BANUHAN ŞAHİN, Ömer DEMİRTAŞ, AYSUN BAY KARABULUT, Erkan ALATAŞ, İbrahim Veysel FENKÇİ, Ömer Tolga GÜLER, Serap Aynur SİMAVLI, Özer ÖZTEKİN, Buğra ŞAHİN, Metin AKBULUT

Histeroskopinin jinekolojik problemleri öngörmedeki etkinliği, retrospektif analiz

Amaç: Bu araştırmanın amacı ardışık kültür ortamı ile kesintisiz tek basamaklı kültür ortamının erken dönemde embriyo kaliteleri üzerine olan etkilerini araştırarak, farklı kültür ortamlarında geliştirilmiş embriyoların olası implantasyon potansiyellerini incelemektir.Gereç ve yöntem: Pamukkale Üniversitesi Kadın Hastalıkları ve Doğum ameliyathanesinde 1 Ocak 2013 - 1 Ocak 2015 tarihleri arasında farklı endikasyonlarla H/S uygulanmış 155 hasta retrospektif olarak incelendi. Transvajinal ultrasonografi (TVUSG) ve histerosalpingografi (HSG) ile preoperatif olarak konulmuş tanıları ile H/S operasyonu sırasında yapılan video kayıt gözlemleri ve postoperatif histopatolojik değerlendirme sonuçları karşılaştırıldı. Tüm veriler SPSS 17.0 (Chicago, IL, ABD) istatistik paket programı kullanılarak analiz edildi.Bulgular: Çalışmaya 18 ile 60 yaş arası (ortanca 33) toplam 155 hasta alındı. Preoperatif ön-tanı olarak 8 hastada endometrial kalınlık artışı, 32 hastada endometrial polip, 14 hastada menometroraji, 10 hastada submukoz myom, 5 hastada asherman olduğu düşünülmüştü. 73 hastaya infertilite ve 13 hastaya kayıp ria (rahim içi araç) nedeni ile H/S yapılmıştı. Peroperatif 13 infertil hastaya septum rezeksiyonu yapılmış, 13 kayıp ria çekilmiş, 5 adezyolizis yapılmıştı. Postoperatif histopatoloji sonuçlarına göre 5 basit atipisiz endometrial hiperplazili hasta, 38 endometrial polipli hasta, 7 submukoz myomlu hasta ve 1 plesantal restli hasta bulunmuştu. TVUSG'nin endometrial polipleri predikte etmede sensitivite, spesifite, pozitif ve negatif prediktif değerleri sırasıyla; %63.1, %93.1, %75 ve %88.6 olarak saptandı. Testin geçerliliği %85.8 olarak hesaplandı. Sonuç: Tranvajinal ultrasonografi endometrial patolojilerin değerlendirilmesinde oldukca bilgi verici bir enstüruman olmasına rağmen, kesin patolojiyi belirlemede yeterli olmamaktadır. Histeroskopi eşliğinde biyopsi endometrial patolojilerin değerlendirilmesinde altın standardı oluşturmaktadır. Benzer şekilde, infertil hasta grubunda HSG yer kaplayıcı lezyon varlığını göstermekle birlikte, uterin septum dışında lezyonun natürünü belirlemede yetersiz kalmaktadır.

Effectiveness of hysteroscopy in assessment of gynecologic problems, retrospective analysis

Purpose: We aimed to evaluate the effectiveness of hysteroscopy (H/S) in the assessment of gynaecological problems by comparing preoperative indications with postoperative outcomes of patients undergoing H/S.Materials and methods: : A total of 155 patients who admitted to Pamukkale University, Obstetrics and Gynecology clinic and underwent hysteroscopy with different indications between 1 January 2013 and 1 January 2015 were evaluated retrospectively. Transvaginal ultrasound (TVUSG) and hysterosalpingography (HSG) findings used in preoperative diagnosis were compared with observations in the video recordings obtained during H/S operation and postoperative histopathological examination results. The data was analyzed with SPSS 17.0 software (statistical package for social sciences, Chicago, IL). Results: A total of 155 patients with a median age of 33 were evaluated retrospectively. Increased endometrial thickness was diagnosed in 8 patients, endometrial polyp in 32 patients, menometrorhagia in 14 patients, submucosal myoma in 10 patients, and asherman in 5 patients. Hysteroscopy was performed in 73 patients with infertility, and intrauterine septum resection was performed in 13 of them. Lost intrauterine device (IUD) was removed in 13 patients and adhesiolysis was performed in 5. According to postoperative histopathology reports; 5 patients with simple endometrial hyperplasia without atypia, 38 patients with endometrial polyp, 7 patients with submucosal myoma and 1 patient with placental rest were detected, results were normal in 9 patients. Sensitivity, specificity, positive and negative predictive values and the accuracy for prediction of endometrial polyps with TVUSG in were calculated as; %63.1, %93.1, %75, %88.6 and %%85.8 respectively.Conclusion: Although TVUSG is very informative instrument in the evaluation of endometrial pathologies, it cannot be discriminatory in determining nature of the pathologies. Hysteroscopy guided endometrial biopsy is the gold standard for the evaluation of endometrial pathologies. Similarly, HSG seems to be very effective in detecting space occupying lesions of the endometrium in infertile patient population, but it may not give enough information about the nature of the mass except uterine septum.

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