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目的:评价宫腔镜对宫腔内病变的诊断价值。方法:对2006年5月～2007年6月期间因不同病因行宫腔镜检查的675例患者的临床资料进行回顾性分析。将患者分成绝经前组和绝经后组。分析两组宫腔内病变的结果差异,并将术中宫腔镜诊断与术后病理诊断或术前临床诊断进行对比分析。结果:①宫腔镜检查诊断子宫黏膜下肌瘤、子宫内膜癌的准确率在两组患者中均较高,达94.8%～99.2%,阴性预测值均大于96.0%;诊断宫腔粘连、子宫纵隔、环嵌顿的敏感度和准确率均为100.0%;在诊断子宫内膜息肉方面,两组的敏感度均较高,大于95.0%,但准确率有差异,绝经前组为79.1%,绝经后组为95.6%,绝经后组明显高于绝经前组(P<0.05)。②两组中子宫内膜癌的发病率不同,绝经前组为0.8%,绝经后组为8.2%,绝经后组明显高于绝经前组(P<0.05)。③两组子宫内膜癌的癌变类型不同,绝经前组4例中仅1例为子宫内膜样腺癌,其他3例分别为子宫内膜间质肉瘤、子宫内膜局限性低分化癌和子宫内膜透明细胞癌,而绝经后组以子宫内膜样腺癌为主,高达12例,与绝经前组相比较有统计学差异(P<0.05)。结论:宫腔镜检查在诊断和鉴别诊断宫腔内病变方面有很高的准确率,可以作为宫腔内病变首选的诊断方法。
Objective: To evaluate the diagnostic value of hysteroscopy in intrauterine lesions. Methods: The clinical data of 675 patients undergoing hysteroscopy for different etiology from May 2006 to June 2007 were analyzed retrospectively. Patients were divided into premenopausal and postmenopausal groups. Analysis of the difference between the two groups of intrauterine lesions, and intraoperative hysteroscopic diagnosis and postoperative pathological diagnosis or preoperative clinical diagnosis comparative analysis. Results: ①The accuracy of hysteroscopy in diagnosing uterine submucous myoma and endometrial carcinoma was higher in both groups (94.8% -99.2%), the negative predictive value was higher than 96.0%. Diagnosis of intrauterine adhesions, Sensitivity and accuracy of uterine mediastinum and ring incarceration were 100.0%; in the diagnosis of endometrial polyps, the sensitivity of both groups were higher than 95.0%, but the accuracy rate was different, pre-menopausal group was 79.1% , Postmenopausal group was 95.6%, postmenopausal group was significantly higher than premenopausal group (P <0.05). ② The incidence of endometrial cancer was different between the two groups, premenopausal group 0.8%, postmenopausal group 8.2%, postmenopausal group was significantly higher than the premenopausal group (P lt; 0.05). ③ The two groups of endometrial cancer of different types of cancer, premenopausal group of 4 cases, only 1 case of endometrial adenocarcinoma, the other 3 cases were endometrial stromal sarcoma, endometrial localized poorly differentiated carcinoma and Endometrial clear cell carcinoma, while the postmenopausal group to endometrioid adenocarcinoma, up to 12 cases, compared with the premenopausal group was statistically significant (P <0.05). Conclusion: Hysteroscopy in the diagnosis and differential diagnosis of intrauterine lesions have a high accuracy, can be used as the preferred method of diagnosis of intrauterine lesions.