Anormal Uterin Kanamalı Hastaların Tanısında Dilatasyon ve Küretaj Sonuçları ile Histeroskopi Sonuçlarının Karşılaştırılması

Yıl 2023, Cilt: 2 Sayı: 1, 30 - 35, 30.03.2023

Esin Kasap , Fatmahorasan Altıntaşoğlu

https://doi.org/10.57221/izmirtip.1256711

Öz

Amaç: Anormal uterus kanamaları, kadını, hayatının değişik dönemlerinde fizyolojik psikolojik ve patolojik anlamda etkileyen önemli bir yakınmadır. Sebepleri oldukça geniş bir spektrum içerir. Bu çalışmamızda; anormal uterus kanaması olan premenapozal ve postmenapozal dönemdeki kadınların endometrial patolojilerinin teşhisinde, diagnostik histeroskopinin dilatasyon ve küretaja göre etkinliği ile karşılaştırdık. Gereç ve Yöntemler: Şubat 2002 ve Aralık 2003 yılları arasında SBÜ, İzmir Tepecik Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği’ne (eski ismi SSK Ege Doğumevi ve Kadın Hastalıkları Hastanesi) jinekoloji polikliniğine başvuran anormal uterin kanaması olan veya uterin patolojiden şüphelenilen 40 hasta çalışmaya alındı. Hastaların küretaj materyallerinin histopatolojik bulguları ile histeroskopik bulguları karşılaştırıldı. Bulgular: Olguların %67.5’unda kanama paterni menometroraji iken %20 ’inde metroraji %12.5’unda postmenopozal kanama şeklinde idi. Çalışma grubu içerisinde %52.5 oranında anormal histopatolojik bulgularla karşılaşırken, %47.5 olgunun histopatolojik incelemeleri normal olarak değerlendirildi. Bu dönemde en çok karşılaşılan patolojik bulgu %17.5 oranında hiperplazi iken bunun %15 oranında endometrit %10 oranında endometrial polip ve %7.5 oranında yetersiz mataryel (atrofi) takip etti. Myoma ise %2.5 oranında rastlanmıştır. Hiperplazilerin tamamı basit atipisiz formdaydı. Endometrial maligniteye ise olgularımızda rastlanılmadı. Sonuç: Dilatasyon ve küretaj öncesi histeroskopi yapılırsa uterin kavite direk olarak görüntülenmiş olur böylece anormal endometrial alanlar lokalize edilmiş ve buralara daha fazla forse küretaj yapmama imkanı doğar.

Anahtar Kelimeler

anormal uterin kanama, histeroskopi, dilatasyon ve küretaj

Destekleyen Kurum

--

Proje Numarası

---

Teşekkür

---

WITH D&C RESULTS IN THE DIAGNOSIS OF PATIENTS WITH ABNORMAL UTERINE BLEEDING COMPARISON OF HYSTEROSCOPY RESULTS

Öz

Aim: Abnormal uterine bleeding is an important complaint that affects women physiologically, psychologically and pathologically at different stages of their life. The causes include a fairly broad spectrum. Materials and Methods: Forty patients with abnormal uterine bleeding or suspected uterine pathology who applied to the gynecology outpatient clinic of SSK Ege Maternity and Gynecology Hospital between February 2002 and December 2003 were included in the study. The histopathological findings of the curettage materials of the patients were compared with the hysteroscopic findings. Results: While the bleeding pattern was menometrorrhagia in 67.5% and metrorrhagia was in 20% of the cases, it was postmenopausal bleeding in 12.5% of the cases. While 52.5% of the study group encountered abnormal histopathological findings, Histopathological examinations of 47.5% of the cases were evaluated as normal. In this period, the most common pathological finding was 17.5% hyperplasia, 15% of which was endometritis, 10% endometrial polyp, and 7.5% insufficient material (atrophy). Myoma was found at a rate of 2.5%. All hyperplasias were in simple form without atypia. Endometrial malignancy was not encountered in our cases. Conclusion: If hysteroscopy is performed before dilation and curettage, the uterine cavity will be directly visualized, so that abnormal endometrial areas have been localized and it is possible to avoid further forced curettage.

Anahtar Kelimeler

abnormal uterin bleeding,dilatation and curettage,hysteroscopy

Proje Numarası

---

Kaynakça

• Referans1. Munro MG, Critchley HOD, Fraser IS, Haththotuwa R, Kriplani A, Bahamondes L et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynecol Obstet. 2018;143:393-408.
• Referans2. Volman RF; The menstrual cycle, in Freidman E,editor, Major problems in obstetrics and gynecology, WB Saunders Co.,Philadelphia,1977.
• Referans3.Treolar AE, Boynton RE, Borghild GB, Brown BW. Variation of the human menstrual cycle through reproductive life. Int J Fertil.1967;12:77.
• Referans4. Vasilenko P, Kraicer PF, Kaplan R, de Masi A, Freed N. A new and simple method of measuring menstrual blood loss. J Reprod Med. 1988;33:293-7.
• Referans5. Mc Calusland AM. Hysteroscopic myonsetrial biopsy; its use in diagnosign adenomyosis and its clinical application. Am J Obstet Gynecol. 1992;166:1619-26.
• Referans6. Derman SG, Rehnstorm J, Neuwirh RS. The long term effectiveness of hysteroscopic treatment of menorrhagia and leiomyomas. Obstet and Gynecol. 1991;77:591-4. Referans 7. Abdelazim IA, Abdelrazak KM, Elbiaa AAM, Al-Kadi M, Yehia AH. Accuracy of endometrial sampling compared to conventional dilatation and curettage in women with abnormal uterine bleeding. Arch Gynecol Obstet. 2015; 291:1121-6.
• Referans8. Sauvan M, Pourcelot A-G, Fournet S, Fernandez H, Capmas P. Office hysteroscopy for postmenopausal women:Feasibility and correlation with transvaginal ultrasound.J Gynecol Obstet Hum Reprod.2018;47:505-10.
• Referans9. Loffer FD. Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: the value of a negative hysteroscopic view. Obstet Gynecol. 1989;73:16-20.
• Referans10. Mutter LG, FrerenczyA. Anatomy and Histology of the Uterine Corpus. In: KurmanRJ(ed). Blaustein's Pathology of the Female Genital Tract. 5th edition. New York: Spinger: 2002. Chapter 9, p: 383- 419.
• Referans11. Emanuel MH, Verdel MJC, Stas H, Wamsteker K, Lammes FB. An audit of true prevalence of intra-uterine pathology: the hysteroscopical findings controlled for patient selection in 1202 patients with abnormal uterine bleeding. Gynaecol Endosc. 1995;4:237-41.
• Referans12. Jennigs JC. Abnormal uterine bleeding. Med Clin North Am. 1995;79:1357-76.
• Referans13. Hemalatha AN, Pai MR, Raghuveer CV. Endometrial aspiration cytology by various techniques. J Indian Med Assoc. 2011;109:426-7. Referans14. Grimes DA. Diagnostic dilatation and curettage: a reaprasial. Am J Obstet Gynecol. 1982;142:1-6.
• Referans15. Itzkowic D. Hysteroscopy. Its place in modern gynaecology. Aust Fam Physician. 1992;21:425-9.
• Referans16. Preuttipan S,Linasmita V,Theppisiai U. Diagnostic hysteroscopy: a result of 125 patient AT Ramathudbodi Hoapital. J Med Assoc Thai. 1997;80:575-9.
• Referans17. Kulkarni S,Wynter HH. Diagnistic hysteroscopy. West Indian Med J. 1992;41:160-1.
• Referans18. Ceonhe HS. Diagnostic hysteroscopy after postmenopausal uterine bleeding. A Afr Med J. 1978;66: 773-7.
• Referans19. Iossa A, Coanferoni L,Ciatto S, Cecchini S, Campatelli C, Lo Stumbo F. Hysteroscopy and endometrial cancer dianosis: a reciew of 2007 consecutive examinations in self referred parients. Tumori. 1991;77:479-83.
• Referans20. Haller H- Matecjcic N, Rukacina B, Krasevic M, Rupcic S, Mozetic D. Transvaginal sonography and hysteroscopy in women with postmenopausal bleeding. Int J Gynaecol Obstet. 1996;54:155-9.
• Referans21. Ohad M.Ben-Yehuda,M.D,Young B.Kim,M.D. Does hysteroscopy improve upon the sensitivity of dilatation and currettage in the diagnosis of endometrial hyperplasia or carcinoma? Gynecologic Oncol. 1998; 68: 4-7.
• Referans22. Townsend DE, Fields G, Mc Causland A et al. Diagnostic and operative hysteroscopy in management of persistent postmenopausal bleeding. Obstet Gynecol. 1993;82:419-21.
• Referans23. Finikiotis G. Hysteroscopy: an analysis of 523 patients. Aust N Z J Obstet Gynaecol. 1989;29:253-5.