閉経後の経腟超音波検査で認められる内膜肥厚についての子宮鏡による評価とその有用性について

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  • Usefulness of Hysteroscopy to Assess Thickened Endometrium in Postmenopausal Women Observed by Transvaginal Ultrasound

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Objective: The objectives of this study were: (1) to compare intimal thickening with hysteroscopic findings as well as hysteroscopic and pathological findings observed in menopausal patients; and (2) confirmation of the usefulness of endometrial curettage in combination with hysteroscopy.<BR>Methods: During a three year period from January 2008 through December 2010 at Kizawa memorial hospital, 42 patients in whom intimal thickening was accurately measured by transvaginal ultrasound (TVS) were included in this study. The hysteroscopic findings, degree of intimal thickening, and results of histopathological examination of these cases were retrospectively studied. Hysteroscopic findings, based on gross findings, were classified into five types: polyp-shaped thickening, uterine myomas, thickening without atypical blood vessels, thickening with atypical blood vessels, and atrophy.<BR>Results: The mean age of the 42 women was 58.2±5.8 years, and the mean age of menopause was 50.2±4.6 years. The mean endometrial thickness before surgery was 8.9±3.7 mm. The most common pathologic finding was endometrial polyps (22/42; 52%). When hysteroscopic findings revealed that the thickening was polyp-shaped, pathological findings also revealed endometrial polyps in 19/23 (83%). Endometrial hyperplasia was found in 5/42 (12%). Endometrial cancer was observed in 2/42 (5%). In all cases, the endometrial polyps were resectable by combined hysteroscopy. In this study, postmenopausal bleeding occurred in 10/42 (24%); 3/5 (60%) had endometrial hyperplasia, and 2/2 (100%) had endometrial cancer.<BR>Conclusions: Curettage combined with hysteroscopy allows for accurate diagnosis and treatment and is particularly valuable for evaluation of postmenopausal bleeding.

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