绝经后子宫内膜增厚349例临床分析

Clinicopathological features of endometrial thickness in 349 postmenopausal women

目的探讨绝经后子宫内膜增厚(≥5 mm)患者的病理分类及临床处理。方法选取经超声提示子宫内膜增厚的患者共349例,其中无出血者227例(无出血组),出血者122例(出血组),分别对两组行内膜病理学检查并进行分析。结果无出血组以子宫内膜息肉占首位,为63%(143/227),其次为子宫黏膜下肌瘤5.72%(13/227),符合绝经期正常表现的占23.79%(54/227),不典型增生占2.2%(5/227),子宫内膜癌占4.84%(11/227)。出血组子宫内膜息肉占26.22%(32/122),符合绝经期正常表现的占33.6%(41/122),子宫内膜癌占31.97%(39/122),癌肉瘤占3.2%(4/122)。结论绝经后子宫内膜增厚伴有阴道流血的患者应警惕并及时行病理学检查以明确子宫内膜性质。绝经后阴道出血不伴内膜增厚的患者,临床处理应根据患者的具体情况行个性化治疗。

Objective To evaluate the pathology and clinical features of endometrial thickness in postmenopausal women. Methods A retrospective reviewwas conducted in 349 women who underwent transvaginal-ultrasonography and had an endometrial thickness of ≥5 mm. Among them 227 were asymptomatic and 122 had uterine bleeding; all patients were subject to endometrial biopsy.Results Among 227 asymptomatic women with endometrial thickness,the prevalence of polyps was63%（ 143 /227）,submucous myoma was 5. 72%（ 13 /227）,normal histological finding was 23. 97%（ 54 /227）,atypical hyperplasia was 2. 2%（ 5 /227）,endometrial carcinoma was 4. 84%（ 11 /227）.Among 122 women with uterine bleeding the prevalence of polyps was 26. 22%（ 32 /122）,normal histological finding was 33. 6%（ 41 /122）,endometrial carcinoma was 31. 97%（ 39 /122）,malignant mixed mullerian tumors was 3. 2%（ 4 /122）. Conclusion In postmenopausal women with endometrial thickness,if patients had uterine bleeding endometrial biopsy in necessary,while for asymptomatic patients the management should be based on individual conditions.