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315例宫腔镜手术患者临床特点及手术热点问题

单莹 邓姗 田秦杰 孙爱军 陈蓉 朱兰 刘欣燕 彭萍

单莹, 邓姗, 田秦杰, 孙爱军, 陈蓉, 朱兰, 刘欣燕, 彭萍. 315例宫腔镜手术患者临床特点及手术热点问题[J]. 协和医学杂志, 2015, 6(3): 206-211. doi: 10.3969/j.issn.1674-9081.2015.03.009
引用本文: 单莹, 邓姗, 田秦杰, 孙爱军, 陈蓉, 朱兰, 刘欣燕, 彭萍. 315例宫腔镜手术患者临床特点及手术热点问题[J]. 协和医学杂志, 2015, 6(3): 206-211. doi: 10.3969/j.issn.1674-9081.2015.03.009
Ying SHAN, Shan DENG, Qin-jie TIAN, Ai-jun SUN, Rong CHEN, Lan ZHU, Xin-yan LIU, Ping PENG. Clinical Characteristics of 315 Hysteroscopic Patients and Relevant Inconclusive Questions in Hysteroscopy[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(3): 206-211. doi: 10.3969/j.issn.1674-9081.2015.03.009
Citation: Ying SHAN, Shan DENG, Qin-jie TIAN, Ai-jun SUN, Rong CHEN, Lan ZHU, Xin-yan LIU, Ping PENG. Clinical Characteristics of 315 Hysteroscopic Patients and Relevant Inconclusive Questions in Hysteroscopy[J]. Medical Journal of Peking Union Medical College Hospital, 2015, 6(3): 206-211. doi: 10.3969/j.issn.1674-9081.2015.03.009

315例宫腔镜手术患者临床特点及手术热点问题

doi: 10.3969/j.issn.1674-9081.2015.03.009
详细信息
    通讯作者:

    邓姗 电话:010-69156204, E-mail:2587054758@qq.com

  • 中图分类号: R711

Clinical Characteristics of 315 Hysteroscopic Patients and Relevant Inconclusive Questions in Hysteroscopy

More Information
  • 摘要:   目的  探讨宫腔镜手术患者的临床特点及宫腔镜手术的相关临床热点问题。  方法  回顾性分析2014年7月至12月在北京协和医院妇产科行宫腔镜手术的315例患者资料, 总结其临床及病理特点, 并对宫腔镜手术相关临床热点问题包括PALM-COEIN病因分类, 子宫内膜息肉的超声诊断, 以及特殊病例子宫腺肌瘤样息肉、乳腺癌辅助内分泌治疗后宫腔占位、子宫瘢痕憩室的特点进行分析。  结果  315例宫腔镜手术患者中, 有异常子宫出血(abnormal uterine bleeding, AUB)症状者172例, 无症状者143例, AUB患者恶性病变的检出率明显高于无症状者(15.7%比2.1%, P=0.000)。育龄期AUB患者128例, 进行PALM-COEIN病因分类, 最常见类型为子宫内膜息肉(AUB-P)(45.3%, 58/128)。子宫内膜息肉患者160例, 阴道超声用于诊断子宫内膜息肉的阳性预测值、阴性预测值、敏感性、特异性和准确性分别为80%、75%、71%、81%和76%。子宫腺肌瘤样息肉17例, 其中非典型腺肌瘤样息肉3例; 10例患者有乳腺癌手术史, 9例辅助内分泌治疗, 宫腔病理均为良性; 剖宫产术后子宫瘢痕憩室患者5例, 宫腔镜下均有特异表现。  结论  宫腔镜作为微创手术技术, 对于诊断和治疗AUB和宫腔占位具有重要价值, 对于子宫内膜息肉、乳腺癌术后的子宫内膜增厚、剖宫产术后的子宫瘢痕憩室等大多数良性病变, 宫腔镜检查明确诊断的同时可以达到治疗目的。对宫腔镜诊治诸多热点问题的探讨有助于改善临床处理策略。
  • 表  1  不同年龄段和症状患者子宫内膜癌及不典型增生的检出率比较

    年龄段症状例数子宫内膜癌及子宫内膜
    不典型增生(例)
    检出率
    (%)
    P
    育龄期AUB1281914.80.000
    无AUB8600
    绝经后AUB44818.20.054
    无AUB5735.3
    全部患者AUB1722715.70.000
    无AUB14332.1
    AUB:异常子宫出血
    下载: 导出CSV

    表  2  乳腺癌辅助内分泌治疗后宫腔占位患者特点

    症状 年龄(岁) 超声提示内膜
    厚度(cm)
    宫腔占位
    (cm)
    内分泌治疗 内分泌治疗
    持续时间(月)
    病理结果
    育龄期AUB
    39 1.4 枸橼酸托瑞米芬 8子宫内膜息肉
    43 1.1 枸橼酸托瑞米芬 32 子宫内膜息肉
    43 1.3 枸橼酸托瑞米芬 36 腺肌瘤样息肉
    育龄期无AUB
    482.4枸橼酸托瑞米芬18分泌期子宫内膜
    472.2枸橼酸托瑞米芬6分泌期子宫内膜
    461.7回声不均枸橼酸托瑞米芬10子宫内膜单纯增生
    521.3中高回声2.5 cm×1.4 cm枸橼酸托瑞米芬36子宫内膜息肉
    410.7中高回声子宫内膜息肉
    绝经后无AUB
    500.7枸橼酸托瑞米芬7子宫内膜息肉
    550.8中高回声1.7 cm×1.4 cm枸橼酸托瑞米芬48子宫内膜息肉
    AUB:同表 1
    下载: 导出CSV
  • [1] Espindola D, Kennedy KA, Fischer EG. Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia[J]. Obstet Gynecol Clin North Am, 2007, 34:717-737. doi:  10.1016/j.ogc.2007.09.001
    [2] Montgomery BE, Daum GS, Dunton CJ. Endometrial hyperplasia:a review[J]. Obstet Gynecol Surv, 2004, 59:368-378. doi:  10.1097/00006254-200405000-00025
    [3] Hernandez E; American College of Obstericians and Gynecologists. ACOG Practice Bulletin number 65:management of endometrial cancer[J]. Obstet Gynecol, 2006, 107:952-953. doi:  10.1097/01.AOG.0000209465.55688.30
    [4] Reed SD, Newton KM, Clinton WL, et al. Incidence of endometrial hyperplasia[J]. Am J Obstet Gynecol, 2009, 200:678.e1-678.e6. doi:  10.1016/j.ajog.2009.02.032
    [5] 王春庆, 田秦杰. FIGO关于育龄期异常子宫出血的病因分类[J].生殖医学杂志, 2013, 22:963-966. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=szyxzz201312016
    [6] 张以文. FIGO关于月经异常相关术语的共识和异常子宫出血病因的新分类系统[J].国际妇产科学杂志, 2013, 40:105-107. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=gwyx-fckx201302001
    [7] Munro MG, Critchley HOD, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age[J]. Int J Gynecol Obstet, 2011, 113:3-13. doi:  10.1016/j.ijgo.2010.11.011
    [8] Uglietti A, Mazzei C, Deminico N, et al. Endometrial polyps detected at ultrasound and rate of malignancy[J]. Arch Gynecol Obstet, 2014, 289:839-843. doi:  10.1007/s00404-013-3037-z
    [9] American Association of Gynecologic Laparoscopists. AAGL practice report:practice guidelines for the diagnosis and management of endometrial polyps[J]. J Minim Invasive Gynecol, 2012, 19:3-10. doi:  10.1016/j.jmig.2011.09.003
    [10] 李锦, 吴瑞瑾.子宫内膜腺肌瘤样息肉91例临床分析[J].实用妇产科杂志, 2014, 30:358-361. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=syfckzz201405015
    [11] Lee EJ, Han JH, Ryu HS. Polypoid adenomyomas sonohysterographic and color Doppler findings with histopathologic correlation[J]. J Ultrasound Med, 2004, 23:1421-1429. doi:  10.7863/jum.2004.23.11.1421
    [12] Kitajima K, Imanaka K, Kuwata Y, et al. Magnetic resonance imaging of typical polypoid adenomyoma of the uterus in 8 patients:correlation with pathological findings[J]. J Comput Assist Tomogr, 2007, 31:463-468. doi:  10.1097/01.rct.0000243447.03116.0c
    [13] Nasu K, Sugano T, Miyakawa I. Adenomyomatous polyp of the uterus[J]. Int J Gynecol Obstet, 1995, 48:319-321. doi:  10.1016/0020-7292(94)02312-M
    [14] Mazur MT. Atypical polypoid adenomyomas of the endometrium[J]. Am J Surg Pathol, 1981, 5:473-482. doi:  10.1097/00000478-198107000-00006
    [15] 陈波, 朱兰, 郎景和.子宫内膜非典型息肉样腺肌瘤的临床特点[J].中华医学杂志, 2012, 92:1049-1051. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyx201215010
    [16] Heatley MK. Atypical polypoid adenomyoma:a systematic review of the English literature[J]. Histopathology, 2006, 48:609-610. doi:  10.1111/j.1365-2559.2005.02315.x
    [17] Yahata T, Nonaka T, Watanabe A, et al. Complete hysteroscopic resection of a large atypical polypoid adenomyoma, followed by a successful pregnancy[J]. Fertil Steril, 2011, 95:2435.e9-2435.e11. http://www.sciencedirect.com/science/article/pii/S0015028211004973
    [18] Early Breast Cancer Trialists' Collaborative Group. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival:an overview of the randomised trials[J]. Lancet, 2005, 365:1687-1717. doi:  10.1016/S0140-6736(05)66544-0
    [19] Swerdlow AJ, Jones ME. Tamoxifen treatment for breast cancer and risk of endometrial cancer:a case-control study[J]. J Natl Cancer Inst, 2005, 97:375-384. doi:  10.1093/jnci/dji057
    [20] Cuzick J, Forbes JF, Sestak I, et al. Long-term results of tamoxifen prophylaxis for breast cancer-96-month follow-up of the randomized IBIS-I trial[J]. J Natl Cancer Inst, 2007, 99:272-282. doi:  10.1093/jnci/djk049
    [21] Davies C, Pan H, Godwin J, et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer:ATLAS, a randomised trial[J]. Lancet, 2013, 381:805-816. doi:  10.1016/S0140-6736(12)61963-1
    [22] Marttunen MB, Cacciatore B, Hietanen P, et al. Prospective study on gynaecological effects of two antioestrogens tamoxifen and toremifene in postmenopausal women[J]. Br J Cancer, 2001, 84:897. doi:  10.1054/bjoc.2001.1703
    [23] Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer:current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study[J]. J Natl Cancer Inst, 2005, 97:1652-1662. doi:  10.1093/jnci/dji372
    [24] Fabres C, Aviles G, De La Jara C, et al. The cesarean delivery scar pouch:clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy[J]. J Ultrasound Med, 2003, 22:695-700. doi:  10.7863/jum.2003.22.7.695
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  • 收稿日期:  2015-04-09
  • 刊出日期:  2015-05-30

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