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目的研究围绝经期及绝经后子宫出血(PMUB)患者宫腔镜病因诊断的临床意义。方法回顾性分析2012年8月至2014年8月收治的258例围绝经期及绝经后子宫出血患者的临床资料,均于超声下实施宫腔镜检查、诊刮、宫腔镜组织活检,依据诊刮病理、宫腔镜检查结果评价围绝经期及绝经后子宫出血病因诊断中的特异性、敏感性及预测值。结果 258例PMUB患者中非器质性病变36例(13.95%),恶性病变32例(12.40%)。良性病变190例(73.64%),良性病变中子宫内膜息肉70例(27.13%),子宫黏膜下肌瘤12例(4.65%),子宫内膜增生26例(10.08%)。宫腔镜检查对子宫内膜癌和子宫内膜息肉诊断的敏感性较高,对子宫内膜增生诊断敏感性最低,对黏膜下肌瘤诊断的特异性最高,内膜息肉诊断的特异性最低。诊刮对子宫内膜息肉、黏膜下肌瘤、内膜增生、子宫内膜癌诊断的特异均性高,敏感性低,对子宫内膜增生诊断的阳性预测值最低。宫腔镜对PMUB诊断的总体敏感性、特异性、阳性预测值及阴性预测值均优于诊刮,差异有统计学意义(P均<0.01)。结论宫腔镜检查对PMUB患者具有较高的诊断敏感性及阴性预测值,并对子宫内膜癌和癌前病变进行准确诊断。
Objective To study the clinical significance of hysteroscopic diagnosis of perimenopausal and postmenopausal uterine bleeding (PMUB). Methods The clinical data of 258 patients with perimenopausal and postmenopausal uterine bleeding admitted to our hospital from August 2012 to August 2014 were retrospectively analyzed. Hysteroscopy, curettage and hysteroscopic biopsy were performed under ultrasound Curettage pathology, hysteroscopy examination evaluation of perimenopausal and postmenopausal uterine bleeding etiology in the diagnosis of specificity, sensitivity and predictive value. Results Among 258 patients with PMUB, 36 were non-organic lesions (13.95%) and 32 were malignant lesions (12.40%). There were 190 cases of benign lesions (73.64%), 70 cases of endometrial polyps (27.13%), 12 cases of uterine fibroids (4.65%) and 26 cases of endometrial hyperplasia (10.08%). Hysteroscopy in the diagnosis of endometrial cancer and endometrial polyps higher sensitivity of the diagnosis of endometrial hyperplasia the lowest sensitivity of submucosal fibroids diagnosis of the highest specificity of the diagnosis of endometrial polyps the lowest . Diagnosis of endometrial polyps, submucosal fibroids, endometrial hyperplasia, endometrial cancer diagnosis of specific average high sensitivity low, the lowest positive predictive value for the diagnosis of endometrial hyperplasia. The overall sensitivity, specificity, positive predictive value and negative predictive value of hysteroscopy in the diagnosis of PMUB are better than those of curettage (P <0.01). Conclusion Hysteroscopy has high diagnostic sensitivity and negative predictive value for PMUB patients, and accurate diagnosis of endometrial cancer and precancerous lesions.