冯书梅 闫彩霞 陈苑红 陈少慧 陈婉仪 李嫦

【摘要】目的：以病理診断为参照，探讨阴道彩色B超与宫腔镜在诊断围绝经期子宫异常出血中的价值。方法：回顾性分析2019年8月至2020年8月期间在我院门诊及住院部初诊为异常子宫出血的180例围绝经期患者，进行阴道彩色B超、宫腔镜检查及病理组织学检查，术中诊刮或定位取材，以病理检查结果作为“金标准”。结果：阴道B超检查子宫内膜过度增生32例，符合率为66.7%；子宫内膜息肉52例，符合率为71.23%，子宫黏膜下肌瘤17例，符合率为70.8%，子宫内膜癌3例，符合率为60.0%，其他16例，符合率为56.7%。联合宫腔镜检查子宫内膜过度增生43例，符合率为89.58%，子宫内膜息肉68例，符合率为93.15%，子宫黏膜下肌瘤22例，符合率为91.67%，子宫内膜癌5例，符合率为100.0%； 其他26例，符合率为86.67%。阴道B超检查的疾病检出率为66.67%，明显低于联合宫腔镜检查的疾病检出率（91.11%），差异具有统计学意义（P<0.05）。结论：诱发围绝经期异常子宫出血的首位病因为子宫内膜息肉，宫腔镜检查与阴道B超相结合大大提高了对围绝经期子宫异常出血疾病诊断的准确性。

【关键词】围绝经期；子宫异常出血；超声；宫腔镜

[中图分类号]R445.1 [文献标识码]A [文章编号]2096-5249（2021）13-0159-02

Analysis of the value of B-ultrasonography and Hysteroscopy in the diagnosis of abnormal uterine bleeding in perimenopausal women

FENG Shu-mei， YAN Cai-xia， CHEN Yuan-hong， CHEN Shao-hui， CHEN Wai-yi， LI Chang （Dong-guan Eastern Central Hospital， Dongguan Guangdong 523000， China）

[Abstract] Objective： Take pathological diagnosis as reference， to explore the value of vaginal color B ultrasound and hysteroscopy in the diagnosis of abnormal uterine bleeding in perimenopausal period. Methods： A retrospective analysis was performed on 180 perimenopausal patients who were initially diagnosed with abnormal uterine bleeding in outpatient and inpatient departments of our hospital from August 2019 to August 2020.They underwent vaginal color B-ultrasound， hysteroscopy， and histopathology， intraoperative scraping or location sampling， take pathological examination result as “gold standard”. Results： B-ultrasonography showed 32 cases of endometrial hyperproliferation， with a coincidence rate of 66.7%. 52 cases of endometrial polyps （71.23%）， 17 cases of submucosal myomas （70.8%）， 3 cases of endometrial cancer （60.0%）， and 16 other cases （56.7%）.By hysteroscopy， endometrial hyperproliferation was examined in 43 cases， with a coincidence rate of89.58%， endometrial polyps in 68 cases （93.15%）， submucosal myomas in 22 cases （91.67%）， and endometrial cancer in 5 cases （100.0%）. In the other 26 cases， the coincidence rate was 86.67%.The disease detection rate of b-ultrasonography was 66.67%， significantly lower than that of combined hysteroscopy （91.11%）， and the difference was statistically significant （P<0.05）. Conclusion： Endometrial polyp is the first cause of abnormal uterine bleeding in perimenopausal period.The combination of hysteroscopy and vaginal B-ultrasound greatly improves the accuracy of the diagnosis of abnormal uterine bleeding in perimenopausal period.

围绝经期子宫异常出血是妇科疾病常见的症状，发病率达70.00%[1]。引起子宫异常出血的原因种类多且复杂，其中最常见的有炎症、内分泌紊乱、肿瘤、凝血功能障碍等。诊断的准确性是正确治疗和预后的关键。本研究通过对180例已排除了明显子宫腔外因素所致异常子宫出血的患者进行回顾性分析，对阴道B超、宫腔镜与病理学检查结果的符合率进行对照分析，并研究引起围绝经期子宫异常出血的主要原因，探讨阴道B超、宫腔镜及病理学对围绝经期异常子宫出血病因的诊断价值。……