宫腔镜在异常子宫出血诊治中的临床应用

摘要

Objective To explore the clinical value of hysteroscopy in the diagnosis and treatment of patients with ab-normal uterine bleeding. Methods Clinic date of 65 cases of abnormal uterine bleeding admitted in Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing University of Chinese Medicine from January to November 2014 were retrospectively analyzed. The patients were checked by hysteroscopy, lesion removal, biopsy for diagnosis and treatment. Through the comparative analysis of the above methods, the clinical application of hysteroscopy in the diagnosis and treatment of abnormal uterine bleeding was analyzed. Results Hysteroscopy found that various degree of endometrial hyperplasia in 20 cases,13 cases of endometrial polyps, 16 cases of endometritis, 9 cases of endometrial hyperplasia or secretory phase change, 4 cases of uterine fibroids, 3 cases of pregnancy residues. After hysteroscopy, all patients were given biopsy,curettage, lesion removal (large polyps and submucosal fibroids were givn hysteroscopic polypectomy). Pathology showed that 27 cases of various degree of endometrial hyperplasia, 10 cases of endometrial polyps, 9 cases of endometritis, 4 cases of endometrial hyperplasia or secretory phase change, submucous myoma of uterus 2 cases, 3 cases of pregnancy residues. The coincidence rate of diagnosis between pathology and pathological examination was 78.46%. Postoperative follow-up, 5 cases of recurence, recurence rate was 9.09%; 50 cases of cure, the cure rate was 93.85%. Conclusion Hysteroscopy can directly observe the intrauterine pathologies, and to assist pathological examination in the diagnosis and treatment of abnormal uterine bleeding, achieve the goal of comprehen-sive, detailed and accurate, is worthy of clinical promotion.%目的：探讨宫腔镜在异常子宫出血诊治中的临床价值。方法回顾分析2014年1~11月南京中医药大学附属南京市中西医结合医院异常子宫出血患者65例的临床资料，所有患者均通过宫腔镜检查、病灶摘除、病理检查进行诊断和治疗。分析宫腔镜检查在异常子宫出血诊治中的临床应用。结果宫腔镜检查发现子宫内膜不同程度增生20例，内膜息肉13例、内膜炎16例，内膜增生或分泌期改变9例，肌瘤4例，妊娠物残留3例。所有患者检查后行定位活检、内膜诊刮、病灶摘除(大的息肉和黏膜下肌瘤采用宫腔镜下电切术)。病理结果示院内膜增殖症27例、内膜息肉10例，内膜炎9例、内膜增生或分泌期改变14例，黏膜下肌瘤2例，妊娠物残留3例。总的宫腔镜和病理检查符合率为78.46%。术后失访10例，随访率为84.62%；随访的55例中复发5例，复发率为9.09%；50例治愈，治愈率为90.90%。结论宫腔镜检查协助病理检查，直视宫内病变，可以明确异常子宫出血者病因并进行相应治疗，达到全面、精细、准确的目的，值得临床推广。