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目的探讨窄带成像(narrow-band imaging,NBI)宫腔镜和普通白光成像(white light imaging,WLI)宫腔镜在子宫内膜病变诊断中的应用价值。方法选取行宫腔镜诊断者213例,行宫腔镜检查,对发现的病灶依次使用WLI和NBI模式进行病灶性质的判断,以病理诊断作为金标准,比较两种观察模式对子宫内膜病变的诊断作用。结果213例患者中共取病灶标本442份,病理诊断:正常56份(占12.7%)、子宫内膜息肉62份(占14.0%)、黏膜下肌瘤15份(占3.4%)、子宫内膜炎28份(占6.3%)、萎缩性子宫内膜34份(占7.7%)、子宫内膜蜕膜样变33份(占7.5%)、低风险子宫内膜增生49份(占11.1%,包括单纯性增生31份、复杂性增生18份)、高风险内膜增生(子宫内膜轻、中、重度非典型增生)92份(占20.8%)、子宫内膜癌53份(占12.0%)。①对于单纯性增生和复杂性增生:NBI和WLI诊断的灵敏度分别为79.6%和49.0%(P=0.003);特异度分别为99.0%和97.2%,(P=0.039)。②对于子宫内膜非典型增生:NBI和WLI诊断的灵敏度分别为93.5%和82.6%(P=0.006);特异度分别为99.1%和92.3%(P=0.001)。③对于子宫内膜癌:NBI和WLI诊断的灵敏度分别为98.1%和73.6%(P=0.000);特异度为99.0%和97.4%(P=0.031),差异均有统计学意义。结论 NBI宫腔镜可以提高对子宫内膜病变诊断的灵敏度和特异度。子宫内膜血管形态和结构的改变越明显,NBI宫腔镜诊断的灵敏度越高;对异型血管的判断,有助于镜下区分子宫内膜良性增生、子宫内膜不典型增生和子宫内膜癌。NBI宫腔镜可加强宫腔镜下内膜定位活检的针对性,减少漏诊。
Objective To investigate the value of narrow-band imaging (NBI) hysteroscopy and white light imaging (WLI) hysteroscopy in the diagnosis of endometrial lesions. Methods Totally 213 cases diagnosed by hysteroscopy were examined by hysteroscopy. WLI and NBI patterns were used to determine the nature of lesion. The pathological diagnosis was taken as the gold standard. The diagnosis of endometrial lesions was compared between the two observation modes effect. Results A total of 442 specimens were collected from 213 patients. The pathological findings were as follows: normal 56 (12.7%), endometrial polyps 62 (14.0%), submucosal fibroids 15 (3.4%), endometrial 28 (6.3%), 30 atrophic endometrial (7.7%), 33 endometrial decidua (7.5%), 49 low risk endometrial hyperplasia (11.1% Including 31 cases of simple hyperplasia and 18 cases of complicated hyperplasia), 92 cases (20.8%) of high risk endometrial hyperplasia (endometrial light, moderate and severe atypical hyperplasia), 53 cases of endometrial carcinoma (12.0% ). ①For simple hyperplasia and complex hyperplasia, the sensitivities of NBI and WLI were 79.6% and 49.0% respectively (P = 0.003); the specificity was 99.0% and 97.2% respectively (P = 0.039). ② For atypical hyperplasia of the endometrium, the sensitivities of NBI and WLI were 93.5% and 82.6% respectively (P = 0.006); the specificity was 99.1% and 92.3% (P = 0.001) respectively. ③ For endometrial carcinoma: The sensitivity of NBI and WLI in diagnosis was 98.1% and 73.6% respectively (P = 0.000); the specificity was 99.0% and 97.4% (P = 0.031) respectively. The differences were statistically significant. Conclusion NBI hysteroscopy can improve the sensitivity and specificity of the diagnosis of endometrial lesions. The more obvious the change of morphology and structure of endometrial blood vessels, the higher the sensitivity of hysteroscopy in diagnosis of NBI; the judgment of abnormal blood vessels can help differentiate benign endometrial hyperplasia, endometrial dysplasia and endometrium cancer. NBI hysteroscopy can enhance the targeted endometrial biopsy hysteroscopy to reduce missed diagnosis.