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探讨宫腔镜对绝经后阴道流血的病因诊断和激光治疗的安全性和有效性。方法:对139例绝经后阴道流血患者作宫腔镜检查,根据镜下诊断结果分别行诊断性刮宫和宫腔镜直视下Nd:YAG激光治疗。结果:以病理标准为金标准,则宫腔镜诊断子宫内膜癌及子宫肉瘤的敏感性为100％,特异性为100％。诊断子宫内膜息肉的敏感性为97.1％,特异性为100％。诊断粘膜下肌瘤的敏感性为100％,特异性为100％。诊断萎缩性子宫内膜炎的敏感性为100％,特异性为100％。宫腔镜诊断与病理学诊断具有高度的一致性。所有手术均顺利进行,平均手术时间3.0±10.2分钟(3～30分钟),患者对宫腔镜检查的耐受性较好,术中术后未发生严重并发症,术后B超随访1～3月宫腔内赘生物均消失。结论:宫腔镜检查对绝经后阴道流血的病因具有较高的诊断价值,宫腔镜下激光治疗宫腔内良性病变如子宫内膜息肉和子宫粘膜下肌瘤安全可行。
To explore the hysteroscopic diagnosis of post-menopausal vaginal bleeding and laser treatment of the safety and effectiveness. Methods: 139 cases of postmenopausal vaginal bleeding patients for hysteroscopy, according to the diagnosis of microscopic diagnosis of curettage and hysteroscopic direct Nd: YAG laser treatment. Results: The pathological criteria for the gold standard, the hysteroscopic diagnosis of endometrial cancer and uterine sarcoma sensitivity was 100%, specificity of 100%. The diagnosis of endometrial polyps sensitivity was 97.1%, specificity was 100%. The diagnosis of submucosal fibroids sensitivity was 100%, specificity of 100%. The diagnosis of atrophic endometritis is 100% sensitive and 100% specific. Hysteroscopy diagnosis and pathology with a high degree of consistency. All operations were carried out smoothly, with an average operation time of 3.0 ± 10.2 minutes (3 to 30 minutes). The patients were well tolerated by hysteroscopy and no serious complications occurred during or after operation. The postoperative B- March intrauterine neoplasm disappeared. Conclusion: Hysteroscopy has a high diagnostic value for the cause of vaginal bleeding after menopause. Hysteroscopic laser treatment of benign lesions in the uterine cavity such as endometrial polyps and uterine fibroids is safe and feasible.