| Objective:In accordance with abnormal uterine bleeding patients as the research object,through the retrospective analysis method,understand the clinical characteristics,age of onset,endometrial situation,the duration of symptoms,analysis of hysteroscopy combined with clinical information,the value and role of diagnosis and treatment of abnormal uterine bleeding,to the early diagnosis of abnormal uterine bleeding guidance of a certain clinical value.Methods:Methods from October 2016 to October 2017,500 cases of AUB in Affiliated Hospital of Yan'an University gynecology clinic were selected,and transvaginal ultrasound,hysteroscopy and postoperative pathological diagnosis were selected.The pathological diagnosis was used as the "gold standard" to record the age,clinical features,and endometrial thickness of AUB patients.The related data were input into SPSS 22 software for processing and analysis,so as to explore the difference between vaginal ultrasonography and hysteroscopy in the diagnosis of common etiologies of AUB,and the guiding role in AUB diagnosis.Result:1.PALM-COEIN etiological classification of pathological diagnosis of AUB:500 patients with AUB were classified according to PALM-COEIN after pathological diagnosis,with 219 structural abnormalities(43.80%)and 281 non-structural abnormalities(56.20%).The most common cause of structural abnormality is AUB-P for AUB,and the most common cause for unstructured anomalies is AUB-O.The ages of patients with structural abnormalities and non-structural abnormalities were 20-54 years old [(32.7± 8.9)years old] and 20-54 years old [(34.9±8.0)years old].The age group of the two groups was compared,P = 0.041,P< 0.05,the difference was statistically significant.See Table 1.2.The age distribution and etiologies of 500 cases of AUB:500 cases of AUB were 20~29 years old:83 cases,accounting for 16.60%,30~39 years old 167 cases,accounting for 33.40%,40~49 years old 198 cases,accounting for 39.60%,198 years old 198 cases,accounted for the ratio.As can be seen from the table 20~29: the most common disease because of dysfunctional uterine bleeding,30~39 of the most common disease because of endometrial polyps,40~49 of the most common disease because of dysfunctional uterine bleeding,50~54 years old the most common etiology of endometrial lesions.See Table 2.3.Analysis of 500 cases of AUB patients with endometrial pathology:500 cases of AUB patients were compared in proliferative phase and secretory phase endometrium(normal endometrium)in 181 cases,the average thickness of endometrium was 6.87 + 2.29 mm,152 cases of endometrial polyps endometrial thickness is 8.33 + 0.54 mm,62 cases of patients with endometrial hyperplasia(including atypical hyperplasia 6)mean intimal thickness was 12.80 + 0.46 mm,13 cases of endometrial carcinoma with thickness of 15.90 + 0.48 mm,27 cases of atrophic endometrium was 2.21 + 0.37 mm.There was a significant difference between the polyps group and the normal group and the atrophic group(P=0.018).There was a significant difference between the hyperplasia group and the normal group(P=0.013),but there was no significant difference between the polyp group and the proliferative group(P>0.05).Hyperplasia group,benign group was 11.1 + 0.34 mm,malignant patients(including endometrial atypical hyperplasia and endometrial carcinoma)mean intimal thickness was 14.90 + 0.37 mm,according to the analysis,compared with patients with benign malignant endometrial thickening,the difference was statistically significant(P < 0.01).There was no statistically significant difference in endometrium uniformity between 500 cases of abnormal uterine bleeding(P>0.05).See Table 3.4.The clinical characteristics of 500 cases of AUB:500 cases of abnormal uterine bleeding in our group,the main clinical manifestations are excessive menstruation,reduced menstruation,prolonged menstrual period,irregular vaginal bleeding and irregular cycle.Among them,the number of patients with irregular vaginal bleeding was the largest,accounting for 42%(212/500),prolonged menstruation accounted for 27%(135/500),and the increase in menstrual volume was 20.40%(102/500),the proportion of menstrual irregularity was 8.80%(44/500),and the reduction of menstrual volume was 1.40%(7/500).In this study,the treatment causes up to irregular vaginal bleeding in 212 cases,84 cases of proliferative phase and secretory endometrium,53 cases of endometrial polyps,26 cases of endometrial hyperplasia,19 cases of submucous myoma,7 cases of endometrial carcinoma,4 cases of endometrial atypical hyperplasia,3 cases of adenomyosis disease,3 cases of intrauterine residue,2 cases of endometritis.In this study,the AUB patients were pathologically diagnosed in 194 cases of proliferative /secretory endometrium,with a proportion of 38.80%.The second was 152 cases of endometrium polyps,with a proportion of 30.40%.The others were intima hyperplasia in 56 cases,which accounted for 11.20%.Submucous myoma in 43 cases,accounting for 8.60%.There were 27 cases of endometrial atrophy,which accounted for 5.40%.Atypical hyperplasia of endometrium in 6 cases,accounting for 1.20%.There were 10 cases of endometrial carcinoma,which accounted for 2%.5 cases of adenomyosis,accounting for 1.00%.There were 5 cases of residual uterine cavity,which accounted for 1%.2 cases of endometritis,accounting for 0.40%.See Table 4.5.Comparison of pathological examination and vaginal ultrasonography:In the diagnosis of AUB,there were 346 cases of intracavitary lesion and 154 normal uterus,and 256 cases were diagnosed by pathological diagnosis.A total of 178 cases of endometrial polyps were diagnosed by vaginal ultrasonography,and 145 cases were confirmed by pathology.The coincidence rate was 81.46%(145/178).In 45 cases of submucosal myoma,38 cases were confirmed by pathology and the coincidence rate was 84.44%(38/45).There were 19 cases of intrauterine occupying lesion,among which 10 cases of atypical hyperplasia/endometrial carcinoma were confirmed,and the coincidence rate was 52.63%(10/19).There were 27 cases of endometrial atrophy,20 cases confirmed by case,and the coincidence rate was 74.07%(20/27).In the normal uterine cavity,137 cases were confirmed by pathology,and the coincidence rate was 91.33%(137/154).The diagnosis of uterine cavity residues and intrauterine contraceptive abnormalities were respectively diagnosed in 5 cases and 23 respectively,which was completely consistent with the pathological diagnosis,and the coincidence rate was 100%.In the case of intrauterine proliferation,37 cases were confirmed by pathology,and the coincidence rate was 84.09%(37/44).Five cases of adenomyosis of the uterus were confirmed by pathology,and the coincidence rate was 80.00%(4/5).See table 5.6.The results of pathological examination and hysteroscopy were compared: the patients with abnormal uterine bleeding were examined by transvaginal ultrasound before the hysteroscopy.152 cases of endometrium polyp were diagnosed by hysteroscopy,150 cases were diagnosed by pathology,and the coincidence rate was 98.68%.31 cases of hysteroscopy were diagnosed as submucous hysteromyoma,29 cases were diagnosed by pathology,and the coincidence rate was 93.54%.The diagnosis of hysteroscopy was 50 cases of endometrial hyperplasia and 45 cases with pathological diagnosis,the coincidence rate was 90%.30 cases of endometrial carcinoma were diagnosed by hysteroscopy,10 cases were diagnosed by pathology.and the coincidence rate was 43.33%.In 163 cases of normal endometrium diagnosed by hysteroscopy,154 cases were confirmed by pathology,and the coincidence rate was 94.49%.27 cases of hysteroscopy were diagnosed as endometrium atrophy,and 26 cases were confirmed by pathology,The coincidence rate was 96.29%.The coincidence rate of hysteroscopy in diagnosis of intrauterine IUD removal,incarceration and uterine cavity residual and pathological diagnosis was 100%.Hysteroscopy was used to diagnose 22 cases of adenomyosis and 5 cases were confirmed by pathology,The coincidence rate was 22.72%.The diagnosis of endometritis was diagnosed by hysteroscopy,2 cases were confirmed by pathology,The coincidence rate was 100%.See Table 6.7.Transvaginal ultrasound compared with the results of pathological diagnosis: 500 cases of transvaginal ultrasound examination,346 cases were diagnosed with lesions,including 292 pathological abnormalities,54 cases were normal,154 cases of transvaginal ultrasonography in the diagnosis of normal,of which 17 pathological abnormalities,137 cases were normal.Calculated the sensitivity;specificity;positive predictive;negative predictive of in the transvaginal ultrasound diagnosis off the AUB value,the value was 91.53%(292/319);71.73%(137/191);84.39%(292/346);88.96%(137/154).See Table 7.8.Compared with the results of pathological diagnosis : 500 cases of hysteroscopy,by hysteroscopy 343 cases diagnosed with lesions,including 300 pathological abnormalities,43 cases were normal,157 cases of intrauterine diagnosis without lesions,including 9 pathological abnormalities,148 cases were normal.calculated the sensitivity;specificity;positive predictive;negative predictive of in the diagnostic hysteroscopy AUB value,the value was 97.09%(300/309);77.49%(148/191);87.46%(300/343);94.26%(148/157).See Table 8.9.Compared with the rate of hysteroscopy and transvaginal ultrasonography and pathological diagnosis:two methods by 2 test for the diagnosis of various AUB.the coincidence rate of the comparative analysis,compared to EP;Adenomyosis;CE;and Atrophic endometriu in the hyperplasia uterine,there was statistical significance.residual SU;EH;Residual uterine cavity;and IUD in the pathological diagnosis coincidence rate,no significant difference(P>0.05).See Table 9.10.Comparison between transvaginal ultrasound and hysteroscopy results: through the above analysis,vaginal ultrasound and hysteroscopy showed higher sensitivity and positive predictive value,but the specificity and negative predictive value of vaginal ultrasound were significantly lower than hysteroscopy.See table 10.Conclusion:1.1.Hysteroscopy is crucial for the classification of PALM-COEIN,and PALM-COEIN plays a decisive role in the diagnosis and treatment of AUB shunts.2.The etiology of AUB is mainly seen in benign dysfunctional uterine bleeding and endometrial polyps.More common in women of childbearing age at the age of 30~49,the main cause of clinical diagnosis is irregular vaginal bleeding.3.It is very important for us to evaluate endometrial thickness by transvaginal ultrasound.It is very important for early evaluation of endometrial lesions.Combined with the characteristics of hysteroscopy,we can early evaluate endometrial benign and malignant lesions.4.Transvaginal ultrasonography has a high sensitivity and positive predictive value in screening for intrauterine lesions,which is superior to hysteroscopy.But hysteroscopy is better in the etiological typing of AUB.It is proved that these two methods have their own advantages and can make up for the disadvantages of each other.Therefore,in the diagnosis of AUB disease,two methods should be used to improve the accuracy of diagnosis. |
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