宫腔镜联合B 超诊断异常子宫出血124 例临床分析

目的:探讨宫腔镜联合B超在诊治异常子宫出血的临床价值。方法:对124例异常子宫出血的病例进行回顾性分析,所有患者作B超及宫腔镜检查,宫腔内切除物或刮出物均送病理检查。结果:124例患者经病理检查确诊为子宫内膜息肉84例(67.7%),合并宫颈息肉10例;子宫内膜增生症16例(12.9%),其中单纯性增生12例,复杂性增生4例;子宫内膜不典型增生1例(0.8%);子宫粘膜下肌瘤12例(9.7%);子宫内膜样腺癌6例(4.8%);子宫内膜炎3例(2.4%);胚物残留2例(1.6%)。结论:宫腔镜联合B超检查是诊断异常子宫出血最好的方法。     

阴道超声与宫腔镜诊断对围绝经期女性异常子宫出血病因的研究对比

目的:研究阴道超声与宫腔镜诊断对围绝经期女性异常子宫出血(Abnormal uterine bleeding,AUB)病因的对比。方法:从2012年3月到2013年3月,我院共有123例围绝经期AUB患者需行手术治疗。全部患者均于术前实施阴道超声检查及宫腔镜检查,分别归入阴道超声组及宫腔镜组,并于术后常规实施病理确诊,并将所得结果作为金标准分别对比。结果:根据术后的病理检查,最终确定患者子宫内膜为正常者4例,内膜增生44例,内膜息肉29例,黏膜下肌瘤26例,内膜癌20例。宫腔镜组在内膜增生及内膜息肉方面的诊断结果与病理检查结果最为接近,诊断结果显著优于阴道超声组,差异均有统计学意义(均P0.05)。但两组在正常内膜、黏膜下肌瘤以及内膜癌等方面的诊断结果对比,差异均无统计学意义(均P0.05)。宫腔镜组与病理检查的符合率在黏膜下肌瘤及内膜癌方面较阴道超声组与病理检查结果的符合率更高,但差异无统计学意义(P0.05)。尤其是关于内膜增生和内膜息肉的符合率,宫腔镜组显著高于阴道超声组,差异有统计学意义(均P0.05)。结论:宫腔镜诊断方案对于围绝经期女性AUB患者的诊断结果更接近于病理结果,但临床在一定条件可与阴道超声联用,以期进一步提升诊断符合率。值得临床推荐。     

经阴道彩色多普勒超声在成人异常子宫出血中的应用价值

目的探讨经阴道彩色多普勒超声在成人异常子宫出血(AUB)中的应用价值。方法选择2010年6月~2013年10月因不规则阴道流血、经期出血量过多或月经后出血到我院就诊行经阴道超声检查的患者300例,对发现异常的187例患者进行分析总结。结果子宫内膜增生72例,子宫内膜息肉25例,宫颈管息肉9例,黏膜下肌瘤34例,子宫内膜癌5例,子宫瘢痕憩室13例,子宫腺肌症23例,宫内节育器异常6例。经阴道彩色多普勒超声在成人异常子宫出血中诊断宫腔内病变与病理诊断符合率达70.71%。结论经阴道彩色多普勒超声检查,对成人AUB具有较高的诊断率和实用价值。     

宫腔镜联合腹腔镜在女性不孕症诊治中的应用

目的：探讨宫腔镜联合腹腔镜在女性不孕诊断及治疗中的临床应用价值。方法：回顾性分析60例我院收治的采用宫腔镜联合腹腔镜进行诊断和治疗的女性不孕症患者为研究对象,对其临床资料进行分析。结果：宫腔镜联合腹腔镜检查发现,60例不孕症患者中,56．7％的患者患有慢性盆腔炎,16．7％的患者为子宫内膜异位症,11．7％的患者为多囊卵巢综合征;单纯腹腔镜检查的阳性检出率为60．0％,单纯宫腔镜检查的阳性检出率为28．3％,宫腔镜联合腹腔镜检查的阳性检出率高达91．7％,宫腔镜联合腹腔镜镜栓阳性发现率明显高于前二者（P〈0．05）。治疗前,双侧不通、一侧通畅和双侧输卵管通畅的患者分别为38．3％、48．3％和13．3％,经宫腔镜联合腹腔镜治疗后分别为11．7％、50．o％和38．3％,差异均有统计学意义（P〈0．05）。34例原发性不孕患者,术后13例妊娠,妊娠率38．2％;26例继发性不孕患者,术后15例妊娠,妊娠率57．7％;总妊娠率为46．7％,其中宫外孕2例。结论：宫腔镜联合腹腔镜检查可帮助明确女性不孕症患者明确原因及发病部位,并可针对病因进行治疗,提高女性不孕症的病因诊断准确率及治愈率。     

基质金属蛋白质酶12在子宫内膜癌中的表达及其意义

目的通过研究基质金属蛋白质酶12（MMP-12）在子宫内膜癌中的表达,探讨其与子宫内膜癌浸润转移的关系。方法应用链霉菌抗生物素蛋白——过氧化物酶免疫组织化学方法（S—P法）和蛋白质印迹（Western—blot）对42例子宫内膜腺癌、12例子宫内膜不典型增生及12例正常子宫内膜组织中的MMP-12的表达进行检测,并分析其与子宫内膜癌临床病理特征之间的关系。结果MMP-12蛋白主要表达于子宫内膜癌细胞胞浆中,在问质中有少量表达。MMP-12在子宫内膜癌、子宫内膜不典型增生的阳性表达率与正常子宫内膜相比差异有显著性（P〈0．05）,但子宫内膜癌与子宫内膜不典型增生中的MMP-12阳性表达率之问差异无显著性（P〉0．05）。MMP-12在子宫内膜癌细胞中病理分级为G3、G2强阳性率分别为80．00％及57．14％,均高于G1者的（17．39％）（P〉0．05）;不同肌层浸润深度（〈1／2、≥1／2）者的强阳性率分别为42．86％及53．85％,均高于无肌层浸润者的0％（P〈0．05）;有淋巴结转移者高于无淋巴结者（P〈0．05）;手术病理分期Ⅰ、Ⅱ、Ⅲ期者的强阳性率分别为24．14％、57．14％及83．34％,随着手术病理分期的升高,MMP-12表达强阳性率之间差异有显著性（P〈0．05）。结论MMP-12在子宫内膜癌中的表达随着病理分级的升高、肌层浸润程度的加深以及手术病理分期的升高而增强。     

宫腔镜辅助下分段诊刮术与单纯分段诊刮术诊断子宫内膜癌的比较研究

目的：探讨宫腔镜辅助下分段诊刮术在子宫内膜癌术前诊断中的意义。方法：回顾性分析140例术前诊断为子宫内膜癌患者的临床资料,分析术前临床分期、手术-病理分期、术后病理诊断、腹水细胞学检查等。结果：1．宫腔镜辅助下子宫内膜活检术组（组1）62例手术前后病理诊断符合率98．4％,单纯分段诊刮术组（组2）78例手术前后病理诊断符合率87,2％,两组比较差异有统计学意义;2．组1和组2手术前后分期诊断符合率比较,差异有统计学意义;3,组1和组2腹水或腹腔冲洗液细胞学检查阳性率分别为4.8％和5.1％,两组比较,差异无统计学意义。结论：宫腔镜辅助下分段诊刮术诊断子宫内膜癌安全、可靠,优于单纯分段诊刮术,值得临床推广应用。     

宫腔镜电切术联合左炔孕酮宫内节育系统对子宫内膜息肉患者性激素、炎症因子及复发的影响

摘要 目的：探讨宫腔镜电切术联合左炔孕酮宫内节育系统（LNG-IUS）对子宫内膜息肉患者炎症因子、性激素及复发的影响。方法：选取2016年4月到2018年4月期间我院收治的98例子宫内膜息肉患者,分为对照组与联合组,各49例。对照组予以宫腔镜电切术治疗,联合组予以宫腔镜电切术联合LNG-IUS治疗,比较两组性激素、炎症因子及复发情况,记录两组不良反应发生情况,观察两组月经周期、月经量、子宫内膜厚度。结果：术后6个月,两组月经周期、月经量、子宫内膜厚度均较术前降低,且联合组低于对照组（P<0.05）。两组术前、术后6个月卵泡生成激素（FSH）、黄体生成激素（LH）、雌二醇（E2）比较无显著性差异（P>0.05）。术后6个月,两组白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）均较术前降低,且联合组低于对照组（P<0.05）,白介素-4（IL-4）升高,且联合组高于对照组（P<0.05）。两组不良反应发生率对比未见显著性差异（P>0.05）。联合组复发率低于对照组（P<0.05）。结论：宫腔镜电切术联合LNG-IUS治疗子宫内膜息肉患者,可有效阻止息肉生长,降低复发率,对性激素水平影响较小,其作用机制可能与抑制炎症反应有关。     

宫腔镜下电切术与刮宫术治疗子宫内膜息肉合并不孕症的疗效比较及术后妊娠的影响因素分析

摘要 目的：比较宫腔镜下电切术与宫腔镜下刮宫术治疗子宫内膜息肉合并不孕症的疗效,并分析术后妊娠的影响因素。方法：选取2018年10月～2020年9月我院收治的318例子宫内膜息肉合并不孕症患者,其中接受宫腔镜下电切术治疗的159例归为电切术组,接受宫腔镜下刮宫术治疗的159例归为刮宫术组,术后均随访12个月,比较两组手术相关指标、子宫内膜厚度、月经量和围术期并发症、息肉复发率、临床妊娠率,多因素Logistic回归分析术后妊娠的影响因素。结果：电切术组术中出血量低于刮宫术组（P＜0.05）,两组患者手术时间、住院时间比较无差异（P＞0.05）。两组患者术后12个月子宫内膜厚度较术前降低,且电切术组术后子宫内膜厚度低于刮宫术组（P＜0.05）。两组患者术后1个月、术后3个月月经量较术前逐渐减少,且电切术组较刮宫术组变化更明显（P＜0.05）。电切术组息肉复发率低于刮宫术组,而临床妊娠率高于刮宫术组（P＜0.05）,两组患者围术期并发症总发生率比较差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示,年龄≥35岁、多发息肉、息肉直径≥1 cm、宫角息肉、术后子宫内膜厚度≥13 mm、术后息肉复发是影响子宫内膜息肉合并不孕症患者术后妊娠的危险因素（P＜0.05）。结论：宫腔镜下电切术治疗子宫内膜息肉合并不孕症患者疗效较宫腔镜下刮宫术更为显著,其术后妊娠率受年龄、息肉类型、息肉直径、息肉部位、术后子宫内膜厚度、术后息肉复发等因素影响。     

经阴道超声与宫腔镜对子宫内膜病变患者的诊断价值比较研究

目的:探讨经阴道超声与宫腔镜检查诊断子宫内膜病变的临床价值,为临床诊断子宫内膜病变提供理论依据。方法:选取2011年3月-2014年3月间我院收治的158例疑似子宫内膜病变患者,分别采用经阴道超声和宫腔镜进行检查,并以病理诊断结果为"金标准",比较两种检查方法的诊断价值。结果:病理检查结果中,143例患者被确诊为子宫内膜病变,其中子宫内膜增生23例(16.08%),子宫内膜息肉31例(21.68%),子宫粘膜下肌瘤24例(16.78%),子宫内膜癌19例(13.29%),慢性非特异性子宫内膜炎46例(32.17%)。宫腔镜对子宫内膜病变诊断的准确率为94.41%,高于阴道超声的81.12%,差异有统计学意义(P0.05),其中阴道超声和宫腔镜对子宫粘膜下肌瘤、子宫内膜癌诊断的准确率比较差异无统计学意义(P0.05),阴道超声对子宫内膜增生、子宫内膜息肉及慢性非特异性子宫内膜炎的诊断准确率均较宫腔镜降低,差异有统计学意义(P0.05)。阴道超声对子宫内膜病变诊断的特异度较宫腔镜更低(P0.05),但两者灵敏度、AUC比较差异无统计学意义(P0.05)。结论:经阴道超声诊断子宫内膜病变简单、有效,而宫腔镜诊断子宫内膜病变具有准确率以及特异度较高的特点。     

有生育要求女性子宫内膜不典型增生的微创治疗

目的：探讨对于有生育要求的子宫内膜不典型增生患者采用宫腔镜微创治疗保留子宫的疗效。方法：回顾性分析新疆医科大学第一附属医院2000年1月-2013年3月因子宫内膜不典型增生行子宫内膜电切术（TCRE）的30例患者的临床资料。术后口服高效孕激素（甲羟孕酮）160mgqd3月或置入宫内左炔诺孕酮宫内缓释植入系统（曼月乐）,对两组患者月经及子宫内膜的病理进行随访。结果：两组患者TCRE手术均顺利完成,未发生严重并发症,术后月经过多、经期延长及贫血均得到明显改善,总有效率93．73％。其中口服高效孕激素组有效率为90．48％,置入曼月乐组有效率为96．30％。结论：对有随访条件的年轻的子宫内膜不典型增生患者,TCRE术联合孕激素或置入曼月乐是治疗的新选择,针对妇女的生育要求可以选择不同的术后用药。微创治疗提高了妇女的生存质量,并发症少。     

Diagnostic accuracy of liquid‐based endometrial cytology in the evaluation of endometrial pathology in postmenopausal women

C. Remondi, F. Sesti, E. Bonanno, A. Pietropolli and E. Piccione
Diagnostic accuracy of liquid‐based endometrial cytology cytology in the evaluation of endometrial pathology in postmenopausal women Objective: The aim of this study was to compare liquid‐based endometrial cytology with hysteroscopy and endometrial biopsy regarding its diagnostic accuracy in a series of postmenopausal women with abnormal uterine bleeding (AUB) or asymptomatic women with thickened endometrium assessed by transvaginal ultrasound as a screening procedure. Methods: Inclusion criteria were: menopausal status; the presence of AUB and/or thickened endometrium assessed by ultrasound (cut‐off 4 mm); a normal Papanicolaou (Pap) smear; and no adnexal pathology at ultrasound. Exclusion criteria were: previous endometrial pathology; and previous operative hysteroscopy. Of 768 postmenopausal women referred to our general gynaecology clinics, 121 fulfilled the inclusion criteria and were recruited to the trial. Twenty‐one refused to participate. Cytological sampling was carried out by brushing the uterine cavity using the Endoflower device with no cervical dilation and the vial was processed using a ThinPrep® 2000 automated slide processor. The slides were stained using a Pap method. Results: In 98 cases with histological biopsies, endometrial cytology detected five cases of endometrial carcinoma, 10 of atypical hyperplasia and 47 of non‐atypical hyperplasia; 36 cases were negative. In two cases cytology was inadequate because of uterine cervical stenosis. Taking atypical hyperplasia or worse as a positive test and outcome, the diagnostic accuracy of the endometrial cytology was 93.5%, with a sensitivity of 92% and specificity of 95%, a positive predictive value of 73% and a negative predictive value of 99%. All the carcinomas were detected by cytology. Only 42% of women with a positive diagnosis were symptomatic. The cytological sampling was well tolerated by all patients. No complication was registered. Conclusions: Liquid‐based endometrial cytology can be considered an useful diagnostic method in the detection of endometrial pathology as a first‐line approach, particularly if associated with transvaginal ultrasound.     

乳腺导管上皮内瘤变32例影像诊断分析

目的：探讨全数字化乳腺X线摄影与磁共振成像检查相结争对乳腺导管上皮内瘤变（DIN）的诊断价值。方法：对32例经乳腺平板数字X线摄影及磁共振检查并且病理证实为乳腺导管上皮内瘤变的病例进行回顾性分析。结果：32例DIN中,普通导管上皮增生（UDH）17例,DIN1A2例;DIN1B1例;乳腺导管原位癌（DIN1C--DIN3）12例。采用全数字化X线乳腺摄影与MRI相结合诊断乳腺增生18例,乳腺导管原位癌11例,3例未能明确诊断。结论：平板数字X线乳腺摄影及磁共振成像综合诊断,对乳腺导管原位癌的旱期发现具有重要意义．显著提高患者的生存质量。     

宫血宁治疗宫内节育器后异常出血的疗效观察

目的：探讨宫血宁胶囊用于治疗宫内放置节育器后异常子宫出血的临床疗效。方法：350例宫内置器后异常出血患者随机分为观察组（175例）与对照组（175例）,其中观察组给予宫血宁胶囊治疗,对照组给予抗菌止血常规西药治疗,比较两组患者治疗前后月经异常变化情况及治疗效果。结果：①观察组治愈率、总有效率分别为56.00%和92.57%,对照组治愈率、总有效率为25.71%和75.43%,组间差异有统计学意义（P〈0.01）。②经过治疗,观察组与对照组患者月经异常症状均得到明显缓解,与治疗前比较差异有显著性（P〈0.01）,其中观察组患者经量增多、经期延长和经间点滴出血等症状例数分别减少至9例、7例和1例,对照组减少至34例、30例和15例,组间差异有统计学意义（P〈0.05）。③经过治疗,观察组患者平均月经持续时间从11.74±4.69d减少至6.92±2.34d,对照组从12.11±5.25d减少至9.28±3.14d,两组间差异有统计学意义（P〈0.05）。结论：宫血宁胶囊可有效治疗因宫内放置节育器所引起的子宫异常出血,且疗效优于抗菌止血西药治疗,值得进一步推广。     

Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy

Background

An endometrial polyp is a frequently encountered gynecologic disease with abnormal uterine bleeding and infertility being the two common presenting problems, and hysteroscopic polypectomy is an effective method to remove them. The postoperative polyp recurrence might result in reappearance of abnormal uterine bleeding or infertility, whereas factors influencing the postoperative recurrence potential have limited data.

Methods

This case-series report included 168 premenopausal women who suffered from endometrial polyps and underwent hysteroscopic polypectomy. All of them were awaiting a future pregnancy. Office hysteroscopy was done before and after hysteroscopic polypectomy, in which preoperative hysteroscopy examined the number, type, and location of endometrial polyps, and postoperative hysteroscopy checked the polyp recurrence. Surgical indications, either infertility or the presentation of abnormal uterine bleeding, and follow-up duration were recorded.

Results

Seventy-three out of 168 (43%) women had polyp recurrence after hysteroscopic polypectomy. Multivariate logistic regression analysis revealed that more endometrial polyps (P = 0.015) and longer duration of follow-up (P = 0.004) were significantly associated with an increased risk of postoperative polyp recurrence. The type of endometrial polyps was not correlated with polyp recurrence potential, whereas pedunculated type endometrial polyps were closely related to the presentation of abnormal uterine bleeding (P = 0.001).

Conclusions

A higher number of endometrial polyps and longer follow-up duration are associated with a greater potential of polyp recurrence after hysteroscopic polypectomy.     

What is the best method of detecting endometrial cancer in outpatients?‐endometrial sampling,suction curettage,endometrial cytology

Objective:  Office methods of endometrial sampling for outpatients with abnormal uterine bleeding should be minimally invasive. The purpose of this study was to determine the best method for detecting endometrial cancer in an outpatients setting.
Methods:  In all, 114 symptomatic women who were suspected of having endometrial disease by their local gynaecologist were enrolled in this study. After pelvic examination and transvaginal ultrasonography, endometrial cytology, suction endometrial curettage, and four-site endometrial biopsy were performed, in this order without anaesthesia in each patient. After endometrial sampling, the patient was asked to comment on the intensity of any pain experienced during each procedure. Then the final histological diagnosis made from the surgical materials was compared with the results of the three pre-operative methods.
Results:  Among the 114 consecutive patients, 56 had endometrial carcinoma, three had carcinosarcoma, six had endometrial hyperplasia, and 49 had benign conditions. The sensitivity of detecting malignancy was 88% (52/59) with endometrial cytology, 92% (54/59) with suction curettage, and 88% (52/59) with four-site biopsy. When endometrial cytology was combined with suction curettage, the sensitivity of detecting malignancy was increased from 92% to 98%, whereas the sensitivity was increased from 88% to 97%, when endometrial cytology was added to four-site biopsy. Suction curettage was significantly less painful than four-site biopsy.
Conclusion:  Our data indicated that suction curettage plus endometrial cytology was the best combination for pathological examination of outpatients with abnormal uterine bleeding.