超聲與宮腔鏡聯合診斷子宮內膜息肉的臨床應用

黃雪蘭　郭端英　陳花金

【摘要】 目的 評價超聲與宮腔鏡聯合診斷子宮內膜息肉的臨床應用。方法 回顧性分析2003-2007年在本院就診經病理確診為子宮內膜息肉的76例患者資料，全部病例在宮腔鏡手術前均行經陰道超聲檢查和超聲與宮腔鏡聯合檢查，比較經陰道超聲和超聲與宮腔鏡聯合檢查對子宮內膜息肉的檢出率，分析子宮內膜息肉的經陰道超聲聲像圖、超聲與宮腔鏡聯合檢查的鏡下特征和兩種檢查方法的誤診原因，評價和探討超聲與宮腔鏡聯合檢查對子宮內膜息肉的診斷價值。結果 病理證實的子宮內膜息肉76例，經陰道超聲檢出率為61.84%，超聲與宮腔鏡聯合檢出率為93.42%，兩種方法檢出率比較有顯著性差異(P<0.01)。經陰道超聲聲像圖表現中高回聲團塊81.58%、低回聲18.42%，基底部顯示血流信號22.37%、基底部未見血流信號77.63%，全部病例息肉內均未見血流信號，誤診病例24例。超聲與宮腔鏡聯合檢查鏡下表現息肉呈卵圓形或圓型，顏色鮮紅色，表面光滑，有時可見微血管網紋，部分息肉可隨膨宮液飄動。誤診病例5例。結論 經陰道超聲無創、操作簡便，可作為子宮內膜息肉普查的首選方法，但漏診率高；超聲與宮腔鏡聯合檢查診斷符合率高，結合病理學檢查，是診斷子宮內膜息肉的金標準。術前對每個患者實行超聲與宮腔鏡聯合檢查，為提高手術成功率提供可靠依據。

【關鍵詞】子宮內膜息肉；超聲與宮腔鏡；經陰道超聲

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 Peoples 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<0.01).81.58%of transvaginal Ultrasonographic showed echo clumps high，while l8.42%showed low echo.22.37%showed blood flow at the bottom，while 77.63 showed no blood flow at the bottom.All the polyps in both cases had no blood flow signals inside.24 cases were misdiagnosed.Conclusion Polyps under the endoscopic ultrasound intervention hysteroscopy were oval or circular,bright red，smooth.

Sometimes microvascular net could be seen and some polyps could be fluttered with the Palace of waves.Five cases were misdiagnosed.Conclusion vaginal ultrasound is non-invasive，simple andcan be used as the preferred way to the census of endometrial polyps，but its missed rate is high.The accordance rate of endoscopic ultrasound intervention hysteroscopy is high，which is the gold standard of the diagnosis of endometrial polyps with pathological examination.If each of the patients was carried out the intervention hysteroscopy ultrasound,the success rate of operation can be improved.

【Key words】Endometrial polyps； Ultrasound intervention； Hysteroscopy； Transvaginal ultrasound

子宮內膜息肉是婦科常見病、多發病，國內文獻報道，估計其發生率為女性的24%~25%^[1]。臨床表現月經量過多、經期不規律、經前或經后少量陰道出血，婦科檢查往往無異常發現，易誤診為功能失調性子宮出血。常規止血、激素治療及刮宮往往無效，常因久治不愈或嚴重貧血而導致子宮切除。本文報告超聲與宮腔鏡聯合診斷子宮內膜息肉的價值。

1 資料和方法

1.1 研究對象 2003-2007年在本院就診經病理確診為子宮內膜息肉的患者76例，年齡21~75歲，平均39歲。