宮腔鏡檢查對子宮出血診斷方面的臨床應(yīng)用

1、宮腔鏡檢查對子宮出血診斷方面的臨床應(yīng)用 【關(guān)鍵詞】 宮腔鏡檢查 摘 要：目的：了解子宮內(nèi)部病變，提高診斷準(zhǔn)確率。方法：對113例子宮異常出血患者行宮腔鏡檢查并針對檢查結(jié)果作出相應(yīng)治療。結(jié)果：本組陽性率72.79%。絕經(jīng)后子宮出血 6例中3例子宮內(nèi)膜癌，非絕經(jīng)期異常子宮出血94例中22例子宮內(nèi)膜增生，10例黏膜下肌瘤或壁間內(nèi)突型肌瘤，18例子宮內(nèi)膜息肉，6例節(jié)育環(huán)異常，病理活檢陽性69.85%。65例宮腔鏡檢查前行b超檢查，23例異常（ 16.91%）；鏡檢異常45例（69.23%）。結(jié)論：宮腔鏡檢查直視宮腔, 有助于鑒別子宮內(nèi)功能性或器質(zhì)性病變，對可疑病灶在直視下取材活檢，診斷準(zhǔn)確率高，優(yōu)于b

2、型超聲檢查。 關(guān)鍵詞：宮腔鏡檢查；病理檢查；b型超聲檢查 clinical application of womb endoscope examination in diagnosing uterine bleeding abstract: 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 wo

3、mbs by 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 t

4、hat indicate 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 pathol

5、ogical 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%)

6、. the 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

7、for obtaining higher diagnostic accuracy. key words: womb endoscope examination； pathological examination； type b ultrasonic inspection 2003年1月至2003年10月我科對113例子宮異常出血患者行宮腔鏡檢查，現(xiàn)報道如下： 1 資料與方法 1.1 研究對象：本組年齡2070歲，均為門診患者，已婚。2030歲20例，3140歲30例，4150歲43例，5160歲16例，6170歲4例。其中，絕經(jīng)后出血6例，異常子宮出血94例，與妊娠有關(guān)子宮出血4例（流產(chǎn)或足月

8、產(chǎn)后異常子宮出血），節(jié)育環(huán)異常9例。 1.2 方法：設(shè)備：（史賽克，美國） xg-3型宮腔鏡，膨?qū)m介質(zhì)為5%葡萄糖，膨?qū)m壓力控制在150200mmhg，檢查前作雙合診了解子宮位置大小，常規(guī)消毒外陰陰道，2%利多卡因作宮頸阻滯麻醉，用宮頸擴張器擴至6.5號，直視下將鏡體朝宮腔方向推進，按順序全面觀察宮腔及宮頸管的形態(tài)，根據(jù)病變部位取組織活檢，患者術(shù)后休息1h便可離院，術(shù)后常規(guī)給予抗生素預(yù)防感染。 2 結(jié) 果 2.1 113例宮腔鏡診斷陽性率72.79%（99/113），并且宮腔鏡檢查與b型超聲波對照：65例宮腔鏡檢查前行b超檢查，異常者23例 （16.91 %）（23/113），鏡檢發(fā)現(xiàn)異常者4

9、5例。見表1。表1 113例宮腔鏡檢查及65例b超診斷結(jié)果略 2.2 除子宮畸型、子宮肌瘤、節(jié)育環(huán)異常等18例患者未作組織活檢外，余95例患者均作病理活檢，病理活檢陽性率69.85 %（95/113）結(jié)果見表2。表2 95例活檢診斷結(jié)果略 3 討 論 宮腔鏡應(yīng)用于婦科臨床，具有其它器械不可替代的優(yōu)點，它在直視下對宮腔病變一目了然，定點診刮，準(zhǔn)確率高1，本組陽性率達72.79%，病理檢出率69.85%，鏡檢與病理檢查具有高度一致性1。 子宮異常出血是子宮鏡檢首要適應(yīng)征2，傳統(tǒng)診刮簡單易行，但在非直視下操作容易遺漏較小病灶。本組在宮腔鏡直視下了解宮腔內(nèi)情況，直接鑒別子宮肌瘤與子宮內(nèi)膜病變，定點診刮，為臨床提供可靠依據(jù)，具有較高的診斷價值。 b型超聲檢查是一種無痛苦的檢查手段，但對發(fā)現(xiàn)宮腔內(nèi)細微的病變有其局限性，本文b型超聲發(fā)現(xiàn)異常與