宫腔镜检查对子宫出血诊断方面的临床应用

1、宫腔镜检查对子宫出血诊断方面的临床应用【关键词】 宫腔镜检查摘 要：目的：了解子宫内部病变，提高诊断准确率。方法：对113例子宫异常出血患者行宫腔镜检查并针对检查结果作出相应治疗。结果：本组阳性率72.79%。绝经后子宫出血 6例中3例子宫内膜癌，非绝经期异常子宫出血94例中22例子宫内膜增生，10例黏膜下肌瘤或壁间内突型肌瘤，18例子宫内膜息肉，6例节育环异常，病理活检阳性69.85%。65例宫腔镜检查前行B超检查，23例异常（ 16.91%）；镜检异常45例（69.23%）。结论：宫腔镜检查直视宫腔, 有助于鉴别子宫内功能性或器质性病变，对可疑病灶在直视下取材活检，诊断准确率高，优于B型超

2、声检查。关键词：宫腔镜检查；病理检查；B型超声检查Clinical Application of Womb Endoscope Examination in Diagnosing Uterine BleedingAbstract: Objective: To study and analyze the pathological changes inside the womb in order to obtain higher diagnostic accuracy. We have examined 113 sufferers with abnormal or bleeding wombs b

3、y womb endoscope, and cure them respectively based on the examination results. It is proved that the masculine rate accounts for 72.79%. Three of the six cases which show the symptom of abnormal womb bleeding during the menopause are caused by womb internal membrane cancer. Among the 94 cases that i

4、ndicate abnormal womb bleeding during the non-menopause, 22 cases are caused by womb internal membrane hyperplasia, 10 by sinew tumor under the mucous membrane or inward -protrusive sinew tumor, 18 by polypus of the womb internal membrane, and six by abnormal conception control loop. The pathologica

5、l examination reveals that the masculine rate reaches 69.85%. There are 65 cases that went through Type B ultrasonic inspection before the endoscope examination, 23 of which indicate abnormity (16.91%). However, the abnormal cases found out during the endoscope examination amount to 45 (69.23%). The

6、 conclusion derived from our study is that the womb endoscope can examine the womb directly and conduce to find out the functional or organic diseases inside the womb. Therefore, to examine the alive cells directly with the help of womb endoscope is better than the Type B ultrasonic inspection for o

7、btaining higher diagnostic accuracy. Key words: Womb endoscope examination； Pathological examination； Type B ultrasonic inspection2003年1月至2003年10月我科对113例子宫异常出血患者行宫腔镜检查，现报道如下：1 资料与方法1.1 研究对象：本组年龄2070岁，均为门诊患者，已婚。2030岁20例，3140岁30例，4150岁43例，5160岁16例，6170岁4例。其中，绝经后出血6例，异常子宫出血94例，与妊娠有关子宫出血4例（流产或足月产后异常子宫出血

8、），节育环异常9例。1.2 方法：设备：（史赛克，美国） xg-3型宫腔镜，膨宫介质为5%葡萄糖，膨宫压力控制在150200mmHg，检查前作双合诊了解子宫位置大小，常规消毒外阴阴道，2%利多卡因作宫颈阻滞麻醉，用宫颈扩张器扩至6.5号，直视下将镜体朝宫腔方向推进，按顺序全面观察宫腔及宫颈管的形态，根据病变部位取组织活检，患者术后休息1h便可离院，术后常规给予抗生素预防感染。2 结 果2.1 113例宫腔镜诊断阳性率72.79%（99/113），并且宫腔镜检查与B型超声波对照：65例宫腔镜检查前行B超检查，异常者23例 （16.91 %）（23/113），镜检发现异常者45例。见表1。表1 1

9、13例宫腔镜检查及65例B超诊断结果略 2.2 除子宫畸型、子宫肌瘤、节育环异常等18例患者未作组织活检外，余95例患者均作病理活检，病理活检阳性率69.85 %（95/113）结果见表2。表2 95例活检诊断结果略3 讨 论 宫腔镜应用于妇科临床，具有其它器械不可替代的优点，它在直视下对宫腔病变一目了然，定点诊刮，准确率高1，本组阳性率达72.79%，病理检出率69.85%，镜检与病理检查具有高度一致性1。 子宫异常出血是子宫镜检首要适应征2，传统诊刮简单易行，但在非直视下操作容易遗漏较小病灶。本组在宫腔镜直视下了解宫腔内情况，直接鉴别子宫肌瘤与子宫内膜病变，定点诊刮，为临床提供可靠依据，具有较高的诊断价值。 B型超声检查是一种无痛苦的检查手段，但对发现宫腔内细微的病变有其局限性，本文B型超声发现异常与