Adenomyozis teşhisinde histeroskopinin değeri

Abstract

6. ÖZET Adenomyozis endometrial gland ve stromanın myometrium içinde bulunmasıdır. Hastalığın tanısı histopatolojik olarak konmaktadır. Dismenore, menoraji ve uterus büyümesi ile karekterize bu semptomlar çoğu zaman major operasyonlara sebep olmaktadır. Çalışmada adenomyozisi ameliyat olmadan, histeroskopi ile teşhis etmek amaçlandı. Selçuk Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği'nde benign sebeplerle histerektomi planlanan 58 vaka araştırmaya alındı. Vakalara önce histeroskopi sonra histerektomi uygulanarak iki bulgu karşılaştırıldı. Histeroskopide endometrial glandların durumu, büyük persiste ostiumun görülmesi ve anormal damarlanmanın mevcudiyeti ile damarların artışı ve genişlemesi, düzensiz uzantıları ve ani kesilmeleri ile endometriumda trabekülasyonlar adenomyozisi düşündürdü. Histeroskopi ile 14 vakaya (% 24.1) adenomyozis tanısı konuldu. Bunlardan 7'sinde histopatolojik olarak adenomyozis bulunurken 7'sinde gözlenemedi. Aksine 44 vakada histeroskopi ile adenomyozis tesbit edilemezken, bunlardan 7'sinde histopatolojik olarak adenomyozis mevcuttu. Bu sonuçlara göre histeroskopinin adenomyozisi teşhis etmedeki seçiciliği (Spesifite) % 53.6, duyarlılığı (Sensitivite) % 50 ve toplam tutarlılık ise % 54.8 olarak bulundu. Histeroskopi adenomyozisi ameliyat olmadan önce de teşhis edebilmekte ümit verici sonuçlar verdiği görüldü. Bu çalışmada histopatolojik olarak % 24.1 oranında adenomyozis tesbit edildi. Anahtar kelimeler : Histeroskopi, Adenomyozis, CA-125, Endometriozis 40

7. SUMMARY EVALUATION OF HYSTEROSCOPY IN THE DIAGNOSIS OF ADENOMYOSIS Adenomyosis is a disease entity in which endometrial glands and stroma are present in the myometrium. The diagnosis of the disease is made by histopathologic examination. The symptoms of the disease are dysmenorrhea, menorrhagia and enlarged uterus. Due to these symptoms a great portion of the patients undergo major operations. In this study it was targeted to diagnose the adenomyosis without an oparation but by hysteroscopy. It was studied 58 patients who will undergo an hysterectomy operation due to benign disorder in Selçuk University Faculty of Medicine Obstetrics and Gynecology Department. It was first performed hysteroscopy and than hysterectomy and compared the findings. During hysteroscopy was noted the status of the endometrial glands and vessels. The criteria of adenomyosis by hysteroscopy was the presence of persistent large glandüler ostium and the abnormal vessels. Number of the vessels are increased and they are dilated with netted pattern, irreguler running and/or sudden disruption of the running regardless of menstrual cycle. Severe adenomyosis has o typical hysteroscopic appearence of cavities and trabeculations. It was diagnosed adenomyosis in 14 patients by histeroscopy. It was diagnosed adenomyosis in 7 of these patients histopathologically, while 7 of the patients were free of disease. In contrast 44 patients were found to be free of adenomyosis by hysteroscopy but histopathologically 7 of them were found to have adenomyosis. According to these findings the sensitivity of the his teroscopy was 50 %, the specificity was 53.6- %, where as the total consistency was 54.8 %. It could have been diagnosed adenomyosis with a hopeful percentage of sensitivity without an operation by hys teroscopy. In this study was found, adenomyosis in 24.1 % of the patiens histopathologically. Key words: Hysteroscopy, Adenomyosis, CA-125, Endometriosis 41