Schwärzler P, Concin H, Bösch H, Berlinger A, Wohlgenannt K, Collins W P, Bourne T H
Department of Obstetrics and Gynaecology, LKH Bregenz, Austria.
Ultrasound Obstet Gynecol. 1998 May;11(5):337-42. doi: 10.1046/j.1469-0705.1998.11050337.x.
The availability of advanced hysteroscopic surgical techniques has changed the management of abnormal uterine bleeding. The aim of this study was to evaluate the use of transvaginal sonography (TVS), sonohysterography (SH) and diagnostic hysteroscopy (DH) for the preoperative assessment of the uterine cavity. The plan was to investigate 100 patients with abnormal uterine bleeding despite conventional medical treatment. The endpoints were uterine abnormalities detected by operative hysteroscopy and histology, and subjective estimates of discomfort during TVS and SH. A total of 104 patients (aged 26-79 years) were recruited and 98 (94%) underwent all three diagnostic procedures. Uterine abnormalities were present in 52 patients (53%). There were 25 cases with at least one endometrial polyp, 17 with submucous fibroids, seven with endometrial hyperplasia and three with an adenocarcinoma. The overall sensitivity of TVS improved after SH from 67 to 87% and the specificity from 89 to 91%. The positive predictive value increased from 88 to 92% and the negative predictive value from 71 to 86%. The use of SH also improved the quality of information about the location and size of polyps and submucous fibroids. Increased endometrial thickness associated with adenocarcinoma was detected in all cases (three of three) by TVS and in four of seven cases of hyperplasia (five of seven cases after SH). Most patients reported minor discomfort during TVS or SH and no side-effects were apparent. The sensitivity of DH was 90% (92% for polyps, 88% for fibroids); two cases with a polyp, two with a submucous fibroid and one with endometrial hyperplasia were not detected. The use of saline infusion to enhance visualization of the endometrium increases the diagnostic accuracy of transvaginal sonography to approach that of diagnostic hysteroscopy and also provides some additional information. This development has implications for the management of uterine bleeding disorders.
先进宫腔镜手术技术的出现改变了异常子宫出血的治疗方式。本研究的目的是评估经阴道超声检查（TVS）、子宫声学造影（SH）和诊断性宫腔镜检查（DH）在子宫腔术前评估中的应用。计划对100例经传统药物治疗后仍有异常子宫出血的患者进行研究。观察终点为手术宫腔镜检查和组织学检查发现的子宫异常，以及TVS和SH检查期间的主观不适估计。共招募了104例患者（年龄26 - 79岁），其中98例（94%）接受了所有三种诊断程序。52例患者（53%）存在子宫异常。有25例至少有一个子宫内膜息肉，17例有黏膜下肌瘤，7例有子宫内膜增生，3例有腺癌。SH检查后，TVS的总体敏感性从67%提高到87%，特异性从89%提高到91%。阳性预测值从88%提高到92%，阴性预测值从71%提高到86%。SH的使用还提高了有关息肉和黏膜下肌瘤位置及大小的信息质量。TVS在所有腺癌病例（3例中的3例）中均检测到与腺癌相关的子宫内膜厚度增加，在7例增生病例中的4例（SH检查后7例中的5例）中检测到。大多数患者在TVS或SH检查期间报告有轻微不适，且未发现明显副作用。DH的敏感性为90%（息肉为92%，肌瘤为88%）；有2例息肉、2例黏膜下肌瘤和1例子宫内膜增生未被检测到。使用生理盐水灌注以增强子宫内膜的可视化，可提高经阴道超声检查的诊断准确性，使其接近诊断性宫腔镜检查，并且还能提供一些额外信息。这一进展对子宫出血性疾病的治疗具有重要意义。
