绝经后妇女子宫内膜病变的临床分析

Clinical analysis on endometrial lesion of postmenopausal women

目的探讨绝经后B超发现的子宫内膜病变患者的诊断和处理方法。方法对65例绝经后B超发现子宫内膜病变但无临床症状的妇女行宫腔镜检查,对其进行临床及病理分析,并与同期112例绝经后有出血等症状的子宫内膜病变妇女的检查结果进行对比。结果无症状组病理检查符合绝经后正常表现的32例(49.23%);良性病变31例(47.69%),其中子宫内膜息肉19例,占良性病变的61.29%;不典型增生2例(3.08%);无恶性病变。有症状组绝经后正常表现者35例(31.25%);良性病变49例(43.75%),其中子宫内膜息肉15例(13.39%);不典型增生11例(9.83%);恶性病变17例(15.17%)。结论绝经后无症状子宫内膜病变患者病理以子宫内膜良性病变为主,子宫内膜息肉发病率高,有潜在恶性;阴道超声可作为绝经后子宫内膜病变的筛查手段;宫腔镜检查因其诊断的准确性优于经阴道超声检查(TVS)及诊断性刮宫,应为首选。

Objective To explore the clinical therapy of asymptomatic endometrial lesion in postmenopausal women by ultrasound scanning. Methods Sixty-five postmenopausal women with asymptomatic lesion were diagnosed by ultrasound scanning. Their clinical and pathologic data were compared with 112 women with symptomatic lesion of postmenopause. Results Thirty-two cases without symptoms of postmenopausal women accounted for 49.23%, while benign hyperplasia in 31 cases accounted for 47.69%. Ninteen cases were found with endometrial polyps, which accounted for 61.29% of benign pathological changes. Two cases （3.08%） were asymptomatic endometrial atypical hyperplasia. None cancer was detected. In the group with symptoms, 35 cases （ 31.25% ） were found to be normal; 49 cases （43.75%） had benign pathological changes, among them 15 cases （13.39%） were found to have endometrial polyp, 11 cases（9.83%） had endometrial atypical hyperplasia, 17 cases （ 15.17%） progressed to cancer. Conclusions Asymptomatic endometrial lesion among postmenopausal women is primary benign pathological changes. The prevalence of endometrial polyp is high. Pathological changes have potential to progress to maligrent lesion. TVS can be used to screen endometrial lesion among postmenopausal women. Hysteroscopy should be adopted as the first choice for regular checkups due to its higher diagnostic accuracy.