超声与宫腔镜联合诊断子宫内膜息肉的临床应用

黄雪兰　郭端英　陈花金

【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<0.01)。经阴道超声声像图表现中高回声团块81.58%、低回声18.42%，基底部显示血流信号22.37%、基底部未见血流信号77.63%，全部病例息肉内均未见血流信号，误诊病例24例。超声与宫腔镜联合检查镜下表现息肉呈卵圆形或圆型，颜色鲜红色，表面光滑，有时可见微血管网纹，部分息肉可随膨宫液飘动。误诊病例5例。结论 经阴道超声无创、操作简便，可作为子宫内膜息肉普查的首选方法，但漏诊率高；超声与宫腔镜联合检查诊断符合率高，结合病理学检查，是诊断子宫内膜息肉的金标准。术前对每个患者实行超声与宫腔镜联合检查，为提高手术成功率提供可靠依据。

【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 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

子宫内膜息肉是妇科常见病、多发病，国内文献报道，估计其发生率为女性的24%~25%^[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。