宫腔镜手术治疗绝经期子宫内膜息肉的应用

 目的探讨官腔镜手术在治疗绝经期子宫内膜息肉方面的临床效果.方法回顾性分析1999年10月～2004年10月在我院经门诊宫腔镜诊断为子宫内膜息肉而行官腔镜手术的49例绝经后妇女的临床资料.41例行单极电切手术:其中13例行单纯息肉切除,15例息肉切除同时行滚球电极子宫内膜剥除,13例息肉切除同时行热球子宫内膜剥除;5例行双极汽化电切息肉及子宫内膜剥除;余3例患者因术中诊为黏膜下子宫肌瘤而行官腔镜下肌瘤切除术.结果49例中术后病理诊断为子宫内膜息肉46例,其中1例合并子宫内膜复杂性伴轻度非典型增生;黏膜下子宫肌瘤3例.宫腔镜检查诊断子宫内膜息肉的符合率为93.88%(46/49).所有患者均耐受手术,无麻醉意外及手术并发症.31例绝经后出血患者均未再出现异常出血.结论官腔镜手术是绝经后妇女子宫内膜息肉的首选微创诊治方法,为了防止息肉复发可于息肉切除同时行子宫内膜去除术.     

宫腔镜检查联合病理对绝经后子宫出血的290例诊断评价

目的:评价宫腔镜联合病理对绝经后子宫出血诊断和治疗价值.方法:对我院2003-02～2009-04收治的290例绝经后阴道流血患者进行宫腔镜检查加病理,对其中114例良性、器质性病变患者宫腔镜手术治疗.结果:子宫内膜息肉62例、萎缩宫腔58例、炎症54例、宫颈管息肉46例、子宫内膜增殖症38例、子宫内膜不典型增生及子宫内膜癌12例、节育器14例、子宫黏膜下肌瘤6例.B超下子宫内膜＜4.0 mm者宫腔内器质性病变33.3%,而≥4.0 mm者器质性病变58.6%,12例子宫内膜癌及癌前病变患者内膜均≥4.0 mm,良性子宫内膜器质性病变者均宫腔镜下手术1次治愈.结论:宫腔镜检查辅以病理是诊断绝经后子宫出血的有效方法.     

宫腔镜检查联合病理对绝经后子宫出血的290例诊断评价

目的：评价宫腔镜联合病理对绝经后子宫出血诊断和治疗价值。方法：对我院2003—02—2009—04收治的290例绝经后阴道流血患者进行宫腔镜检查加病理，对其中114例良性、器质性病变患者宫腔镜手术治疗。结果：子宫内膜息肉62例、萎缩宫腔58例、炎症54例、宫颈管息肉46例、子宫内膜增殖症38例、子宫内膜不典型增生及子宫内膜癌12例、节育器14例、子宫黏膜下肌瘤6例。B超下子宫内膜〈4．0mm者宫腔内器质性病变33．3％，而≥4．0mm者器质性病变58．6％，12例子宫内膜癌及癌前病变患者内膜均≥4．0mm，良性子宫内膜器质性病变者均宫腔镜下手术1次治愈。结论：宫腔镜检查辅以病理是诊断绝经后子宫出血的有效方法。     

超声与宫腔镜检查在诊断绝经期子宫出血的临床应用

绝经后子宫出血是自然绝经1年以上的子宫出血,其中子宫内膜息肉、子宫黏膜下肌瘤最为常见。本组报告超声与宫腔镜联合检查在诊断绝经后子宫出血的临床应用。     

宫腔镜及B超联合诊治绝经后出血的临床价值

目的:探讨宫腔镜及B超联合诊治技术对于绝经后出血患者的临床价值。方法:对我科2000年2月~2005年8月收治的167例绝经后出血患者进行了宫腔镜及B超联合诊治。所有患者均先进行B超检查,之后行宫腔镜诊治,必要时辅以B超引导监护。结果:167例中84例内膜厚度<5mm,5~10mm者64例,>10mm者19例;同时提示宫腔内病变者12例。出血的病因依次为子宫内膜炎54例(32.3%)、子宫粘膜下肌瘤38例(22.8%)、子宫内膜息肉32例(19.2%)、子宫内膜癌22例(13.2%)、子宫内膜增生11例(6.6%)、宫颈息肉6例(3.6%),其它4例(2.3%)。保守治疗11例,化疗1例,31例同时进行了宫腔镜下治疗,99例实施宫腔镜电切手术,25例开腹手术,病理学诊断总的符合率为80.8%。结论:宫腔镜检查联合B超应作为绝经后出血患者的首选,内膜厚度<5mm者应慎行刮宫术。宫腔镜联合B超进行宫腔内病变治疗及电切手术对于老年宫腔内良性疾患的治疗具有重要临床价值。     

经阴道超声及宫腔镜对子宫内膜病变的诊断价值

目的：探讨经阴道超声表现与宫腔镜检查对子宫内膜病变的诊断价值。材料和方法：对86例临床疑为子宫内膜病变的患者行阴道超声及宫腔镜检查,并行摘除、活检或刮宫,与病理结果对照分析。结果：病理诊断子宫内膜息肉39例,子宫黏膜下肌瘤9例,子宫内膜增生过长14例,子宫黏膜下肌瘤伴息肉4例,子宫内膜癌4例,正常子宫内膜16例,宫腔镜检查与阴道超声检查对各类子宫内膜病变的诊断准确性相当,两者无统计学差异（P〉0.05）。结论：阴道超声是筛选子宫内膜病变的简便、经济而有效的方法,宫腔镜下活检是可靠的诊断方法,联合检查是目前诊断子宫内膜病变的理想方法。     

经阴道彩色多普勒超声对绝经后阴道出血子宫内膜病变的诊断价值

目的:探讨经阴道彩色多普勒超声(transvaginal ultrasonography,TVS)对绝经后出血患者子宫内膜病变的诊断价值。方法:对96例绝经后出血患者行TVS检查,重点观察子宫内膜厚度、回声、形态及血供情况,将超声检查结果与组织病理结果进行对照分析。结果:TVS能有效地诊断子宫萎缩性内膜、内膜增生、内膜息肉、黏膜下肌瘤和子宫内膜癌。非器质性萎缩性子宫内膜厚度最薄<5mm,子宫内膜癌内膜厚度与萎缩性内膜厚度比较,差异有统计学意义(P<0.01),子宫内膜癌血流最丰富,RI最低<0.4,萎缩性子宫内膜无彩色血流。结论:TVS能有效地鉴别诊断绝经后出血宫内膜病变,可作为其首选的常规检查及子宫内膜癌的最佳筛选方法,具有较高的临床实用价值。     

阴道超声在宫腔镜对绝经后妇女子宫内膜病变的临床应用

绝经后阴道流血是子宫内膜病变，尤其是子宫内膜癌的危险信号，以往常规诊断方法是分段诊断性刮宫，随着微创技术的发展，宫腔镜技术越来越受到重视，已广泛应用到临床中，宫腔镜直视下活检是诊断异常子宫出血的金标准。但盲目进行宫腔镜检查会增加宫腔感染的机会和患者的负担，我们通过阴道超声测量子宫内膜厚度，对厚度〉5mm的患者均采用宫腔镜检查，对早期发现子宫内膜病变尤其是子宫内膜癌具有重要的临床意义。     

阴道内镜诊治绝经后阴道流血的应用

目的：评价阴道内镜对绝经后阴道流血的诊断和治疗价值。方法：对我院2010-02～2011-11间收治的86例绝经后阴道流血患者进行阴道内镜检查。结果：子宫内膜息肉16例,萎缩宫腔29例,宫颈炎症10例,宫颈管息肉13例,子宫内膜增殖症6例,子宫内膜不典型增生及子宫内膜癌2例,节育器7例,子宫黏膜下肌瘤3例。结论：阴道内镜检查是诊治绝经后阴道流血的有效方法,特别适用于生殖器萎缩严重者。     

超声观察绝经后子宫内膜的临床意义

目的：探讨超声观察绝经后子宫内膜的临床意义。材料与方法：超声观察自１９９０年１月以来就诊的７８例绝经后妇女子宫内膜的声像图特征，与诊刮病理结果对照。，子宫内膜声像图分为四型，分析其与病理结果的关系。结果：超声图像为Ⅰ、Ⅱ型的（内膜厚度＜５ｍｍ）５５例，病理全部证实为萎缩的子宫内膜，超声图像为Ⅲ、Ⅳ型的（内膜厚度＞５ｍｍ）２３例，２例为萎缩的子宫内膜，１０例为子宫内膜息肉，５例为子宫内膜增生，６例为子宫内膜腺癌。结论：声像图呈Ⅰ、Ⅱ型提示绝经后萎缩的子宫内膜，Ⅲ、Ⅳ型反映子宫内膜的肥厚状态     

磁共振扩散加权成像对Ⅰa期子宫内膜癌的鉴别诊断价值

目的：探讨表观扩散系数(ADC)值测量对Ⅰa 期子宫内膜癌的鉴别诊断价值。方法回顾性分析经手术病理证实的Ⅰa期子宫内膜癌患者18例,子宫良性病变患者22例,其中子宫内膜增生9例,子宫内膜息肉8例,黏膜下肌瘤变性5例,所有患者均行 MRI、扩散加权成像(DWI)检查,采用单次激发的平面回波成像(EPI)序列,b 值为0 s/mm2和1000 s/mm2。结果Ⅰa 期子宫内膜癌、子宫内膜增生、子宫内膜息肉和黏膜下肌瘤变性的 ADC 值分别为(0.89±0.21)×10-3 mm2/s、(1.45±0.19)×10-3 mm2/s、(1.29±0.32)×10-3 mm2/s、(1.32±0.29)×10-3 mm2/s,组间差异有统计学意义(F =48.021 P =0.00,one-way NOVA ),两两组间比较(LSD)Ⅰa 期子宫内膜癌和各组良性病变间均有统计学意义(P <0.05)。结论ADC 值测量对Ⅰa 期子宫内膜癌有很好的鉴别诊断价值。     

经阴道彩色多普勒超声诊断子宫内膜病变的临床价值

目的:评价经阴道彩色多普勒超声(TDS)对妇女子宫内膜病变的临床价值。方法:对98例子宫内膜病变患者行阴道彩色多普勒超声检查,分析超声图像与手术病理结果对照。结果:98例患者子宫内膜诊刮病理分类有子宫内膜息肉、粘膜下肌瘤、内膜增生过长和子宫内膜癌,经阴道超声诊断子宫内膜疾病诊断符合率为94.2%。另外,我们也比较了内膜癌与其他宫内膜良性病变的血流显示率及动脉阻力指数RI值有显著差异(P0.5)。结论:经阴道彩色多普勒超声检查患者无痛苦,且内膜结构显示清晰,为诊断子宫内膜疾病的首选方法。     

Diagnostic performance of sonohysterography and MRI diffusion in benign endometrial lesion characterization

Objectives

To assess pretreatment endometrial abnormalities in newly diagnosed, nontreated histologically documented breast cancer patients using sonohysterography and MRI diffusion.

MR扩散加权成像对宫腔良恶性病变的鉴别诊断价值

目的:初步探讨DWI检查时表观扩散系数(ADC)值对局限于宫腔的子宫内膜癌与常见宫腔良性病变的鉴别诊断价值.方法:对32例经手术病理证实为局限于宫腔的子宫内膜癌和19例经分段诊刮病理检查证实为宫腔的良性病变(内膜增生l2例、内膜息肉7例)的患者行常规MRI和DWI检查(b=1000s/mm2),经后处理获得ADC图,测...     

经阴道宫腔声学造影诊断子宫内膜息肉的价值

目的:探讨经阴道子宫腔造影技术(Transvaginal sonohysterography,SHG)诊断子宫内膜息肉的价值。材料和方法:对39例有异常阴道出血者行SHG检查,并将检查结果与经阴道超声(Transvaginal sonography,TVS)、诊断性刮宫或宫腔镜所获得的结果进行比较分析。结果:病理证实的子宫内膜息肉34例,粘膜下子宫肌瘤3例,子宫内膜增生1例。SHG诊断子宫内膜息肉32例,均可清晰地显示宫腔轮廓和病灶的形态,30例与内膜界限清楚,可见病灶附着部位,23例于结节内部或蒂部显示血流信号;TVS诊断子宫内膜息肉26例,均可见子宫内膜稍强回声结节,其中19例边界清楚,6例可见病灶附着部位;8例结节内部或蒂部显示血流。使用TVS34例均未显示宫腔的轮廓。本组子宫内膜病例在宫腔轮廓及病灶附着部位方面SHG和TVS的显示率分别为94.1%、88.2%和0%、17.6%。SHG明显优于TVS(P<0.001)。SHG诊断粘膜下子宫肌瘤3例,回声与基底部的子宫肌层相似,略低于子宫内膜,病灶基底部与子宫肌层无界限,表面可见内膜与造影剂构成的亮线,1例可见蒂部,CDFI显示2例内部血流丰富,1例见肌层血管穿入病灶。TVS诊断粘膜下子宫肌瘤2例,表现为为子宫内膜低回声结节,1例子宫内膜呈非均质改变,CDFI可见内部丰富的血流信号(SHG显示宫腔内为2枚粘膜下子宫肌瘤,已得到HSC证实)。结论:SHG能明显提高病变的显示率,对于子宫内膜息肉的术前诊断具有重要的临床价值。     

Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding

Transvaginal ultrasound with SIS is a cost-minimizing screening tool for perimenopausal and postmenopausal women with vaginal bleeding. Its use decreases the need for invasive diagnostic procedures for women without abnormalities, and ultrasound increases the sensitivity of detecting abnormalities in women with pathologic conditions. Vaginal sonography is preferred over uniform biopsy of postmenopausal women with vaginal bleeding because it (1) is a less invasive procedure, (2) is generally painless, (3) has no complications, and (4) may be more sensitive for detecting carcinoma than blind biopsy. Transvaginal sonography is rarely nondiagnostic. Endometrial sampling is less successful in women with a thin endometrial stripe on ultrasound than in women with real endometrial pathologic condition. A limitation of ultrasound is that an abnormal finding is not specific: ultrasound cannot always reliably distinguish between benign proliferation, hyperplasia, polyps, and cancer. Although ultrasound may not be able to distinguish between hyperplasia and malignancy, the next step in the clinical treatment requires tissue sampling. Because of the risk of progression of complex hyperplasia to carcinoma, patients with this finding may benefit from hormonal suppression, dilatation and curettage, endometrial ablation, or hysterectomy, depending on the clinical scenario. The inability to distinguish these two entities based on ultrasound alone should not be seen as a limitation because tissue sampling is required in either case. Occasionally (in 5% to 10% of cases), a woman's endometrium cannot be identified on ultrasound, and these women also need further evaluation. Ultrasonography also may be used as a first-line investigation in other populations with abnormal uterine bleeding. In a multicenter, randomized, controlled trial of 400 women with abnormal uterine bleeding, the investigators found that transvaginal sonography combined with Pipelle endometrial biopsy and outpatient hysteroscopy was as effective as inpatient hysteroscopy and curettage. The subject, included women older than 35 years with PMB, menorrhagia, intermenstrual bleeding, postcoital bleeding, or irregular menses. Transvaginal sonography may be a cost-effective. sensitive, and well-tolerated method to evaluate most women with abnormal bleeding in combination with physical examination and endometrial biopsy and hysteroscopy us indicated. Hysteroscopy is likely to become the new gold standard in the future because of its ability to visualize directly the endometrium and perform directed biopsies as indicated. As office-based hysteroscopy becomes more practical and widespread, the technique may become more cost effective. An evaluation plan using transvaginal sonography as the initial screening evaluation followed by endometrial biopsy or, more likely, hysteroscopy is likely to become the standard of care (Fig. 12). It remains unproven whether certain patients at higher risk for carcinoma should proceed directly to invasive evaluation. Women on tamoxifen with persistent recurrent bleeding, women with significant risk factors for carcinoma, and women with life-threatening hemorrhage comprise this group. Further studies are still necessary to evaluate high-risk patients and determine whether ultrasound or biopsy is really the most cost-effective initial test.     

经阴道超声及宫腔造影对鉴别子宫内膜息肉与其他病变的意义

目的分析子宫内膜病变的声像图和血流特征,并评价经阴道彩色多普勒超声宫腔造影对子宫内膜息肉的诊断价值。方法采用经阴道彩色多普勒加宫腔造影,分别对19例子宫内膜息肉和32例子宫内膜其他病变之声像图、彩色血流及频谱表现进行对比,全部病例经宫腔镜及手术后的病理证实。结果经阴道彩色多普勒超声检诊子宫内膜息肉,清晰显示了内膜与黏膜下肌层之界限和息肉的病变边界,还显示了息肉蒂基底的彩色血流或黏膜下肌瘤周边彩色血流环,适时加做宫腔造影则更有益于对细小病变的诊断。结论经阴道彩色多普勒超声加做宫腔造影可大大提高对子宫内膜息肉与子宫内膜其他病的鉴别诊断水平。