影响子宫内膜不典型增生诊断及病理升级的相关因素分析

Analysis of Related Factors that Influence the Diagnosis of Atypical Endometrial Hyperplasia and Pathological Upgrade

目的探讨影响子宫内膜不典型增生(AEH)的诊断及术后病理升级为子宫内膜癌的相关因素及临床特点。方法因AEH行全子宫切除术的患者共74例,根据术后病理分为子宫内膜癌组(A组,28例)和AEH组(B组,46例),并进行回顾性分析。结果 1AEH手术前后诊断符合率为62.6%,37.8%(28/74)的患者在切除的子宫标本中发现并存有子宫内膜癌,但多数分化较好,分期早,92.9%(26/28)的患者均为Ⅰ期;2宫腔镜辅助诊刮诊断符合率88.5%,高于单纯诊刮组47.9%(P<0.05);3术中快速病理与术后石蜡病理有较高的诊断符合率(94.6%);4两组年龄、血脂、BMI、糖尿病史、子宫内膜厚度比较,差异均有统计学意义(P值均<0.05)。结论对于不正常阴道出血的女性、年龄>50岁,伴有血脂代谢异常、糖尿病史、子宫内膜增厚的患者,特别是绝经状态的患者,进行子宫内膜活检时应联合宫腔镜检查;全子宫切除需术中行冰冻快速病理检查,以提高诊断的准确性。

Objective To explore the related factors and clinical characteristics for atypical endometrial hyperplasia（AEH） diagnosis and the pathological upgraded to endometrial carcinoma in women with tissue-diagnosed. Methods Seventy-four patients with atypical endometrial hyperplasia （AEH） who underwent total hysterectomy were analyzed retrospectively. According to the postoperative pathological diagnosis, they were divided into two groups：endometrial carcinoma group （28 cases in group A ） and atypical endometrial hyperplasia group （ 46 cases in group B ）. Results （1）AEH diagnosis coincidence rate before and after operation was respectively 62.6% ,37.8% （28/74 ） of the patients were found to have endometrial cancer in the resected uterine specimens, but most of them were well differentiated and early stage,and all of the 92.9% （26/28） patients were stage I. （2）Auxiliary diagnostic hysteroscopy diagnosis coincidence rates 88.5%, higher than D＆C single group 47.9% （ P 〈 0. 05 ）. （3）Fast frozen section pathological and paraffin pathology had a higher diagnostic coincidence rate, about 96.4%. （4）The age, blood hpid, diabetes history, BMI and endometrial thickness between two groups were all statistically different （ P 〈 0.05 ）. Conclusion The aged patients （ 〉 50 years old）, with abnormal vaginal bleeding, blood metabolic abnormalities, diabetes histo- ry,the atypical hyperplasia of endometrial thickening,especially those in postmenopausal state, should be examined in combination with hysteroscopy. It＇s better for patients under total hysterectomy to undergo a frozen section in order to improve the accuracy of diagnosis and reduce the chance of postoperative pathological escalation.