子宫内膜取样方法的演变与进展

doi:10.12280/gjfckx.20230697

摘要/Abstract

摘要：

子宫内膜病变是妇科的常见病、多发病。子宫内膜组织病理学是诊断的“金标准”，传统的子宫内膜取样方法是诊断性刮宫术，其为盲法操作，可能造成漏诊，而且可引起患者明显的疼痛。其他子宫内膜取样方法包括子宫内膜组织取样器、子宫内膜细胞学取样器、微量组织子宫内膜取样器和宫腔镜下定位活检等。各子宫内膜取样方法常用于诊断异常子宫出血、慢性子宫内膜炎，部分方法可筛查子宫内膜癌。子宫内膜组织或微量组织取样器可用于子宫内膜病变筛查，但不适用于局灶性病变和内膜萎缩者；子宫内膜细胞学取样器同样适用于子宫内膜病变筛查，特别是内膜萎缩患者，但细胞学诊断无确诊价值；宫腔镜下定位活检可诊断局灶性病变，是子宫内膜取样的“金标准”，但不用于筛查。临床医生要针对不同人群选择适当的方法进行子宫内膜取样。

关键词: 子宫内膜, 子宫内膜肿瘤, 子宫内膜增生, 子宫内膜炎, 子宫出血, 活组织检查, 刮宫术, 宫腔镜检查

Abstract:

Endometrial lesions are common and prevalent gynecological diseases. Endometrial histopathology is the 'gold standard' for diagnosis, the traditional method of endometrial sampling is dilatation and curettage, which is a blind procedure that can causes missed diagnosis and severe pain. Other methods of endometrial sampling include endometrial tissue sampler, endometrial cytology sampler, microscale endometrial sampler and hysteroscopic-guided biopsy, etc. These various methods of endometrial sampling are commonly used to diagnose abnormal uterine bleeding or chronic endometritis, and some can be used for screening endometrial cancer. Endometrial tissue sampler and microscale endometrial sampler are suitable for screening lesions, but not for patients with focal lesions and atrophy endometrium. Endometrial cytology sampler is also used for screening lesions, especially for patients with atrophy endometrium, but cytology has no diagnostic value. Hysteroscopic-guided biopsy can diagnose focal lesions and is the 'gold standard' in endometrial sampling, but is not used for screening. The appropriate methods of endometrial sampling should be used for different kinds of condition.

Key words: Endometrium, Endometrial neoplasms, Endometrial hyperplasia, Endometritis, Uterine hemorrhage, Biopsy, Dilatation and curettage, Hysteroscopy

李英涛, 黄晓武. 子宫内膜取样方法的演变与进展[J]. 国际妇产科学杂志, 2024, 51(1): 105-109.

LI Ying-tao, HUANG Xiao-wu. Evolution and Advances in Endometrial Sampling[J]. Journal of International Obstetrics and Gynecology, 2024, 51(1): 105-109.

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