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.     

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。     

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。     

宫腔镜下子宫内膜电切术联合刮宫术治疗多发性子宫内膜息肉的效果探讨

目的:探讨宫腔镜下采取子宫内膜电切术联合刮宫术对于治疗多发性子宫内膜息肉(EMP)患者的临床效果。方法:选取2012年6月至2014年3月在我院确诊为EMP的患者100例,随机平均分为两组,研究组采取宫腔镜下子宫内膜电切术联合刮宫术治疗,对照组单纯采取宫腔镜下子宫内膜电切术治疗。观察两组患者术中出血量、手术时间、一年内子宫息肉的复发率及子宫异常出血的发病率。结果:两组术中出血量、手术时间及子宫息肉复发率比较差异无统计学意义(P0.05)。研究组子宫异常出血发病率低于对照组,差异有统计学意义(P0.05)。结论:宫腔镜下电切术联合刮宫术对于治疗EMP的效果更佳,可降低子宫异常出血发病率,安全有效,值得临床进一步推广。     

电视宫腔镜配合阴道超声检查诊治80例绝经后子宫出血的效果分析

目的:评价宫腔镜配合阴道超声检查对绝经后妇女异常子宫出血的临床价值.方法:回顾性分析80例绝经后妇女异常子宫出血行宫腔镜配合阴道超声检查及相关病理检查的临床资料.结果:阴道超声检查非正常41例,阳性率为51.25%,官腔镜检查非正常58例,阳性率为72.50%,两者比较具有统计学意义(P＜0.01);病理检查非正常54例,符合率为93.10%.结论:阴道超声检查可作为异常子宫出血的常规无创普查手段,宫腔镜检查可对异常患者进一步检查,两者配合检查可提高诊断准确率.     

宫腔镜与阴道超声用于诊断子宫内膜病变的临床价值探讨

目的:探究阴道超声与宫腔镜对诊断子宫内膜病变的临床应用价值。方法:选取我院妇产科收治的子宫内膜病变患者153例,进行阴道超声及宫腔镜检测,观测患者病变类型以及病变部位,比较术后患者临床资料与术前阴道超声以及宫腔镜的检测结果,对阴道超声及宫腔镜的准确率、敏感性、阳性预测率以及阴性预测率等进行比较。结果:阴道超声检测内膜增生漏诊3例、内膜息肉误诊3例、粘膜下肌瘤误诊2例、内膜炎漏诊2例、内膜癌漏诊1例;宫腔镜检测内膜息肉误诊1例、黏膜下肌层误诊2例、内膜炎漏诊1例;与病理活检结果的符合率比较,宫腔镜的总符合率显著高于阴道超声,差异有统计学意义(P0.05)。宫腔镜检测子宫内膜病变的准确率、敏感性、阳性预测率及阴性预测率显著优于阴道超声,差异有统计学意义(P0.05)。结论:阴道超声和宫腔镜均可检测子宫内膜病变,前者操作简单、创伤小,后者操作复杂,但检出率、准确率及敏感度均较高,可减少临床误诊、漏诊的发生率。     

三种方法诊断不孕症患者子宫内膜息肉的临床价值研究

目的:探讨单用阴道超声(TVS)、子宫输卵管造影(HSG)、超声子宫水造影(SIS)以及三种方法联合诊断不孕症患者子宫内膜息肉(EP)的临床价值。方法:以206例行宫腔镜联合诊刮或病检的不孕症患者为研究对象,回顾性分析各种检查方法对EP的筛查结果,评价各种检查方法的真实性、可靠性以及预测值。结果:206例不孕症中,共确诊EP患者60例,阳性率29.1%。三种检查方法中,TVS的灵敏度最高(70.0%),特异度最低(73.3%),漏诊率最低(30.0%),误诊率最高(26.7%),正确诊断指数最高(43.3%),阴性似然比最小(0.409),阴性预测值最高(85.6%);SIS检查的灵敏度最低(38.7%),漏诊率最高(61.3%),但是特异性最高(93.3%),误诊率最低(6.7%),阳性似然比最大(4.284),阳性预测值最大(66.6%),正确诊断指数最低(32.0%);HSG检查的上述各项评价指标均介于TVS和SIS之间。TVS和SIS与金标准的符合率低,Kappa值均小于0.4;HSG符合率最高(86.2%),Kappa值0.647。三种检查联合诊断的灵敏度89.3%,漏诊率10.7%,特异度91.4%,误诊率8.6%,正确诊断指数80.7%,阳性似然比10.384,阴性似然比0.117,符合率89.3%,Kappa值0.792,阳性预测值83.3%,阳性预测值94.6%。结论:对于宫腔可能存在内膜息肉的不孕症患者,单一采用阴道超声检查、子宫输卵管造影或超声子宫水造影方法的灵敏度均较低,漏诊率高,与金标准的一致性较差,而三种方法联合用于诊断不孕症患者EP的真实性、可靠性及预测值均较好。     

干细胞相关因子在子宫内膜息肉中的表达

探讨ipo13、c-kit、CD146、bcl-2和bax在子宫内膜息肉(endometrial polyp,EP)和正常内膜组织中的表达差异及临床意义。收集本院2010年3-7月行宫腔镜手术取得的40例子宫内膜息肉(病例组)与40例正常内膜组织(对照组)。采用实时荧光定量PCR技术(RT-PCR)检测ipo13、c-kit、bcl-2和bax mRNA的表达;免疫组织化学S-P法检测ipo13、CD146、bcl-2和bax蛋白的表达。无论在月经周期的增生期或分泌期,EP中ipo13、c-kit、CD146和bax mRNA和蛋白的表达均低于同期正常子宫内膜组织,差异有统计学意义(P<0.05),bcl-2均比同期正常子宫内膜增加,差异有统计学意义(P<0.05)。子宫内膜干/祖细胞活性异常和子宫内膜凋亡减少与子宫内膜息肉发病有关,其中子宫内膜干/祖细胞活性异常使内膜凋亡减少可能是EP发病的主要因素。     

超声监视子宫输卵管造影的临床研究

目的:探讨超声监视子宫输卵管造影(sonohysterosalpingography,SHSG)在临床中的实用价值.方法:对86例不孕症患者行阴道超声监视子宫输卵管生理盐水造影,观察宫腔、输卵管通畅情况,宫腔检查结果与宫腔镜(hysteroscopy,HS)检查宫腔的结果做比较,输卵管检查结果与宫腹腔镜联合检查作比较.结果:SHSG检查的86例不孕患者中发现子正常宫腔58例,宫内膜息肉样改变12例,子宫内膜异常增生11例,粘膜下子宫肌瘤2例,子宫粘连2例,纵隔子宫1例.宫腔镜检查发现宫腔正常56例,异常宫腔30例.SHSG灵敏度为80.00%,特异度为92.86%.另外SHSG检查发现44条输卵管通畅,49条通而不畅,79条梗阻.将SHSG与宫腹腔镜检查宫腔及输卵管结果分别进行统计学分析,显示两组均无明显差异(P>0.05).结论:SHSG方法简单,诊断可靠,操作方便,可重复,动态观察,痛苦小,安全可靠,可以作为女性不孕症的筛检方法之一.     

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.     

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.     

Aspiration cytology from the pouch of Douglas at hysteroscopy

Eighty-seven fine needle aspiration cytological samples from 29 patients suffering from irregular perimenopausal uterine bleeding were evaluated. Aspiration cytology was performed prior to hysteroscopy, after distension of the uterine cavity and finally after uterine curettage. In this paper, cytological examination of fluid from the pelvic content in women with benign endometrial findings is compared with that of patients with adenocarcinoma. Endometrial curettage influenced the cell content of the cytologica specimens.     

子宫动脉化疗栓塞术治疗子宫瘢痕妊娠

目的：本文采用双侧子宫动脉化疗栓塞术治疗子宫瘢痕妊娠,通过讨论其临床疗效、术后并发症及愈后情况,旨在为临床治疗子宫瘢痕妊娠提供一种安全、有效、合理的治疗方法。方法：对27例确诊为子宫瘢痕妊娠的患者采用seldinger技术穿刺股动脉,在DSA监视下,分别超选择双侧子宫动脉,各灌注甲氨蝶呤20mg,再注入明胶海绵颗粒栓塞至子宫动脉完全闭塞。3～5天后,在硬膜外麻醉及彩超监视下行宫腔镜病灶切除术。术后随访3～6个月,观察月经恢复情况。结果：本组所有患者均一次性栓塞治疗成功,造影显示子宫动脉闭塞良好,患者阴道不规则出血迅速停止。宫腔镜病灶切除术中出血极少,无子宫破裂、大出血等严重并发症发生。术后5～10天,所有患者血hCG均恢复至正常水平;随访3～6个月,所有患者月经均恢复正常。结论：子宫动脉化疗栓塞术治疗子宫瘢痕妊娠损伤小、安全有效,可以减少子宫破裂、大出血等严重并发症发生,保留患者子宫及附件的正常解剖及生理功能,尤其适用于有生育要求的妇女,适合临床广泛应用。     

Primary malignant lymphoma of the uterine corpus diagnosed by endometrial cytology. A case report

BACKGROUND: A relatively small number of cases of primary malignant lymphoma of the uterine corpus have been reported, and it is rare for cases to be preoperatively diagnosed by cytology. CASE: A 59-year-old female experienced abnormal uterine bleeding of two months' duration. Preoperative evaluation of endometrial cytology revealed malignant cells. These cells demonstrated a rather round or oval configuration, with a markedly increased nuclear/cytoplasmic ratio, and were isolated and scattered in an inflammatory background. The nuclei were round or oval, and macronucleoli were marked. The cytologic diagnosis was malignant lymphoma. Postoperative histologic evaluation verified the presence of a primary malignant lymphoma in the uterine corpus, with a B-cell phenotype. CONCLUSION: Preoperative endometrial cytology correctly demonstrated malignant lymphoma of the uterine corpus.     

22例子宫卒中性平滑肌瘤的临床病理特征分析

目的:探讨卒中性平滑肌瘤的临床病理特征、免疫表型及预后。方法:回顾性分析22例子宫卒中性平滑肌瘤的临床特点、病理形态学特点及免疫表型,并复习相关文献。结果:卒中性平滑肌瘤患者的临床症状主要为异常子宫出血,腹痛等。肿瘤大体常伴有以下特征,多灶性出血、坏死、囊性变、水肿变性及质地变软等,镜检可见多灶出血区,呈放射状、卵圆形或不规则形,其中央常可伴有坏死、玻璃样变或肿瘤细胞减少,周边肿瘤细胞富集。22例卒中性平滑肌瘤中,15例核分裂增加(最高达13个/10HPF),但细胞均未见病理性核分裂及显著细胞异型性;22例肿瘤组织弥漫强表达Desmin、SMA、H-caldesmon,Ki67指数范围(3%-15%);18例出血及凝固性坏死区及其周围的肿瘤组织不同程度表达CD10。22例患者均获得完整随访资料,平均随访30个月(10~110个月),均无瘤生存。结论:子宫卒中性平滑肌瘤预后较好,但由于其具有一系列异常的病理形态学特征,如多发出血灶,出血灶中央可伴有坏死,其周围富于肿瘤细胞区细胞可见轻度非典型性且核分裂不同程度增加,易被误诊为子宫恶性潜能未定的平滑肌瘤甚至是子宫平滑肌肉瘤。正确认识该类肿瘤宽广的形态学谱系,有助于临床病理医师做出正确诊断。