778例绝经后阴道出血患者的临床病理分析

The Clinical Pathology Analysis of 778 Patients with Postmenopausal Bleeding

目的：探讨绝经后阴道出血的临床特点及病理类型。方法：回顾性分析自2008年1月1日—2013年12月31日于中国医科大学附属盛京医院妇科病房收治的778例绝经后阴道出血患者,每例均行盆腔超声、宫腔镜检查及手术,且取得病理及确切诊断。结果：778例患者中,子宫内膜息肉所占比例最高49.23%（383例）,其次是子宫内膜癌16.71%（130例）,第三位是黏膜下肌瘤11.44%（89例）;绝经后阴道出血在绝经5年内发病例数最多（311例）,其中以子宫内膜息肉为主（175例）,绝经≥21年发病例数最少（78例）,其中以子宫内膜癌为主（44例）;〈49岁阴道出血例数最少（7例）,55~59岁阴道出血例数最多（228例）,两者均以子宫内膜息肉为主,≥75岁出血的71例中以子宫内膜癌为主（38例）;子宫内膜良恶性病变患者在子宫内膜厚度、体质量指数（BMI）及是否反复出血方面差异有统计学意义（均P〈0.01）,子宫内膜恶性病变患者与良性病变患者相比其子宫内膜更厚、BMI更高且更易发生反复出血。结论：引起绝经后阴道出血的主要病因为子宫良性病变;随着绝经时间的增加,子宫内膜息肉、子宫内膜增生及黏膜下肌瘤的发生率整体呈下降趋势,子宫内膜炎及子宫内膜癌的发生率整体呈上升趋势;随着绝经后发生阴道出血年龄的增加,子宫内膜息肉、子宫内膜增生及黏膜下肌瘤的发生率整体呈下降趋势,子宫内膜炎及子宫内膜癌的发生率整体呈上升趋势。

Objective：To explore the clinical features and pathologic type of postmenopausal vaginal bleeding. Methods：A retrospective analysis was performed from January 1, 2008 to December 31, 2013 at China Medical University Sheng Jing Hospital gynecology wards after a total of 778 cases of postmenopausal bleeding women, each patient underwents pelvic ultrasound, hysteroscopy and surgery and obtain pathology and definitive diagnosis. Results： From 778 cases of patients,endometrial polyps accounts for the highest proportion of 49.23%（383 cases）, the second is endometrial cancer 16.71%（130cases）, the third is the submucous myoma 11.44%（89 cases）. The most number of cases within 5 years of menopause are postmenopausal vaginal bleeding（311 cases）, most of which is endometrial polyps（175 cases）, and for menopause more than 21 years, there are the lowest incidence cases（78cases）, most of which is endometrial cancer（44 cases）. The vaginal bleeding cases are the least（7 cases） for those who are younger than 49, and the most cases（228 cases） for those between 55 to 59 years old,most of which are endometrial polyps. There are 71 patients older than 75 years of age, most of which are endometrial carcinoma（38 cases）. In the endometrial thickness, body mass index（BMI）, and whether repeated bleeding, endometrial benign and malignant disease has the obvious statistical significance（P〈0.01）. Compared with the patients with endometrial benign lesions,endometrial malignant lesions patients own thicker endometrial, greater body mass index（BMI）, and are more likely to be repeated bleeding. Conclusions： The main reason caused postmenopausal vaginal bleeding is uterine benign lesions. As the menopause time increasing, endometrial polyps, endometrial hyperplasia and the incidence of submucosal myoma is downward trend on the whole, endometritis, and the incidence of endometrial cancer is on the rise as a whole. With the increase of vaginal bleeding after menopause age, endometrial polyps, endometrial hyperplasia and the incidence of submucosal myoma is downward trend on the whole, endometritis, and the incidence of endometrial cancer is on the rise as a whole.