子宫内膜非典型增生79例临床病理特征分析

An analysis on the clinicopathological characteristics of 79 cases atypical endometrial hyperplasia

目的 分析子宫内膜非典型增生患者的临床病理特征.方法 选择2007年3月至2010年7月北京大学人民医院收治的诊断为子宫内膜非典型增生患者79例,其中49例（62%）为单纯子宫内膜非典型增生（增生组）,30例（38%）为子宫内膜非典型增生合并癌变（癌变组）.回顾性分析子宫内膜非典型增生患者的临床病理特征[包括年龄、孕产次、体质指数（BMI）、绝经及阴道流血情况、合并症、B超检查等],并对两组患者进行比较.分析了分段诊刮及宫腔镜检查在子宫内膜非典型增生诊断中的价值.结果 （1）年龄：患者平均年龄为（50±11）岁,其中癌变组为（51±11）岁,增生组为（50±10）岁,两组比较,差异无统计学意义（P=0.994）.（2）孕产次：两组患者孕产次分别比较,差异均无统计学意义（P＞0.05）.（3）合并症：增生组和癌变组有合并症的患者分别为23例（47%）和13例（43%）,两组比较,差异无统计学意义（P=0.755）.（4）BMI：癌变组明显高于增生组[分别为（27.9±5.4）和（25.2±2.9）kg/m2,P=0.024].（5）绝经及阴道流血情况：绝经后患者癌变组为50%（15/30）,增生组为31%（15/49）,两组比较,差异无统计学意义（P=0.085）;绝经后阴道流血患者癌变组为13/15,增生组为8/15,两组比较,差异无统计学意义（P=0.109）;未绝经有月经改变患者癌变组为12/15,增生组为68%（23/34）,两组比较,差异无统计学意义（P=0.590）.（6）B超检查：癌变组阳性（指官腔有回声团）率明显高于增生组[分别为73%（22/30）和51%（25/49）,P=0.050].（7）分段诊刮和官腔镜检查的诊断价值：行分段诊刮活检患者23例（29%）、宫腔镜活检44例（56%）,两者对非典型增生的初次诊断率分别为87%（21/23）和93%（41/44）,对非典型增生伴癌变的初次诊断率分别为6/12和12/16,诊断为非典型增生的患者中癌变的漏诊率分别为6/13和19%（4/21）,分别比较,差异均无统计学意义（P＞0.05）.结论 对于围绝经期异常阴道流血患者,应积极进行分段诊刮及官腔镜检查,分段诊刮或官腔镜活检诊断为子宫内膜非典型增生患者中,若其BMI较高或B超提示官腔有回声团,应警惕合并子宫内膜癌的可能.

Objective To explore the clinicopathological characteristics in atypical endometrial hyperplasia patients. Methods A retrospective study was carry out on 79 cases with atypical endometrial hyperplasia patients admitted to Department of Gynecology, Peking University People＇s Hospital from Mar.2007 to Jul. 2010. All patients were divided into two groups, hyperplasia group （merely atypical endometrial hyperplasia, 49 cases, 62%） and cancerization group （atypical endometrial hyperplasia accompanying endometrial carcinoma, 30 cases, 38%）. Results The mean age of 79 cases were （50 ± 11） years old ,while they were （50 ± 10） and （51 ± 11） years old for hyperplasia group and cancerization group, there were not difference （P = 0.994）. The gravidity and delivery frequencies were also not differently between two groups. The rates of complicated other diseases were 47% （23/49） and 43% （13/30）, which was not significantly different （P = 0.755）. The body mass index （BMI） of cancerization group was higher than that of hyperplasia group [（27.9 ± 5.4） vs. （25.2 ± 2.9） kg/m2, P = 0.024]. There were 50% （15/30） and 31% （15/49） menopause cases in two groups, respectively. Among them there were 13/15 and 8/15 cases showed vaginal bleeding. Among premenopausal patients, there were 12/15 and 68% （23/34） showed abnormal vaginal bleeding, but there were not significantly different between two groups （all P 〉 0.05）. The uterine cavity mass found by ultrasonography in the cancerization group patients was more than that in hyperplasia group [73% （22/30） vs. 51% （25/49）, P = 0.050]. There were 23 cases （29%）, 44 cases （56%） and 12 cases （15%） were diagnosed by dilatation and curettage （D＆G）, hysteroscopy and hysterectomy, respectively. The rates of diagnosing atypical endometrial hyperplasia by D＆G and hysteroscopy were 87 % （21/23） and 93 % （41/44）, respectively. The rate of diagnosis of canceration were 6/12 and 12/16, respectively. While, the rate of missed diagnosis of canceration in the atypical endometrial hyperplasia patients by D＆G and hysteroscopy were 6/13 and 19% （4/21） ,respectively. Which all did not shown significantly different （P 〉 0.05）. Conclusion Hysteroseopy or D＆G should be chosen on those peri-menopausal patients with abnormal bleeding, while those atypical endometrial hyperplasia patients with high BMI and uterine cavity mass diagnosed with D＆G and ultrasonography should consider the possibility of canceration.