宫腔镜诊治绝经后出血的临床应用

目的探讨宫腔镜检查在诊治绝经后子宫出血的作用。方法回顾分析159例行宫腔镜检查的绝经后子宫出血患者，总结镜下所见，进行临床与病症分析。结果子宫内膜正常105例，异常35例，其中有高危因素的30例病人中有不典型增生者6例，子宫内膜癌的7例，其中有5例子宫内膜厚度小于5mm，病理为子宫内膜癌。结论宫腔镜检查是诊断绝经后子宫出血的最准确可靠的方法。     

超声和宫腔镜检查在219例绝经后子宫出血中的诊断价值

目的探讨宫腔镜及B超检查在绝经后子宫出血病因中的诊断价值。方法对我院2001年8月至2011年8月219例绝经后子宫出血妇女的临床资料及宫腔镜检查的病理结果进行回顾性分析。结果以病理诊断为基础,宫腔镜诊断子宫内膜增生症、子宫内膜炎、子宫粘膜下肌瘤、子宫内膜息肉、子宫内膜癌与病理诊断的符合率分别为60.8%（48/79）、91.9%（34/37）、90.9%（20/22）、93.1%（27/29）、80.0%（20/25）,超声检查的符合率分别为48.1%（38/79）、35.1%（13/37）、59.1%（13/22）、65.5%（19/29）、44.0%（11/25）。宫腔镜诊断与病理诊断的符合率为78.1%（171/219）,明显高于超声诊断与病理诊断的符合率48.9%（107/219）（χ2=40.334,P=0.01）。结论绝经后子宫出血的患者最佳诊断方法是,先做超声检查了解子宫及盆腔情况,再宫腔镜检查后行分段诊刮术做组织病理学检查确诊。     

绝经后阴道出血的病因探究

目的 探讨妇女绝经后阴道出血的原因,以便更好的指导临床工作.方法 回顾性分析430例绝经后阴道出血患者的临床和病理资料.结果 因炎症引起的绝经后阴道出血287例(66.74%),因非器质性疾病引起的出血98例(22.79%),因恶性肿瘤引起的出血45例(10.47%),其中以子宫内膜癌发生率最高.绝经时间越长,恶性肿瘤的发生率越高.结论 炎症性疾病是引起绝经后出血的主要原因,绝经的时间越长,恶性肿瘤的发病率越高.对绝经后阴道出血的患者要应用常规妇科检查和必要的辅助检查以明确病因,早期治疗.     

经阴道超声对绝经后子宫异常出血疾病的诊断

目的 评价经阴道彩色多普勒超声(TVS)对绝经后子宫异常出血妇女子宫内膜疾病的诊断价值,及对子宫内膜恶性病变肌层侵润的估测.方法 对102例绝经后子宫出血妇女进行阴道超声检查,观察其内膜厚度,内膜回声,内部回声状态及血流情况. 结果 TVS测量内膜呈线样或厚度<5mm者可以不做诊断性刮宫,定期观察.内膜异常增厚,分布不均匀者进行临床诊刮,并判断是否向肌层侵润.结论 TVS可作为绝经后子宫出血患者的首选检查方法.     

阴道B超对绝经后阴道出血原因分析

对绝经后妇女以不明原因的阴道出血而就诊者 ,以往常以诊断性刮宫作为子宫内膜病变的主要诊断手段。我们对该类患者行阴道B超检测子宫内膜厚度和形态学改变、子宫内膜动脉血流动力学变化 ,结合临床诊断性刮宫术和子宫内膜病理检查 ,对出血原因进行分析并做出诊断。总结如下。1　资料与方法1.1　临床资料收集我院自 2 0 0 1年 6月～ 2 0 0 2年 4月门诊及住院绝经后阴道出血患者 4 5例 ,年龄 4 5岁～ 70岁 ,平均 5 2岁 ,其中大于 5 0岁者 34例 ,绝经时间 1a～2 4a。 4 1例表现为阴道不规则少量出血 ,4例表现为白带带血或接触性出血。1.2　方…     

阴道超声与宫腔镜在诊断围绝经期子宫异常出血中的应用

目的探讨阴道超声和宫腔镜检查诊断围绝经期子宫异常出血的临床应用价值。方法收集患者180例,以病理检查结果作为＂金标准＂,比较阴道超声和宫腔镜检查的灵敏度及阳性预测的价值。结果在子宫内膜过度增生、子宫内膜癌、未见明显占位性病变（正常子宫内膜、子宫内膜炎、萎缩性子宫内膜）的诊断中,阴道超声检查的灵敏度分别为77.3%、57.1%、82.2%,宫腔镜检查的灵敏度分别为97.7%、92.9%、95.6%,两组之间的差异有统计学意义（P〈0.05）。在子宫内膜息肉、子宫内膜过度增生的诊断中,阴道超声检查的阳性预测价值为79.7%和75.6%,宫腔镜检查的阳性预测价值为96.2%和93.5%,两组之间的差异有统计学意义（P〈0.05）。结论阴道超声可以作为围绝经期妇女临床筛检的常规方法 ,宫腔镜检查可以作为在阴道超声发现宫腔异常情况或不能明确时进一步检查的重要手段。     

绝经后阴道出血217例分析

目的对2000～2006年我科诊治的217例PMB患者进行病因及病理分析,探讨PMB的产生原因及规律。方法217患者均通过活检、诊断性刮宫（部分为宫腔镜下定位活检）、手术取得标本,再经常规石蜡切片HE染色行病理检查,部分行特殊染色。结果病因与恶性肿瘤、良性疾病和非器质性疾病有关;随着绝经时间的延长,恶性肿瘤发生的危险性增大;出血时间功能性和恶性肿瘤有明显差异。结论绝经后阴道出血的病因复杂,以良性病变较常见,多发。但随着绝经年限延长,恶性肿瘤的发病率也随之增加,且绝经5年以后患者更应提高警惕。因此,绝经后阴道出血仍是一个危险信号。妇女绝经后一旦出现阴道出血,不管血量多少,均应及时检查,明确诊断,积极治疗良性病变与非器质性病变,防止癌变。     

200例绝经后妇女阴道出血原因分析

目的探讨妇女绝经后阴道出血的病因、病理及诊断方法。方法回顾性分析了200例绝经后妇女阴道出血的临床及病理资料。结果妇女绝经后阴道出血的主要原因依次为老年性阴道炎、功能失调性子宫出血、恶性肿瘤、宫内节育器。结论妇女绝经后阴道出血绝大部分是由良性病变、非器质性病变引起,但仍要高度重视恶性肿瘤的发生,绝经时间越长,恶性肿瘤发病率越高。     

阴道超声联合宫腔镜对子宫内膜息肉的诊断分析

目的:分析阴道超声联合宫腔镜对子宫内膜息肉的诊断价值.方法:回顾性分析2018年1月至2020年7月德兴市中医院超声科接收的146例子宫内膜病变患者的临床资料,以子宫内膜活检为"金标准",比较阴道超声、宫腔镜以及联合检查诊断子宫内膜息肉的准确度差异,并统计检查过程中患者出现的不良反应.结果:经子宫内膜活检80例患者确诊为子宫内膜息肉.阴道超声诊断子宫内膜息肉的敏感度为78.75％,特异度为87.88％,准确度为82.87％.宫腔镜检查诊断子宫内膜息肉的敏感度为90.00％,特异度为93.94％,准确度为91.78％.联合检查诊断子宫内膜息肉的敏感度为97.50％,特异度为98.48％,准确度为97.94％.阴道超声不良反应发生率明显低于宫腔镜检查和联合检查(P<0.05).结论:阴道超声联合宫腔镜能应用于子宫内膜息肉的早期诊断,具有较高临床诊断价值.     

Cost-effectiveness of the use of transvaginal sonography in the evaluation of postmenopausal bleeding

Objectives: To assess the cost-effectiveness of transvaginal sonography (TVS) in the diagnostic work-up of women with postmenopausal bleeding. Methods: We performed a decision analysis in which we estimated life expectancy and cost of four strategies for the evaluation of postmenopausal bleeding: TVS (I), TVS and office endometrial biopsy (II), TVS and hysteroscopy (III), and endometrial biopsy (IV). In strategies incorporating TVS, calculations were performed for three different cut-off values between 3 and 9 mm double layer. Expectant management, i.e. no diagnosis or treatment was considered to be the reference strategy to which the other four strategies were compared. Data were obtained from the published literature. In extensive sensitivity analyses, we varied patient's age, discount rate, prevalence of endometrial carcinoma and atypical hyperplasia, and costs. Results: The strategy with endometrial biopsy and the strategy with TVS followed by endometrial biopsy in case of an increased endometrial thickness were the most cost-effective strategies. The strategy starting with endometrial biopsy was the most cost-effective when the prevalence of endometrial carcinoma was ≥15.3%, whereas the strategy with TVS and endometrial biopsy was the most cost-effective for women in which the prevalence of endometrial carcinoma was lower. In these strategies, a cut-off level for abnormality of 9 mm resulted in lowest cost per life-year gained. Conclusions: TVS is of use in women with postmenopausal bleeding and a probability of endometrial carcinoma below 15%.     

超声监测联合宫腔镜诊断不孕患者子宫内膜异常的价值

目的探讨阴道超声和宫腔镜检查对不孕患者子宫内膜病变的诊断价值。方法对在我中心不孕门诊进行阴道超声、宫腔镜检查的152例患者分为两组进行对照分析。自然周期超声监测内膜回声异常的105例为研究组,超声监测内膜正常的47例为对照组。结果研究组宫腔镜检查确诊内膜病变为84例（80.00%）,对照组为4例（8.51%）,两组比较差异有非常显著性意义（P〈0.001）。研究组中,子宫内膜息肉占30.48%（32/105）,内膜增殖36.19%（38/105）,粘膜下肌瘤0.95%（1/105）,输卵管阻塞8.57%（9/105）,内膜炎症3.81%（4/105）;对照组异常内膜为内膜粘连4.25%（2/47）,内膜炎症4.25%（2/47）。以宫腔镜结果为金标准,经阴道超声监测对子宫内膜病变诊断的敏感度95.45%（84/88）,特异度67.19%（43/64）。研究组确诊内膜异常者84例,妊娠率46.43%（39/84）,对照组确诊为内膜正常者43例,妊娠率74.41%（32/43）,两组比较差异有显著意义（P〈0.05）。结论阴道超声是诊断不孕症患者宫腔内病变的一种简便、廉价、无创伤、诊断率高的方法,可以作为不孕患者宫腔镜检查的初筛,而宫腔镜检查则为内膜病变提供准确的诊断。     

Uterine findings by transvaginal sonography during percutaneous estrogen treatment in postmenopausal women

Objectives: To evaluate the effect of hormone replacement treatment (HRT) with percutaneous estradiol and cyclical peroral medroxyprogesterone acetate (MPA) every month or every third month on the uterus and endometrium of postmenopausal women. Methods: Uterine size and endometrial thickness were measured by transvaginal sonography in 159 postmenopausal women before HRT, and after 6 and 12 months on HRT during 9–12 days of the MPA administration periods. Results: During HRT, uterine size and endometrial thickness increased. The percentage increase in uterine diameter varied between 3.8% and 19.6%, and endometrial thickness varied between 28.7% and 76.4%, being greater in the group receiving MPA every third month than in the groups receiving MPA every month. Myomas grew during the first 6 months on HRT but increased no further during the next 6 months on HRT. Conclusions: The increases in uterine size, myomas and endometrial thickness during HRT were moderate and not problematic and occurred mainly during the first 6 months on HRT.     

Diagnostic evaluation of the endometrium in postmenopausal bleeding: an evidence-based approach

Postmenopausal bleeding (PMB) is a common complaint in general gynecological practice. Women with PMB have around a 10% chance of having endometrial carcinoma and therefore PMB always needs further evaluation. This article summarizes the reviews on the subject and provides an overview of the use of diagnostic tools in patients with PMB. Four types of diagnostic test are described: sonographic measurement of endometrial thickness, endometrial sampling, hysteroscopy and saline infusion sonography. All four have been independently shown to be accurate in excluding endometrial cancer. However, neither in systematic reviews nor in international guidelines is consensus found regarding the sequence in which these methods should be employed in women with PMB. For measurement of endometrial thickness in symptomatic women, a cut-off value of 3mm is recommended, but the cost-effectiveness of this strategy has yet to be shown. Research should now focus on the incorporation of individual patient characteristics and pre-test probabilities for cancer in algorithms for the investigation of PMB, and the most cost-effective sequenced combination of the four types of test.     

经阴道与经腹部超声检查早期诊断宫颈机能不全的对照分析

目的探讨经阴道超声检查在早期诊断宫颈机能不全中的应用价值.方法对同一组(108例)习惯性流产的孕妇于中孕时分别应用经阴道与经腹部超声进行检查,并做对照分析.结果经阴道超声检查对宫颈的显示率和对宫颈机能不全的早期诊断率明显高于经腹超声检查.结论经阴道超声检查是早期诊断宫颈机能不全的一种安全、准确的方法.     

Transvaginal sonography and hysteroscopy in postmenopausal uterine bleeding

OBJECTIVE: To compare the diagnostic accuracy of transvaginal ultrasound and hysteroscopy in the detection of endometrial pathologies in women with postmenopausal bleeding not using hormonal replacement therapy (HRT). METHODS: Between January 1997 and April 1998, 106 postmenopausal women with uterine bleeding not using HRT underwent a diagnostic work-up including pelvic examination, transvaginal ultrasound, hysteroscopy and endometrial biopsy. Sonographic measurement of endometrial thickness and hysteroscopic findings were compared with histological results. The 'classification tree' method was used to identify cut-off values of sonographic endometrial thickness that could be indicative of a class of uterine pathology. Statistical analysis was performed with the McNemar test. RESULTS: No case of endometrial cancer was found with a cut-off point of 5 mm of endometrial thickness evaluated by ultrasound, whereas all patients with endometrial thickness > or = 15 mm at sonography had an endometrial carcinoma. In the group of patients with endometrial thickness between 6 and 14 mm, we found normal atrophic endometria, benign and malignant pathology. On the other hand, the McNemar test showed a very good correspondence between hysteroscopy and histology (sensitivity 97.5% and specificity 100%), confirming its usefulness in diagnosis of postmenopausal uterine bleeding. CONCLUSIONS: Transvaginal ultrasound has revealed some limitations, mainly in the group of patients with endometrial thickness between 6 and 14 mm. The absence of endometrial malignancy in women with endometrial thickness < or = 5 mm and the high possibility of cancer in those with endometrial thickness > or = 15 mm should be confirmed in larger series. Hysteroscopy proved to be a simple and safe outpatient procedure with a high diagnostic accuracy, and in our opinion it should be considered in all women with postmenopausal uterine bleeding.     

Diagnostic accuracy of hysteroscopy in endometrial hyperplasia

Objectives: To determine the diagnostic accuracy of hysteroscopy in the diagnosis of endometrial hyperplasia in women with abnormal uterine bleeding. Methods: From 1993 through 1995, 980 women referred to our institution for abnormal uterine bleeding underwent diagnostic hysteroscopy with eye direct biopsy of the endometrium in case of macroscopic abnormalities. Hysteroscopic features were compared with pathologic findings in order to detect the reliability of the endoscopic procedure. Statistical analysis was performed with the McNemar test. Results: Positive predictive value of hysteroscopy in the diagnosis of endometrial hyperplasia accounted for 63%. In fact hysteroscopic diagnosis of endometrial hyperplasia was confirmed at pathologic examination in 81 out of 128 patients. Sensitivity and specificity of the endoscopic procedure accounted for 98% and 95%, respectively. Negative predictive value accounted for 99%, as only two cases of atypical hyperplasia were missed at hysteroscopy. Positive predictive value was higher in postmenopausal patients compared to women in the fertile age (72 vs. 58%). Conclusions: Overall, results appear encouraging, since no case of endometrial hyperplasia was missed by hysteroscopy. The high diagnostic accuracy, associated with a minimal trauma, renders hysteroscopy the ideal procedure for both diagnosis and follow-up of conservative management of endometrial hyperplasia.     

Oral dexketoprofen for pain treatment during diagnostic hysteroscopy in postmenopausal women

Objective: To assess the efficacy of dexketoprofen (DEX) in reducing pain at different stages of the hysteroscopic procedure in comparison with local anaesthesia in menopausal women. Methods: Menopausal patients affected by uterine bleeding submitted to diagnostic hysteroscopy, were randomised to receive either 25 mg DEX tablet (n=148) or intracervical injection of 5 ml mepivacaine 2% (n=150). Pain suffered during the procedure itself and 30, 60, 120 min after, was scored on the 11 point Visual Analogic Scale, recorded and analysed. Results: No statistical difference were noted during the procedure itself in both groups of treatment. Patients treated with DEX has significantly less postoperative pain. Conclusions: DEX is not superior to mepivacaine in reducing the discomfort of the procedure but does significantly reduce postoperative pain.     

Clinical usefulness of endometrial screening by ultrasound in asymptomatic postmenopausal women

Objective: The aim of the present study was to evaluate the clinical usefulness of routine use of endometrial ultrasound in asymptomatic, bleeding-free postmenopausal women. Methods: We retrospectively reviewed the data of 850 postmenopausal women subjected to hysteroscopy, focusing our attention on those cases (148) with an ultrasound indication of endometrial thickening. Results: In 850 postmenopausal women, we identified 27 (3.2%) endometrial adenocarcinomas. In these subjects, the indication for office hysteroscopy was abnormal uterine bleeding in 24 (24/27; 88.9%) cases; pathological pap smear with abnormal endometrial cells in 2 (2/27; 7.4%) cases and thickened endometrium upon transvaginal ultrasound (tvUS) only in one (1/27; 3.7%) patient. On the other hand, 148 hysteroscopies were performed on the basis of the tvUS indication in otherwise asymptomatic (bleeding free) postmenopausal women; only 1(0.7%) of these presented an adenocarcinoma. Conclusion: Our findings show that the use of tvUS as a screening tool for endometrial pathology in asymptomatic postmenopausal women generates 93.2% false positive results, so that most of these women undergo this second level invasive procedure uselessly. Our data suggest that, in asymptomatic postmenopausal women, endometrial ultrasound evaluation is not worthwhile as a screening tool, such as it is considered in common clinical practice. The present results call for a larger prospective trial to further elucidate this controversial issue.