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目的探讨经阴道超声检查(TVS)联合宫腔镜检查(HS)在绝经后宫腔积液病因诊断中的临床价值。方法回顾性分析2013年6月-2016年6月南京市妇幼保健院妇产科就诊的60例绝经后宫腔积液患者的临床资料,所有患者均接受TVS及HS,并在宫腔镜直视下采取可疑病变组织送病理检查,分析TVS及HS结果,并与病理结果进行对照分析。结果 TVS提示60例患者宫腔内存在液性暗区,均经HS证实为宫腔积液。TVS诊断子宫内膜病变的灵敏度、特异度、阳性预测值、阴性预测值分别为96.15%、50.00%、92.59%、66.67%。HS诊断子宫内膜病变的灵敏度、特异度、阳性预测值、阴性预测值分别为98.08%、75.00%、96.23%、85.71%。TVS+HS诊断子宫内膜病变的灵敏度、特异度、阳性预测值、阴性预测值分别为98.08%、87.50%、98.08%、87.50%。HS及TVS+HS的特异度及阴性预测值均显著高于TVS(均P<0.05),灵敏度及阳性预测值比较差异均无统计学意义(均P>0.05)。TVS+HS与HS的特异度比较差异有统计学意义(P<0.05),灵敏度、阳性预测值及阴性预测值比较差异均无统计学意义(均P>0.05)。结论 TVS可作为筛查宫腔积液病因的首选手段,配合HS能够明确病因,提高子宫内膜病变的早期诊断率。
Objective To investigate the clinical value of transvaginal ultrasonography (TVS) combined with hysteroscopy (HS) in the etiological diagnosis of post-menopausal uterine effusion. Methods The clinical data of 60 patients with postmenopausal women with uterine effusion treated in obstetrics and gynecology department of Nanjing Maternal and Child Health Hospital from June 2013 to June 2016 were retrospectively analyzed. All patients received TVS and HS and underwent hysteroscopy Take suspicious lesions under the organization sent to pathological examination, analysis of TVS and HS results, and pathological findings were analyzed. Results TVS prompted 60 patients with intrauterine fluid dark areas, confirmed by the HS uterine fluid. The sensitivity, specificity, positive predictive value and negative predictive value of TVS in diagnosing endometrial lesions were 96.15%, 50.00%, 92.59% and 66.67%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of HS in diagnosing endometriosis were 98.08%, 75.00%, 96.23% and 85.71% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of TVS + HS in diagnosing endometriosis were 98.08%, 87.50%, 98.08% and 87.50% respectively. The specificity and negative predictive value of HS and TVS + HS were significantly higher than those of TVS (all P <0.05). There was no significant difference between the sensitivity and positive predictive value (all P> 0.05). There were significant differences in the specificity of TVS + HS and HS (P <0.05), but there was no significant difference in sensitivity, positive predictive value and negative predictive value (all P> 0.05). Conclusion TVS can be used as the first choice of screening the etiology of uterine effusion. With HS, the etiology of uterine fluid can be clarified and the early diagnosis rate of uterine endometrial lesions can be improved.