分析2004－2013年湖北省妇幼保健院妇科门诊宫腔镜手术指征变化趋势，探讨门诊宫腔镜手术在妇科疾病诊治中的价值。

选择2004－2013年于湖北省妇幼保健院妇科门诊宫腔镜检中心就诊的15 001例接受门诊宫腔镜手术患者的临床病历资料为研究对象。将2004－2013年分为2个阶段，即前5年(2004－2008年)和后5年(2009－2014年)。将所有患者的术前拟诊情况为指征，将其分为对妇科疾病采用门诊宫腔镜手术进行诊断和治疗2种类型，再按照前5年和后5年分别进行统计，并对2个阶段进行比较。本研究遵循的程序符合湖北省妇幼保健院人体试验委员会制定的伦理学标准，得到达该委员会的批准。

①2004－2013年门诊宫腔镜手术共完成15 001例，其中采用门诊宫腔镜手术对妇科疾病进行诊断者为12 092例，治疗者为2 909例。②前5年门诊采用宫腔镜手术对妇科疾病进行诊断的指征前3位分别为异常阴道出血(37.9%，458/1 209)、月经量少或闭经(24.8%，300/1 209)及不孕症(21.1%，255/1 209)；后5年中的前3位分别为月经量少或闭经(32.2%，3 505/10 883)、不孕症(29.8%，3 240/10 883)及异常阴道出血(22.5%，2 446/10 883)。③前5年门诊采用宫腔镜手术对妇科疾病进行治疗的指征前3位分别为Ⅰ°～Ⅱ°宫腔黏连分离术(37.2%，103/277)、子宫内膜去除术(32.5%，90/277)、宫内残留胎盘清宫术(24.9%，69/277)，后5年中的前3位分别为宫内残留胎盘清宫术(42.1%，1 109/2 632)、Ⅰ°～Ⅱ°宫腔黏连分离术(34.5%，908/2 632)、断裂或嵌顿的宫内节育器(IUD)取出术(8.3%，218/2 632)。

2004－2013年门诊宫腔镜手术指征变化不大，但后5年的就诊患者的数量较前5年增加。采用门诊宫腔镜手术进行检查联合活组织检查是诊断宫腔内疾病的金标准。在具备条件的情况下采用门诊宫腔镜手术进行治疗可以缩短患者就诊时间。

To analyze office hysteroscopy indication change tendency in Hubei Province Maternal and Child Health Care Hospital between 2004 and 2013, and to discuss the value of office hysteroscopy in diagnosing and treating of gynecology diseases.

A retrospective analysis was made on the 15 001 outpatients who received office hysteroscopy from 2004 to 2013. Firstly, the 10 years were divided into two stages, the former 5 years (2004-2008) and the latter 5 years (2009-2014). Furthermore, all the patients were divided into diagnose indication and therapeutic indication according to preoperative diagnosis. The comparison was conducted on diagnose indication and therapeutic indication by different periods. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Hubei Province Maternal and Child Health Care Hospital.

① A total of 15 001 outpatients underwent office hysteroscopy between 2004 and 2013, among which 12 092 cases for diagnose indication and the rest for therapeutic indication. During the former 5 years, the top three diagnose indications were abnormal vaginal bleeding (37.9%, 458/1 209), menstrual quantity decreasing or amenorrhea(24.8%, 300/1 209), and infertility (21.1%, 255/1 209), and during the latter 5 years, the top three diagnose indications were menstrual quantity decreasing or amenorrhea(32.2%, 3 505/10 883), infertility (29.8%, 3 240/10 883) and abnormal vaginal bleeding (22.5%, 2 446/10 883). ③Meanwhile, during the former 5 years, the top three therapeutic indications were degree Ⅰ-Ⅱ intrauterine adhesions (37.2%, 103/277), endometrial ablation(32.5%, 90/277) and uterine curettage (24.9%, 69/277); and during the latter 5 years, the top three therapeutic indications were uterine curettage (42.1%, 1 109/2 632), degree Ⅰ-Ⅱ intrauterine adhesions(34.5%, 908/2 632) and intrauterine device(IUD) removing (8.3%, 218/2 632).

There were little changes of office hysteroscopy indications between 2004 and 2013, but the case number increased significantly. Targeted hysteroscopic biopsy was the gold standard in the diagnosis of the uterine cavity diseases. The patients who were treated with office hysteroscopy spend less time than the one who was treated with hysteroscopy in the operating room.