放置与未放置IUD子宫异常出血患者的子宫内膜病理变化对比分析

Comparative analysis of endometrial pathological changes in abnormal uterine bleeding patients with or without IUD

目的探讨放置宫内节育器(IUD)后子宫异常出血患者子宫内膜病理变化。方法选取2012年4月至2015年12月在青岛市黄岛区妇幼保健计生服务中心治疗的子宫异常出血患者318例,其中放置IUD患者186例,未放置IUD患者132例,比较各患者诊断性刮宫病理结果。结果放置IUD患者子宫内膜病理示增殖期比例为39.25%,明显高于未放置IUD患者(χ~2=23.195,P<0.05);放置IUD患者子宫内膜病理示单纯增生的比例为3.23%,明显低于未放置IUD患者(χ~2=10.722,P<0.05);两组子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ~2值分别为0.011、0.828、1.550和0.030,均P>0.05);放置IUD组>40岁和≤40岁患者子宫内膜病理示增殖期、单纯增生、子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ~2值分别为0.776、0.095、0.035、0.037和0.923,均P>0.05);IUD放置年限≥5年和<5年患者子宫内膜病理示增殖期、单纯增生、子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ~2值分别为0.371、0.775、1.600、0.322和0.002,均P>0.05)。不同类型IUD患者子宫内膜病理示增殖期、单纯增生、子宫肌瘤、子宫内膜息肉、子宫内膜炎及子宫内膜癌的比例比较差异无统计学意义(χ~2值分别为0.019、2.386、0.401、0.746和2.386,均P>0.05)。结论 IUD不会增加子宫内膜炎、子宫内膜息肉、子宫内膜异常增生、子宫肌瘤等的发病率;IUD是一种安全的避孕措施。

Objective To investigate the pathological changes of endometrium in patients with abnormal uterine bleeding after placing intrauterine device （IUD）. Methods Altogether 318 cases of abnormal uterine bleeding treated in Maternal and Child Health Care and Family Planning Service Center of Huangdao District of Qingdao from April 2012 to December 2015 were selected, in which 186 patients implanted with IUD and 132 patients without IUD. Pathological results of diagnostic curettage of every patient were compared. Results Endometrial pathology showed proportion of proliferative phase in patients with IUD was 39.25% , which was significantly higher than that in patients without IUD （χ2 =23. 195 ,P 〈 0. 05 ）. Endometrial pathology showed proportion of simple hyperplasiain in patients with IUD was 3.23% , which was significantly lower than that in patients without IUD （χ2 = 10. 722, P 〈 0.05 ）. The differences in proportion of uterine fibroids, uterine endometrial polyps, endometritis and endometrial cancer between two groups had no statistical significance （χ2 value was 0.011, 0. 828, 1. 550 and 0. 030 respectively, all P 〉 0.05 ）. In IUD group endometrial pathology showed that proportion difference in proliferative phase, simple hyperplasia, uterine fibroids, uterine endometrial polyps, endometritis and endometrial cancer between patients over and less than 40 had no statistical significance （χ2 value was 0. 776, 0. 095, 0. 035, 0. 037 and 0. 923, respectively, all P 〉 0.05 ）. Endometrial pathology revealed that the proportion difference in proliferative phase, simple hyperplasia, uterine fibroids, uterine endometrial polyps, endometritis and endometrial cancer between patients with IUD implantation over and under 5 years had no statistical significance （χ2 value was 0. 371, 0. 775, 1. 600, 0. 322 and 0. 002, respectively, all P 〉 0.05 ）. Endometrial pathology showed that the proportion difference in proliferative phase, simple hyperplasia, uterine fibrolds, uterine endometrial polyps, endometritis and endometrial cancer between patients implanted with different types of IUD had no statistical significance （χ2 value was 0. 019, 2. 386, 0. 401, 0.746 and 2. 386, respectively, all P 〉0.05）. Conclusion IUD does not increase the incidence of endometritis, uterine endometrial polyps, abnormal endometrial hyperplasia and uterine fibroids. IUD is a safe method of contraception.