其中病理證實35(3.39%)例；982(95.16%)例經(jīng)宮腔鏡診斷為異常，其中病理證實964(93.41%)例，50(4.84%)例經(jīng)宮腔鏡診斷無異常，其中病理證實44(4.26%)例。宮腔鏡預(yù)測子宮內(nèi)膜正常或異常的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值(99.38%、70.97%、98.17%、88.00%)均高于陰道B超（96.91%、56.45%、97.21%、53.85%)。與病理診斷相比較，宮腔鏡對粘膜下肌瘤、內(nèi)膜增生、萎縮性內(nèi)膜、內(nèi)膜炎、正常內(nèi)膜和其它（子宮畸形、妊娠相關(guān)、IUD）造成的異常子宮出血診斷符合率（81.46%、58.25%、73.53%、76.92%、70.97%、100%）均高于陰道B超（75.50%、45.63%、61.76%、69.23%、56.45%、94.59%），二者比較，差異無顯著性（P0.05）；對子宮內(nèi)膜息肉、內(nèi)膜癌（85.92%、82.69%）的診斷符合率亦高于陰道B超（62.27%、63.46%），但二者比較，，差異有顯著性（P0.05）。 結(jié)論：宮腔鏡可直視宮腔，具有較高的特異性及陰性預(yù)測值，尤其在診斷子宮內(nèi)膜息肉和內(nèi)膜癌方面。陰道B超診斷異常子宮出血無創(chuàng)、簡單、經(jīng)濟，但特異性及陰性預(yù)測值較低。臨床可將陰道B超作為初篩，結(jié)合宮腔鏡，提高異常子宮出血的診斷符合率。
[Abstract]:Objective: to investigate the clinical value of transvaginal ultrasonography and hysteroscopy in the diagnosis of abnormal uterine bleeding. Methods: 1032 patients with abnormal uterine bleeding in Shanghai sixth people's Hospital from January 2012 to December 2013 were included in this study. All patients were examined by (TVS) and hysteroscopy, and biopsy of suspected sites was performed under hysteroscopy. Postoperative pathology was sent and the results were recorded. The sonographic changes of the endometrium were analyzed and the hysteroscopy features were analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of the two methods for predicting normal or abnormal endometrium were calculated and the diagnostic rate of abnormal uterine bleeding was analyzed by comparing the results of two kinds of vaginal ultrasonography and hysteroscopy with pathological results, and calculated the sensitivity, specificity, positive predictive value and negative predictive value of the two methods for the prediction of normal or abnormal endometrium. Misdiagnosis rate and missed diagnosis rate. Results 967 (93.70%) of 1 032 patients were diagnosed as abnormal by transvaginal ultrasonography, of which 940 (91.09%) cases (91.09%) were diagnosed by pathology, 65 (6.30%) by transvaginal B-ultrasound, and 982 (95.16%) by hysteroscopy were diagnosed as abnormal by pathology. Among them 964 cases (93.41%) were confirmed by pathology, 50 cases (4.84%) were diagnosed by hysteroscopy, and 44 cases (4.26%) were confirmed by pathology. The sensitivity, specificity, positive predictive value and negative predictive value (99.38%) of hysteroscopy in predicting normal or abnormal endometrium were higher than that of vaginal ultrasound (96.91%). Compared with pathological diagnosis, hysteroscopy is associated with submucous myoma, endometrial hyperplasia, atrophic endometrium, endometritis, normal endometrium, and other abnormalities. The diagnostic coincidence rate of abnormal uterine bleeding caused by pregnancy related IUD (81.4658.25 and 73.53 and 76.92U 70.97g / 100%) was higher than that of vaginal B-mode ultrasound (75.505055.630.63cm) (69.2356.459.59%). There was no significant difference between the two groups (P0.05); for endometrial polyps, endometrial carcinoma (85.922 / 82.69%) was also higher than vaginal B ultrasound (62.2763.46%), but compared with vaginal ultrasound (62.2763.46%), the diagnostic accuracy of endometrial carcinoma (85.922%) was higher than that of vaginal ultrasound (62.2763.46%). The difference was significant (P0.05). Conclusion: hysteroscopy has high specificity and negative predictive value, especially in the diagnosis of endometrial polyps and endometrial carcinoma. The diagnosis of abnormal uterine bleeding by vagina B ultrasound is noninvasive, simple and economical, but its specificity and negative predictive value are low. Vaginal ultrasound can be used as primary screen and hysteroscopy to improve the diagnostic accuracy of abnormal uterine bleeding.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R711.52;R445.1

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