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Ultrazvuk endometrija u postmenopauzi

Ultrazvuk endometrija u postmenopauzi. Boris Ujević. Postmenopauza. Žene koje krvare Asimptomatske Ultrazvučni pregled vaginalnom sondom. Žene u postmenopauzi s krvarenjem. Tanki endometrij - praćenje Zadebljani endometrij – dijagnoza Što je “tanki”, a što “debeli” endometrij?.

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Ultrazvuk endometrija u postmenopauzi

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  1. Ultrazvuk endometrija u postmenopauzi Boris Ujević

  2. Postmenopauza • Žene koje krvare • Asimptomatske • Ultrazvučni pregled vaginalnom sondom

  3. Žene u postmenopauzi s krvarenjem • Tanki endometrij - praćenje • Zadebljani endometrij – dijagnoza • Što je “tanki”, a što “debeli” endometrij?

  4. Žene u postmenopauzi s krvarenjem • mjeri se “double layer” • gotovo da nema rada koji opisuje Ca-endometrija ispod 4mm • gotovo 100% negativna prediktivna vrijednost

  5. Žene u postmenopauzi s krvarenjem • “4mm or less has a risk of malignancy of one in 917, and therefore endometrial biopsy is not required” ACOG Committee Opinion No. 426. The role of transvaginal ultrasonography in the evaluation of postmenopausal bleeding. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;113:462-4.

  6. Žene u postmenopauzi s krvarenjem Litta P, et al. Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding. Maturitas. 2005;50:117-23. Epstein E, et al. Dilatation and curettage fail to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 2001;80:1131-6. • Zadebljani endometrij >4mm • 80% patologija • >90% fokalne promjene (60% polipi)

  7. Postmenopauza • Asimptomatske žene • Zadebljani endometrij !?! • Hyperplasio endometrii • D&C

  8. SIS • SIS (saline infusion sonography) • Office histeroscopy

  9. Hysterosonography • Sonohysterography • Saline Infusion Sonography (SIS)

  10. SIS • kavum koji je virtualna šupljina postaje prava šupljina i može se pregledati u cijelosti • jednostavno, bezbolno i jeftino obogaćenje ultrazvuka • podudarnost histerosonografije i histeroskopije oko 95%

  11. SIS • tvrdi kateter • Foley – balon ometa vizualizaciju • zrak u kateteru radi artefakte • stenoza cerviksa

  12. Endometralni polipi • spoznaje o uzrocima, ponašanju i incidenciji nepotpune • točna prevalencija nepoznata • do 25% žena u generativnoj dobi • do 10% žena u postmenopauzi • Ben-Arie A, et al. The Malignant potential of enodmetrial polyps. • Eur J Obs Gyn Rep Biol 2004;115:206-10.

  13. Ca u endometralnom polipu • premenopauza 1,7% • postmenopauza 5,42% • postmenopauza asimptomatska 1,51% • postmenopauza simptomatska 4,47% • veličina (ni)je povezna s malignitetom • Lee SC, et al. The oncogenic potential of endometrial polyps: a systematic • review and meta-analysis.Obstet Gynecol. 2010;116:1197-205.

  14. D & C • slijep postupak • uzorak pokriva oko 50% kavuma • D & C neće odstraniti fokalnu leziju u cijelosti u oko 80% slučajeva (a fokalne su 90%) • “promaši” oko 50% polipa • opća anestezija??? Epstein E, et al. Dilatation and curettage fail to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 2001;80:1131-6.

  15. Histeroskopija • histeroskopija sa polipektomijom ili uzimanjem uzorka s fokalnog zadebljanja • histeroskopska ablacija polipa je optimalna terapija • pouzdano odstranjuje polip u bazalnoj zoni • sprečava ponovno javljanje

  16. Histeroskopija • histeroskopija invazivan zahvat kao i D&C, manje komplikacija • polipektomija kod žena u postmenopauzi je zahvat malog rizika • dijagnostički i terapeutski zahvat

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