阴超检测用三苯氧胺治疗绝经后妇女子宫内膜病变的作用

THE ROLE OF TRANSVAGINAL ULTRASOUND IN THE DETECTION OF ENDOME TRIAL PATHOLOGIES IN POSTMENOPAUSAL WOMEN TAKING TAMOXIFEN

目的评估用三苯氧胺 (Tamoxifen TAM)作为辅助治疗的绝经后乳腺癌妇女，阴超测量其子宫内膜厚度的价值。方法研究 82例患乳腺癌的绝经后妇女，用 TAM辅助治疗 6月以上的超声检查结果，子宫内膜厚度以两层厚度计算，将内膜厚度≥ 5mm作为绝经后妇女异常的标准，作内膜活检。结果 82例中 22例 (28.1％ )有阴道流血症状，所有这些病人阴超子宫膜厚度均超过 5mm。子宫内膜厚度超过 9mm的妇女，内膜有异常组织学发现的比例显示高于内膜厚度低于 9mm的妇女 (前者 63.6％，后者 6.1％， P< 0.001)。子宫内膜厚度 > 9mm，同时有阴道流血者，将预示子宫内膜有病变。结论使用 TAM的绝经后妇女，阴超子宫内膜厚度超过 9mm，同时存在阴道流血是子宫内膜病变的重要信号，必须作内膜活检。鉴于检测子宫内膜的敏感性达 86.9％，可见阴超用于研究用 TAM治疗的绝经后妇女子宫内膜的变化是十分有效的。

Objective To evalute transvaginal ultransonographic measurements of endometrial thickness in postmenoparsal woman taking adjuvant tamoxifen therapy for breast cancer. Methods Medical records and sonograms of 82 postmenopausal woman treated for breast cancer with adjuvant tamoxifen therapy more than six months were reviewed retrospectively. Endometrial thickness was recorded as a double－ layer thickness and considered abnormal when greater than 5mm for postmenopausal women, endometrial biopsies were performed. Results 22 of 82(28.1％ )women had vaginal bleeding, all of whom had endometrial thickness greater than 5mm. The proporiton of women with abnormal histologic findings was greater among those with endometrial thickness exceeding 9mm compared with those with endometrial thickness 9mm or less (63.6％ versus 6.1％ ,P< 0.001).Endometrial thickness greater than 9mm and vaginal bleeding were predictors of endometrial disease. Conclusions In postmenopausal women taking tamoxifen, sonographic endometrial thickness exceeding 9mm and the presence of vagianal bleeding are independent predictors of endometrial disease, biopsy should be done. With a sensitivity of detecting endometrial abnormalities 86.9％ ,transvaginal sonography was useful for detecting endometrial abnormalitiesin postmenopausal tamoxifen－ treated woman.