Analysis of office hysteroscopy indication change tendency from 2004 to 2013

doi:10.3877/cma.j.issn.1673-5250.2015.06.018

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

Key words: Hysteroscopes, Ambulatory care, Indication, Analysis, Gynecological examination

表1 2004－2013年门诊宫腔镜手术数量构成比[例数(%)]

时间段	例数	诊断	治疗
前5年	1 486	1 209(81.4)	277(18.6)
后5年	13 515	10 883(80.5)	2 632(19.5)
χ²值	?	0.596
P值	?	0.440

表1 2004－2013年门诊宫腔镜手术数量构成比[例数(%)]

时间段	例数	诊断	治疗
前5年	1 486	1 209(81.4)	277(18.6)
后5年	13 515	10 883(80.5)	2 632(19.5)
χ²值	?	0.596
P值	?	0.440

表2 2004－2013年采用门诊宫腔镜手术对妇科疾病进行诊断的指征构成比

诊断指征	例数	前5年		后5年
诊断指征	例数	顺位	例数(%)	顺位	例数(%)
月经量少或闭经	3 805	2	300 (24.8)	1	3 505 (32.2)
不孕症	3 495	3	255 (21.1)	2	3 240 (29.8)
异常阴道出血	2 904	1	458 (37.9)	3	2 446 (22.5)
生殖道畸形	1 117	5	80(6.7)	4	1 037(9.5)
宫腔占位性病变(肌瘤)	563	4	108(8.9)	5	455(4.2)
宫内残留	121	7	4(0.3)	6	117(1.1)
IUD异位	50	6	1(0.1)	7	49(0.4)
恶性肿瘤及癌前病变	37	8	3(0.2)	8	34(0.3)
总计	12 092	?	1 209(100.0)	?	10 883(100.0)

表2 2004－2013年采用门诊宫腔镜手术对妇科疾病进行诊断的指征构成比

诊断指征	例数	前5年		后5年
诊断指征	例数	顺位	例数(%)	顺位	例数(%)
月经量少或闭经	3 805	2	300 (24.8)	1	3 505 (32.2)
不孕症	3 495	3	255 (21.1)	2	3 240 (29.8)
异常阴道出血	2 904	1	458 (37.9)	3	2 446 (22.5)
生殖道畸形	1 117	5	80(6.7)	4	1 037(9.5)
宫腔占位性病变(肌瘤)	563	4	108(8.9)	5	455(4.2)
宫内残留	121	7	4(0.3)	6	117(1.1)
IUD异位	50	6	1(0.1)	7	49(0.4)
恶性肿瘤及癌前病变	37	8	3(0.2)	8	34(0.3)
总计	12 092	?	1 209(100.0)	?	10 883(100.0)

表3 2004－2013年采用门诊宫腔镜手术进行妇科疾病诊断的指征为恶性肿瘤及癌前病变的分类情况[例数(%)]

恶性肿瘤及癌前病变	例数	前5年	后5年
子宫内膜癌	14	3(21.4)	11 (78.6)
子宫内膜非典型增生	10	0	10(100.0)
宫颈癌前病变(CINⅠ～Ⅲ)	9	0	9(100.0)
乳腺癌根治术后	2	0	2(100.0)
阴道癌	1	0	1(100.0)
滋养细胞肿瘤	1	0	1(100.0)
总计	37	3(8.1)	34 (91.9)

表3 2004－2013年采用门诊宫腔镜手术进行妇科疾病诊断的指征为恶性肿瘤及癌前病变的分类情况[例数(%)]

恶性肿瘤及癌前病变	例数	前5年	后5年
子宫内膜癌	14	3(21.4)	11 (78.6)
子宫内膜非典型增生	10	0	10(100.0)
宫颈癌前病变(CINⅠ～Ⅲ)	9	0	9(100.0)
乳腺癌根治术后	2	0	2(100.0)
阴道癌	1	0	1(100.0)
滋养细胞肿瘤	1	0	1(100.0)
总计	37	3(8.1)	34 (91.9)

表4 2004－2013年采用门诊宫腔镜手术对妇科疾病进行治疗的指征构成比

治疗指征	例数	前5年		后5年
治疗指征	例数	顺位	例数(%)	顺位	例数(%)
宫内残留胎盘清宫术	1 178	3	69(24.9)	1	1 109 (42.1)
Ⅰ度～Ⅱ度宫腔黏连分离术	1 011	1	103(37.2)	2	908 (34.5)
断裂或嵌顿的IUD取出术	228	4	10(3.6)	3	218(8.3)
宫腔镜联合经阴道注水腹腔镜检查	159	5	5(1.8)	4	154(5.9)
子宫内膜去除术	147	6	0	5	147(5.6)
宫颈癌根治术后取双J管	43	6	0	6	43(1.6)
子宫内膜去除术	111	2	90(32.5)	7	21(0.8)
0型黏膜下肌瘤剔除术	20	6	0	8	20(0.76)
内膜癌根治术后取双J管	12	6	0	9	12(0.5)
总计	2 909	?	277(100.0)	?	2 632(100.0)

表4 2004－2013年采用门诊宫腔镜手术对妇科疾病进行治疗的指征构成比

治疗指征	例数	前5年		后5年
治疗指征	例数	顺位	例数(%)	顺位	例数(%)
宫内残留胎盘清宫术	1 178	3	69(24.9)	1	1 109 (42.1)
Ⅰ度～Ⅱ度宫腔黏连分离术	1 011	1	103(37.2)	2	908 (34.5)
断裂或嵌顿的IUD取出术	228	4	10(3.6)	3	218(8.3)
宫腔镜联合经阴道注水腹腔镜检查	159	5	5(1.8)	4	154(5.9)
子宫内膜去除术	147	6	0	5	147(5.6)
宫颈癌根治术后取双J管	43	6	0	6	43(1.6)
子宫内膜去除术	111	2	90(32.5)	7	21(0.8)
0型黏膜下肌瘤剔除术	20	6	0	8	20(0.76)
内膜癌根治术后取双J管	12	6	0	9	12(0.5)
总计	2 909	?	277(100.0)	?	2 632(100.0)

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