1029例绝经期异常子宫出血病例分析

A retrospective study of 1 029 cases with postmenopausal bleeding:etiology and diagnosis

目的回顾性分析本院绝经期异常子宫出血(postmenopausal bleeding,PMB)发病趋势,探讨子宫内膜癌(endometrial cancer,EC)的诊断方法。方法选取本院2013年1月-2017年12月1 029例PMB患者临床资料,分析引起PMB的各类疾病发生情况以及这些疾病与绝经时间的关系,比较阴式B超、诊断性刮宫和宫腔镜对PMB患者子宫内膜癌的诊断效能。结果 1 029例PMB患者平均年龄(56.3±7.7)岁,其中182例(17.7%)确诊为子宫内膜癌;良性病变中子宫内膜增生占38.6%,功血/萎缩性子宫内膜占23.4%,子宫肌瘤和息肉占6.6%和5.2%,宫内节育器引起占8.5%;绝经1~5年发病506例(49.2%),6~10年189例(18.4%)、11~15年146例(14.2%)、15~20年110例(10.7%)、> 20年78例(7.6%);宫腔镜诊断EC的准确率(97.7%)高于诊断性刮宫(94.4%)与阴式B超(90.7%)(P均<0.05)。结论除功血/萎缩性子宫内膜外,其他疾病随绝经时间延长发病率逐渐降低,对于绝经期异常子宫出血患者,宫腔镜检查是首选方法。

Objective To analyze the causes of PMB disease in our hospital retrospectively, and discuss the diagnostic methods for endometrial carcinoma（EC）. Methods Clinical data about 1 029 postmenopausal bleeding patients in our hospital from January 2013 to December 2017 were analyzed. Incidences of various diseases causing PMB and their constituent ratio during different period of menopause were analyzed, and the diagnostic values of transvaginal ultrasonography, diagnostic curettage and hysteroscopy for endometrial carcinoma were compared. Results Of the 1 029 PMB patients with average age of（56.3±7.7） years, 182（17.7%） cases were diagnosed with endometrial carcinoma. In benign lesions, endometrial hyperplasia accounted for 38.6%, uterine bleeding/atrophic endometrium accounted for 23.4%, uterine myoma and polyp accounted for 6.6% and 5.2%, and intrauterine device（IUD） accounted for 8.5%. The total number of PMB patients during the first 5 years after menopause was 506（49.2%）, and the incidence of PMB decreased gradually over time [18.4%（6-10 years）, 14.2%（11-15 years）, 10.7%（15-20 years）, 7.6%（ 〉20 years）]. The accuracy rate of hysteroscopy（97.7%） for diagnosing EC was significantly higher than those of diagnostic curettage（94.4%） and transvaginal ultrasonography（90.7%）（P〈0.05, respectively）. Conclusion The incidence of endometrial hyperplasia, endometrial cancer, IUD, uterine fibroids and polyps are high in the first 5 years after menopause, and it decreases gradually over time. Hysteroscopy can be an optimal choice for cases with postmenopausal bleeding.