Nagele F, O'Connor H, Davies A, Badawy A, Mohamed H, Magos A
University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, United Kingdom.
Obstet Gynecol. 1996 Jul;88(1):87-92. doi: 10.1016/0029-7844(96)00108-1.
To evaluate the feasibility and acceptability of outpatient diagnostic hysteroscopy.
The outcome of 2500 consecutive outpatient hysteroscopies was analyzed. Cervical dilation was performed when necessary and local anesthesia was not administered routinely. Endometrial biopsy and minor hysteroscopic procedures were carried out when indicated. Findings and outcome were compared according to patient characteristics.
The most common indication for hysteroscopy was abnormal uterine bleeding (87%). Hysteroscopy was performed successfully in 96.4%, and a complete view of the uterine cavity was obtained in 88.9%. Local anesthesia was used in 29.8% and was associated with the need for cervical dilation; both local anesthetic use and cervical dilation were significantly more often required in nulligravid, nulliparous, and postmenopausal women. Intrauterine pathology was diagnosed in 48%, the highest incidence being found in those 50-60 years old (53.7%). The presence of fibroids was the most common abnormality (24.3%) but was seen in only 6.8% of women older than 60 years. Conversely, the incidence of endometrial polyps increased with age, up to 20.5% in women over 60 years. Endometrial biopsy was performed in 68% and produced adequate tissue for histologic examination in 83.7%. Endometrial hyperplasia or carcinoma was detected in 1%. One hundred sixteen women (4.6%) underwent a minor hysteroscopic procedure.
Outpatient diagnostic hysteroscopy is both feasible and acceptable in the overwhelming majority of cases, with a high detection rate for intrauterine pathology. This procedure may become as routine in the 21st century as D&C has been in the 20th.
评估门诊诊断性宫腔镜检查的可行性和可接受性。
分析连续2500例门诊宫腔镜检查的结果。必要时进行宫颈扩张，不常规给予局部麻醉。根据指征进行子宫内膜活检和小型宫腔镜手术。根据患者特征比较检查结果。
宫腔镜检查最常见的指征是子宫异常出血（87%）。96.4%的检查成功完成，88.9%的患者获得了子宫腔的完整视野。29.8%的患者使用了局部麻醉，且这与宫颈扩张的需求相关；未孕、未产和绝经后女性使用局部麻醉和进行宫颈扩张的情况明显更为常见。48%的患者诊断出子宫内病变，其中50 - 60岁的患者发病率最高（53.7%）。子宫肌瘤是最常见的异常情况（24.3%），但在60岁以上的女性中仅占6.8%。相反，子宫内膜息肉的发病率随年龄增长而增加，60岁以上女性中高达20.5%。68%的患者进行了子宫内膜活检，其中83.7%获取了足够的组织用于组织学检查。1%的患者检测出子宫内膜增生或癌。116名女性（4.6%）接受了小型宫腔镜手术。
门诊诊断性宫腔镜检查在绝大多数情况下既可行又可接受，子宫内病变的检出率高。该检查在21世纪可能会像刮宫术在20世纪一样成为常规检查。
