青少年子宫内膜癌的诊断误区及应对策略

Misdiagnosis and Countermeasures of Adolescent Endometrial Carcinoma

目的:探讨青少年子宫内膜癌的临床特征及诊断策略。方法:回顾性分析北京协和医院2007～2017年收治的青少年子宫内膜癌患者的临床表现、诊治经过及延误诊断的情况。结果:10年间北京协和医院共收治子宫内膜癌患者3312例,其中16～24岁青少年患者为21例(0. 63%)。首诊表现为阴道不规则流血者20例(95. 2%);所有患者均合并贫血(100. 0%),其中10例(47. 6%)为重度贫血; 14例(66. 7%)患者体质量指数(BMI)≥28 kg/m2。以阴道不规则流血为首诊症状的患者平均确诊时间为35个月,其中有性生活史者确诊时间为15. 0±14. 3月,无性生活史者确诊时间为64. 0±33. 1月,两组比较差异有统计学意义(P <0. 05);以阴道不规则流血为主要症状者11例(55. 0%),在确诊前按青春期功能失调性子宫出血长期行药物治疗,8例(40. 0%)行中药治疗,1例(5. 0%)因合并多囊卵巢综合征口服炔雌醇环丙孕酮片;所有该类患者(100%)初次就诊时均未行相关影像学检查、妇科查体,且未进行定期随诊。结论:青少年子宫内膜癌较为罕见,以阴道不规则流血为主要临床表现,易误诊。对于长期阴道不规则流血的年轻女性,应及时行B超检查及妇科查体并定期密切随诊,必要时行有创的活检明确诊断。

Objective：To summarize the clinical features and diagnosis strategies of endometrial carcinoma in adolescents aged 16 -24 years. Methods.Retrospectively analyze the clinical manifestations of adolescent endo- metrial carcinoma patients treated in Peking Union Medical College Hospital from 2007 to 2017. Results：A total of 3312 cases of endometrial carcinoma were admitted to Peking Union Medical College Hospital during 10 years, and only 21 cases were adolescents aged 16 -24. The results were as follows.The initial symptom of 20 cases was irregular vaginal haemorrhage（95.2% ）. All 21 cases were complicated with anemia（ 100% ） ,and 10 of them were severe anemia（47. 6% ）. 14 cases had basal BMI i〉 28 kg/m2 （66.7%）. For 20 cases whose initial symp- tom was irregular vaginal bleeding, the average diagnosis time was 35 months. Among them, the diagnosis time was 15.0 ±14.3 months for the women with sexual history at the first visit, and 64.0 ± 33. 1 months for the women without sexual history at the first visit. There was significant difference in the diagnosis time between the two groups（P〈0.05）. Among 20 adolescent patients with irregular vaginal bleeding as the main symptom,ll of them were treated repeatedly with drugs according to puberty dysfunctional uterine bleeding before infinite diagnosis（55.0% ） ,8 of them were discontinuously treated with Chinese medicine by themselves（40.0% ）while 1 patient with basic polycystic ovary syndrome （PCOS） was treated with Dain-35 orally for a long period of time （5.0%）. In addition,all of 20 patients were without any imaging examination,gynecological examination and reg- ular follow-up （100.0%）. Conclusions.The incidence of endometrial carcinoma in adolescent aged 16 -24 years is rare, and the main clinical manifestation is irregular vaginal bleeding,which is prone to misdiagnosis. For adoles- cent with long-term （≥3 months）irregular vaginal bleeding, ultrasonic examination and gynecologic examination should be performed in time and should be followed up regularly,and invasive biopsy might be necessary in order to confirm the diagnosis in time.