绝经后无症状子宫内膜增厚患者的临床及病理分析

Analysis on clinical and pathological characteristics among post-menopausal asymptomatic patients with thickened endometrium

目的总结绝经后无症状子宫内膜增厚患者的临床情况和诊断性刮宫病理结果。方法收集北京协和医院妇产科2008年1月至2010年12月绝经后无症状(无腹痛、阴道流血等)子宫内膜增厚的患者,并行回顾性分析。患者正常体检中经阴道超声发现子宫内膜增厚≥5 nn,且均接受了诊断性刮宫(诊刮)。根据患者的一般情况及诊断性刮宫病理分析比较子宫内膜厚度,并根据病理结果(良性组及不典型增生组)及内膜厚度(<15 mm组及≥15 mm组)分别比较患者的一般情况。结果 89例绝经后无症状子宫内膜增厚的患者,平均年龄58.2岁、(42～78)岁,平均绝经年限7.9年、(1～38)年,平均内膜厚度9.7 mm、(5.0～32.0)mm。诊刮病理为中重度不典型增生(2例)、增殖期内膜(13例)、萎缩性内膜(32例)、破碎的内膜及腺体组织(23例)和内膜息肉(1 9例)。患者平均内膜厚度分别为(14.0±5.6)mm、(10.9±5.1)mm、(9.7±5.2)mm、(9.2±3.6)mm和(8.9±3.0)mm(P>0.05)。2例中重度不典型增生的患者均接受了全子宫及双侧附件切除,病理证实为高分化子宫内膜样癌。2例内膜不典型增生患者均患糖尿病(2/2),87例良性患者中10例患有糖尿病。<15 mm组及≥1 5 mm组在年龄、绝经时间、体重、身高、体重指数(BMI)、是否高血压、高血压年限、是否糖尿病、糖尿病年限等方面均无显著性差异(P均>0.05)。使用他莫昔芬者子宫内膜厚度有显著增加(P<0.05)。结论绝经后无症状子宫内膜增厚的患者病理证实为恶性的比例较低,预后较好。

Objective： To study the clinical and pathological characteristics among post-menopausal asymptomatic patients with thickened endometrium. Methods. The post-menopausal asymptomatic （without abdominal pain or abnormal bleeding et al） patients with endometrium ≥5 mm detected by transvaginal ultrasound received dilatation and curettage. The endometrial thickness was compared among different groups of patients, and the clinical and pathological characteristics were compared between groups with different pathological outcomes （benign and endometrial intraepithelial neoplasia, EIN） and with different endometrial thickness 〈15 mm or ≥15 mm）. Results： Eighty nine patients with mean age of 58.2 years （42-78）, mean menopause period of 7.9 years （1-38） and mean endometrial thickness ofig. 7 mm （5.0-32.0） were included in the study in the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital （PUMCH） from January 2006 to November 2010. There were 2 patients with moderate-severe EIN, 13 patients with proliferative eridometrium, 32 patients with atrophic endometrium, 23 patients with cracked endometrium or glands, and 19 patients with endometrial polyp. Their mean endometrial thickness was （14.0 ±5.6）, （10.9±5.1）, （9.7±5.2）, （9.2±3.6） and （8.9±3.0） mm respectively （P=0. 433）.Two patients with EIN received hysterectomy and bilateral adnexectomy, and the pathologic findings were both well-differentiated endometrioid carcinoma. There are no significant differences about the ages, menopause periods, body weight, body height, body mass index, hypertension and diabetes history, history of taking tamoxifen, and pathological outcomes of breast cancers between the groups with endometrial thickness 〈15 mm or ≥15 mm （all P〉0. 05）. The endometrial thickness was significantly thicker in the patients using tamoxifen than the patients without using tamoxifen（P〈0.05）. Conclusion： There are a few patients of malignancy among post-menopause asymptomatic patients with thickened endometrium who have a better prognosis.