绝经妇女阴道流血患者并发子宫内膜癌的病理研究

Study on the Pathology of Endometrial Carcinoma in the Women with Vaginal Bleeding

目的：对绝经后阴道流血（ PMB）并发子宫内膜癌进行病理学研究,探讨其临床特征。方法：回顾性分析我站和靖煤集团总院2012年5月-2014年6月317例PMB患者的临床资料,根据刮宫及（或）术后病理检查结果,将PMB患者按病理学类型分为子宫内膜癌、良性病变及非器质性病变。对比子宫内膜癌与其他两类病变的临床指标,分析子宫内膜癌PMB的相关因素。结果： PMB患者中,病理学诊断为子宫内膜癌者占10.4%（33/317）；子宫内膜癌PMB患者的绝经年龄、绝经年限、出血持续时间、肥胖、高血压、糖尿病比例及子宫内膜厚度与宫腔深度均高于其他病变的PMB患者,差异均有统计学意义（P〈0.05）。多因素回归分析表明,子宫内膜厚度是子宫内膜癌PMB的独立相关因素（OR=3.07,95%CI=12.4-17.9, P=0.008）。结论：应纠正以往将PMB与子宫内膜癌等同的错误观点, PMB者应及早诊断,明确病因,可先行B超测量子宫内膜厚度,初步筛查子宫内膜癌后再以刮宫或术后病理诊断确诊。

OBJECTIVE： To study the pathology of PMB caused by endometrial cancer and to investigate its clinical characteris-tics. METHODS： 317 patients of PMB during May 2012-June 2014 were retrospectively analyzed. Curettage and （ or） postoperative pathological diagnosis were used to determine pathology： endometrial cancer, benign or non-organic disease. A contrast of clinical indicators between endometrial cancer and the other two was carried on. RESULTS： PMB patients caused by endometrial cancer were 10. 4% （33/317）. And their age at menopause, menopause period, bleeding duration, obesity/hypertension and diabetes rate, endometrial thickness and uterine cavity depth were all higher than those caused by benign or non-organic disease. Further studies showed that endometrial thickness was the only independent related factor of PMB caused by endometrial cancer. CONCLUSION： The view that equals PMB and endometrial cancer should be corrected and PMB should be early diagnosd to figure out its cause.