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目的:探讨超声下诊断性刮宫与宫腔镜检查对绝经后子宫出血的诊断价值。方法:绝经后子宫出血患者216例随机分为A、B 2组,每组108例。A组超声引导下行分段诊断性刮宫,刮出的颈管和宫内组织行病理检查。B组行宫腔镜检查,根据镜下所见刮取子宫内膜送检,占位病变取活组织或直接手术摘除病灶行病理检查。比较2组诊断结果。结果:A组74例(68.5%)取出送检组织,B组104例(96.3%)取出送检组织,2组比较差异有统计学意义(P<0.05)。A组未取出送检组织34例(31.5%),于诊断性刮宫术后14 d内行宫腔镜检查,病例明确诊断。A组诊断性刮宫后子宫仍出血者19例(17.6%),于诊断性刮宫术后14 d内行宫腔镜检查,4例与诊断性刮宫送检结果不一致,其中子宫内膜不典型增生1例,宫腔镜病理诊断为子宫内膜癌;子宫内膜炎症2例,宫腔镜病理诊断为子宫内膜息肉;未见异常1例,宫腔镜病理诊断为黏膜下肌瘤。结论:宫腔镜可直视观察子宫内膜及宫内占位病变,定位活检,取材成功率高,安全可靠,可作为绝经后子宫出血首选检查方法。
Objective: To investigate the diagnostic value of diagnostic curettage and hysteroscopy in postmenopausal uterine bleeding under ultrasound. Methods: 216 cases of postmenopausal uterine bleeding were randomly divided into A, B 2 group, 108 cases in each group. A group of ultrasound-guided sub-segment diagnostic curettage, scraping the neck and intrauterine tissue pathology. Group B hysteroscopy, according to the endoscopic screening to see the endometrial examination, lesions take live tissue or direct surgical removal of pathological examination. Compare two groups of diagnosis results. Results: Totally 74 cases (68.5%) in group A were taken out of the test group, and 104 cases (96.3%) in group B were taken out of the test group. The difference between the two groups was statistically significant (P <0.05). In group A, 34 cases (31.5%) were not removed from the test group, and hysteroscopy was performed within 14 days after the diagnosis of curettage. The cases were definitely diagnosed. In group A, 19 cases (17.6%) had uterine hemorrhage after diagnostic curettage, hysteroscopy was performed within 14 days after diagnostic curettage, 4 cases were inconsistent with diagnostic curettage results, of which endometrial dysplasia 1 Cases, hysteroscopy pathological diagnosis of endometrial cancer; endometrial inflammation in 2 cases, hysteroscopy pathological diagnosis of endometrial polyps; no abnormalities in 1 case, hysteroscopic diagnosis of submucosal fibroids. Conclusion: Hysteroscopy can directly observe the endometrium and intrauterine lesions, positioning biopsy, drawing high success rate, safe and reliable, can be used as the preferred screening method for postmenopausal uterine bleeding.