摘要
目的分析B超检查和宫腔镜检查对绝经后阴道流血(PMB)患者子宫内膜病变性质的诊断效能。方法回顾性收集2015年9月至2017年9月因PMB在兰州大学第二医院妇科就诊并行手术治疗的211例患者的临床资料。所有患者接受B超检查、宫腔镜检查及病理检查。根据子宫内膜病变性质分为非恶性病变组(152例)和恶性肿瘤组(59例),比较两组的临床特征。以病理检查结果为金标准,比较B超检查、宫腔镜检查的诊断效能。采用ROC曲线分析法探讨两种检查对诊断子宫内膜病变性质的效能。结果与非恶性病变组比较,恶性肿瘤组年龄更大,绝经年限更长,子宫内膜更厚,合并高血压、糖尿病的比例更高,差异有统计学意义(P<0.05)。B超诊断子宫内膜息肉的灵敏度和特异度分别为63.83%和96.34%;诊断子宫黏膜下肌瘤的灵敏度和特异度分别为48.57%和99.43%;诊断子宫内膜恶性肿瘤的灵敏度和特异度分别为11.86%和96.05%。宫腔镜检查诊断子宫内膜息肉的灵敏度和特异度分别为97.87%和96.95%;诊断子宫内膜恶性肿瘤的灵敏度和特异度分别为96.61%和96.71%;诊断子宫内膜简单型和(或)复杂型增生的灵敏度和特异度分别为50.00%和98.95%;诊断子宫内膜炎的灵敏度和特异度分别为93.33%和99.49%;诊断子宫黏膜下肌瘤的灵敏度和特异度分别为91.43%和98.86%。ROC曲线分析结果显示,子宫内膜厚度具有诊断子宫内膜恶性肿瘤的价值[AUC(95%CI)=0.877(0.828~0.926),P=0.001],其最佳截断值为5.50 mm,灵敏度为71.19%,特异度为88.16%。结论年龄大、绝经年限长、子宫内膜异常增厚、合并高血压或糖尿病是PMB患者罹患子宫内膜恶性肿瘤的危险因素。B超可作为PMB患者的初筛检查,对于B超提示子宫内膜厚度>5.50 mm的PMB患者,临床医师应警惕子宫内膜恶性肿瘤的可能。对可疑宫腔内病变者,可进一步行宫腔镜检查。
Objective To analyze the diagnostic performances of B-ultrasound examination and hysteroscopy for the nature of endometrial lesions in patients with postmenopausal bleeding(PMB).Methods The clinical data of 211 patients who underwent surgery in the Department of Gynecology of Lanzhou University Second Hospital due to PMB from September 2015 to September 2017 were retrospectively collected.All the patients received B-ultrasound examination,hysteroscopy and pathological examination.According to the nature of the patients′endometrial lesions,they were divided into non-malignant lesion group(152 cases)and malignant tumor group(59 cases).The clinical characteristics were compared between the two groups.The diagnostic performances of B-ultrasound examination and hysteroscopy were compared by using the pathological examination results as the gold standard.Receiver operator characteristic(ROC)curve analysis was used to investigate the performances of the two examinations in diagnosing the nature of endometrial lesions.Results Compared with the non-malignant lesion group,the malignant tumor group had older age,longer menopause years,thicker endometrium,and higher proportions of complicated hypertension and diabetes mellitus,and the differences were statistically significant(P<0.05).The sensitivity and specificity of B-ultrasound in diagnosing endometrial polyps were 63.83%and 96.34%,respectively;the sensitivity and specificity in diagnosing submucosal myoma of uterus were 48.57%and 99.43%,respectively;the sensitivity and specificity in diagnosing endometrial malignant tumors were 11.86%and 96.05%,respectively.The sensitivity and specificity of hysteroscopy in diagnosing endometrial polyps were 97.87%and 96.95%,respectively;the sensitivity and specificity in diagnosing endometrial malignancies were 96.61%and 96.71%,respectively;the sensitivity and specificity in diagnosing simple hyperplasia endometrium and(or)complex hyperplasia endometrium were 50.00%and 98.95%,respectively;the sensitivity and specificity in diagnosing endometritis were 93.33%and 99.49%,respectively;the sensitivity and specificity in diagnosing submucosal myoma of uterus were 91.43%and 98.86%,respectively.The results of ROC curve analysis showed that endometrial thickness had the value of diagnosing endometrial malignancies[AUC(95%CI)=0.877(0.828-0.926),P=0.001],with the best cut-off value being 5.50 mm,the sensitivity being 71.19%and the specificity being 88.16%.Conclusion Older age,longer menopause years,abnormal endometrial thickening,complicated hypertension or diabetes are the risk factors for endometrial malignancies in PMB patients.B-ultrasound can be used as a primary screening test for PMB patients.For the PMB patients with endometrial thickness>5.50 mm indicated by B-ultrasound examination,clinicians should be alert to the possibility of endometrial malignancies.For suspected intrauterine lesions,hysteroscopy can be further performed.
作者
安慧蒙
郭钰珍
AN Hui-meng;GUO Yu-zhen(Department of Obstetrics, the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People′s Hospital), Zhengzhou 450003, China)
出处
《中国临床新医学》
2022年第4期331-336,共6页
CHINESE JOURNAL OF NEW CLINICAL MEDICINE
基金
甘肃省自然科学基金项目(编号:17JR5RA242)。
关键词
绝经后阴道流血
宫腔镜检查
B超检查
子宫内膜厚度
子宫内膜恶性肿瘤
Postmenopausal bleeding(PMB)
Hysteroscopy
B-ultrasound examination
Endometrial thickness
Endometrial malignant tumor
