超声与宫腔镜联合诊断子宫内膜息肉临床应用.docVIP

超声与宫腔镜联合诊断子宫内膜息肉临床应用 　　【摘要】 目的 评价超声与宫腔镜联合诊断子宫内膜息肉的临床应用。方法 回顾性分析2003-2007年在本院就诊经病理确诊为子宫内膜息肉的76例患者资料，全部病例在宫腔镜手术前均行经阴道超声检查和超声与宫腔镜联合检查，比较经阴道超声和超声与宫腔镜联合检查对子宫内膜息肉的检出率，分析子宫内膜息肉的经阴道超声声像图、超声与宫腔镜联合检查的镜下特征和两种检查方法的误诊原因，评价和探讨超声与宫腔镜联合检查对子宫内膜息肉的诊断价值。结果 病理证实的子宫内膜息肉76例，经阴道超声检出率为61.84%，超声与宫腔镜联合检出率为93.42%，两种方法检出率比较有显著性差异(P 　　【关键词】子宫内膜息肉；超声与宫腔镜；经阴道超声 　　 　　The clinical application of ultrasound and hysteroscopy in the diagnosis of endometrial polyps 　　HUANG Xue-lan，GUO Duan-ying，CHEN Hua-jin.Department of Ultrasound,Shenzhen Longgang Central Hospital(Shenzhen NO.9 People’s Hospital),Guangdong 518116,China 　　【Abstract】 Objective To evaluate the clinical application of ultrasound and hysteroscopy in the diagnosis of endometrial polyps.Methods A retrospective analysis of 76 cases diagnosed by the pathological diagnosis of endometrial polyps from 2003 to 2007 in our hospital was adopted，all of which were examined by transvaginal ultrasound examination and ultrasound intervention hysteroscopy beforeoperation.The detection rate of endometrial polyps in these two methods was compared.The characteristics and misdiagnosis of these two ways were analyzed.The diagnostic value of ultrasound intervention hysteroscopy was estimated and explored.Results 76 cases were confirmed of endometrial polyps by pathology.The detection rate of which was 61.84%by transvaginal ultrasound，and 93.42%by ultrasound intervention hysteroscopy.The detection rate of the two methods are of significant different(P[1]。临床表现月经量过多、经期不规律、经前或经后少量阴道出血，妇科检查往往无异常发现，易误诊为功能失调性子宫出血。常规止血、激素治疗及刮宫往往无效，常因久治不愈或严重贫血而导致子宫切除。本文报告超声与宫腔镜联合诊断子宫内膜息肉的价值。 　　 　　1 资料和方法 　　 　　1.1 研究对象 2003-2007年在本院就诊经病理确诊为子宫内膜息肉的患者76例，年龄21~75岁，平均39岁。 　　1.2 诊断方法 用HDI-4000超声仪，腹部超声探头频率3.5 MHz和/或经阴道超声(探头频率5.0~7.0 MHz)检查。宫腔镜检查用Olympus持续灌流检查镜及纤维检查镜。所有患者先行经经阴道超声检查，再行超声与宫腔镜联合检查，选择在月经干净后3~8 d内，术前常规查血常规、血糖、凝血功能及心电图。以5%葡萄糖溶液作为膨宫介质，膨宫压力13~15 kPa，术前6 h患者阴道后穹窿放置米索前列醇400 μg，以利于术中软化扩张宫颈，麻醉采用腰硬联合麻醉，以保持患者术中神志清晰。患者取膀胱截石位于手术台上，外阴、阴道常规消毒后术野常规消毒铺巾，在超声监视下用宫腔镜扩张宫颈达10 mm