子宫内膜细胞学检测在取出宫内节育器时的临床应用

Clinical application of cytological detection of endometrium for removing intrauterine device

目的:应用子宫内膜细胞学方法探讨宫内节育器(IUD)对子宫内膜的影响。方法:应用子宫内膜细胞采集器在募集对象取出IUD时采集子宫内膜组织制片,样本集中寄往北京大学附属医院妇产科宫腔细胞学检测中心阅片。结果:有症状组和无症状组子宫内膜细胞病理未见异常率及不典型增生发生率差异有统计学意义(P<0.01),良性增生性改变发生率差异有统计学意义(P<0.05)。阴道流血症状发生细胞学诊断未见异常人群组与良性增生人群组差异有统计学意义(P<0.05),与不典型增生人群组差异有统计学意义(P<0.01);肥胖情况细胞学诊断非典型增生人群组和良性增生人群组均高于未见异常人群组,但差异无统计学意义(P>0.05),高血压、初潮早等其他高危因素情况细胞学诊断不典型增生人群组和良性增生人群组均高于未见异常人群组,但差异无统计学意义(P>0.05)。宫内节育器类型组两两对比,良性增生和不典型增生的发生率均无统计学意义(P>0.05)。结论:放置IUD后子宫异常出血常伴有子宫内膜良性增生及非典型增生,子宫内膜细胞学异常与宫内节育器类型无明显关系。取器时行子宫内膜细胞学检测,可以对子宫内膜状况有初步了解,以便正确拟定诊治方案。

Objective：To explore the effect of intrauterine device（IUD） on endometrium by endometrial cytological detection.Methods：Endometrial cell collector was used to collect endometrial tissue to prepare smears when IUD was removed from the respondents,then the samples were sent to cervical cytological detection center,department of gynecology and obstetrics,affiliated hospital of Beijing university.Results：There was statistically significant difference in the non-abnormal rate of pathological examination and incidence of atypical hyperplasia between the cases with symptoms and the cases without symptoms（P0.01）,but there was statistically significant difference in the incidence of benign hyperplastic changes between the two groups（P0.05）;there was statistically significant difference in the incidence of vaginal bleeding between the cases without abnormal findings detected by cytological diagnosis and the cases with benign hyperplasia（P0.05）,compared with that in the cases with atypical hyperplasia,there was statistically significant difference（P0.01）;the incidences of obesity in cases with atypical hyperplasia and benign hyperplasia were higher than that in cases without abnormal findings,but there was no statistically significant difference（P0.05）;the incidences of high risk factors,such as hypertension and early menarche,in cases with atypical hyperplasia and benign hyperplasia were higher than those in cases without abnormal findings,but there was no statistically significant difference（P0.05）;compared with each other among different types of IUD,there was no statistically significant difference in the incidences of benign hyperplasia and atypical hyperplasia.Conclusion：After placing IUD,uterine abnormal bleeding combined with benign hyperplasia and atypical hyperplasia of endometrium often occurs,there is no apparent correlation between endometrial cytological abnormality and types of IUD.Conducting endometrial cytological detection when removing IUD can understand endometrial status preliminarily,and then a correct diagnostic and therapeutic scheme is drawn up.