1372例不孕妇女子宫内膜息肉样病变宫腔镜检查与病理对照研究

Hysteroscopic and Pathological Characteristics of Endometrial Polypoid Lesion in 1372 Infertile Patients:A Retrospective Study

目的:探讨不孕妇女宫腔镜下子宫内膜息肉(EP)样病变形态学特征,以提高宫腔镜诊断与组织病理学诊断的符合率。方法:选择2005年2月—2014年7月因不孕在广东省计划生育专科医院行宫腔镜检查者,其中EP样病变者进行宫腔镜下内膜形态学特点及组织病理学诊断的对比分析。结果:17.4%(1 372/7 884)的不孕妇女宫腔镜检查提示EP样病变。宫腔镜下EP样病变常见的形态学表现为:内膜赘生物、内膜局部隆起、内膜毛糙碎片多,所占比例依次为88.0%(1 207/1 372)、6.7%(92/1 372)和5.3%(73/1 372)。经病理诊断检出率前3位依次为EP 83.0%(1 139/1 372)、EP样增生9.3%(128/1 372)、子宫肌瘤2.2%(31/1 372)。宫腔镜下典型赘生物组宫腔镜与病理诊断符合率较无典型赘生物组高,差异有统计学意义(P<0.05)。多发性EP样赘生物占宫腔镜下EP样病变的77.8%(1 068/1 372),宫腔镜与病理诊断的符合率达98.0%(1 047/1 068)。结论:宫腔镜下内膜有典型赘生物尤其多发性EP样赘生物者宫腔镜诊断与病理诊断符合率高。宫腔镜检查结合组织病理学检查可作为诊断子宫内膜病变的金标准。

Objective：To analyze retrospectively the hysteroscopic and morphological characteristics of endometrial polypoid（EP） lesion in infertile patients, so as to improve the diagnostic coincidence rate of hysteroscopy and histopathology. Methods：Those infertile patients performed hysteroscopy were analyzed retrospectively from February 2005 through July 2014. Hysteroscopic characteristics were then compared with histopathologic characteristics in those patients with EP. Results：17.4%（1 372/7 884） of infertile patients were diagnosed with EP lesion by hysteroscopy. The morphological manifestation of EP lesion under hysteroscopy were as follows： endometrial neoplasm（88.0%, 1 207/1 372）, endometrial local uplift（6.7%, 92/1 372）, and endometrial coarse and fragment（5.3%, 73/1 372）. The three most prevalent diagnoses by histopathology were endometrial polyp（83.0%, 1 139/1 372）, endometrial polypoid hyperplasia（9.3%, 128/1 372） and hysteromyoma（2.2%, 31/1 372）. The diagnostic coincidence rate in those patients with typical polypoid neoplasm under hysteroscopy was significantly higher than that in those patients without typical lesion（P 〈0.05）. Multiple polypoid neoplasm accounted for 77.8%（1 068/1 372） of endometrial polypoid lesion diagnosed by hysteroscopy,while the coincidence rate in those patients was 98.0%（1 047/1 068）. Conclusions：The diagnostic coincidence rate of hysteroscopy and histopathology is high in those patients with typical endometrial neoplasm under hysteroscopy. The hysteroscopy combined with histopathology is the golden standard for the diagnosis of endometrial lesion.