Clinical Value Of Office Hysteroscopy In The Diagnosis And Treatment Of Endometrial Polyps And Cervical Polyps

Objective: To explore the clinical value of office hysteroscopy in the diagnosis and treatment of endometrial polyps and cervical polyps,analyze the clinical characteristics,pathological types and research progresses of endometrial polyps and cervical polyps,so as to improve the rates of diagnosis and treatment,the quality of life and the clinical prognosis of outpatients with polyps.Methods: A retrospective analysis was made on the medical records of patients with endometrial polyps and cervical polyps which were diagnosed and treated by office hysteroscopy in the obstetrics and gynecology clinics of the Second Hospital of Lanzhou University from January 2015 to June 2016.The findings of office hysteroscopy and ultrasonography were compared with the histological results respectively to know the accuracy of hysteroscopy in the diagnosis of endometrial polyps and cervical polyps.At the same time,the security and feasibility of office hysteroscopic polypectomy in treating endometrial polyps and cervical polyps were analyzed.SPSS 19.0 software was applied for ?2 test and Kappa test.Results: 1.A total of 772 cases of polyps were diagnosed by hysteroscopy,including 384 cases of endometrial polyps,342 cases of cervical polyps,46 cases of cervical polyps co-existing with endometrial polyps.Among them,569 cases(73.70%)of the patients were diagnosed mainly because of abnormal uterine bleeding,postmenopausal bleeding,increased vaginal discharge,abdominal pain and infertility accounted for 6.35%,4.66%,4.02% and 3.63%,respectively.Another 7.64% of the patients were asymptomatic and found in gynecological examinations.2.66 cases of polyps which had no pathological or ultrasound results were ruled out,the remaining 706 cases diagnosed pathologically were endometrial polyps in 316 cases,cervical polyps in 312 cases,cervical polyps co-existing with endometrial polyps in 43 cases,the other 35 cases were non-polyp patients.The 312 cases of cervical polyps and 43 cases of co-existing polyps were all benign lesions.There were 3 cases of hyperplasia with atypia and 1 case of carcinomatous polyps in the endometrial polyps,the prevalence of premalignant and malignant polyps comprised 1.3% of the cases.3.Based on histopathological results,the sensitivity,agreement rate and Youden’s index of hysteroscopy in the diagnosis of endometrial polyps were 96.52%,93.77% and 0.88 respectively,the above indexes for cervical polyps and co-existing polyps were 98.72%,97.45% and 0.95,97.67%,99.29% and 0.97 respectively.While the sensitivity,agreement rate and Youden’s index of ultrasonography in the diagnosis of endometrial polyps were 58.23%、75.07% and 0.47,the above indexes for cervical polyps and co-existing polyps were 23.40%,65.30% and 0.22,and2.33%,94.05% and 0.02,respectively.When compared the diagnosis results of hysteroscopy and ultrasound with the acceptance standard of ?=0.05,the difference was statistically significant(P<0.05).4.Kappa test was applied to analyze the consistency of hysteroscopy and ultrasound diagnosis with pathological results,respectively.It showed that ultrasound had a moderate consistency with pathological results in the diagnosis of endometrial polyps,but a low consistency in the cervical polyps and cervical polyps co-existing with endometrial polyps.However,hysteroscopy showed a high consistency with pathological results in the diagnosis of all these three types of polyps.The difference betwween hysteroscopy and ultrasound was statistically significant(P<0.05).5.A successful see-and-treat hysteroscopic polypectomy was performed in 185 cases of polyps in an outpatient setting,including 152 cases of cervical polyps,21 cases of endometrial polyps and 12 cases of co-existing polyps.Polyps were mostly single,smaller in size(≤2cm)and pedicle,and the average operation time was less than 15 min.There were no serious complications occurred except for 4 cases with vagal symptoms such as dizziness,nausea and hypotension.Conclusions: 1.Endometrial polyps and cervical polyps mainly cause abnormal uterine bleeding,followed by postmenopausal bleeding,increased vaginal discharge and infertility.Both of them have the risk of malignant,for the reason that the clinical diagnosis should be made as soon as possible and treat them targetedly.2.The accuracy and consistency with the pathological results of office hysteroscopy in the diagnosis of endometrial polyps,cervical polyps,especially the co-existing polyps are higher than those of ultrasound.Ultrasound can be used as a screening method for polyps,but the final diagnosis still need be made by hysteroscopy and biopsy under its guidance.3.Office hysteroscopic polypectomy is a safe,feasible and well tolerated method for the treatment of polyps with thin pedicle,single and size no more than 2cm,which should be popularized and applied.