绝经后无症状子宫内膜增厚患者子宫内膜病变的临床研究

Clinical study of endometrial pathology in postmenopausal women with asymptomatic thickened endometrium

目的·探讨绝经后无症状子宫内膜增厚患者的子宫内膜的临床病理特征。方法·回顾性分析自2013年10月至2015年10月在上海交通大学医学院附属国际和平妇幼保健院住院的绝经后无症状,体检发现子宫内膜增厚(经阴道超声检查内膜≥5 mm)而行宫腔镜检查及诊断性刮宫术的患者,分析子宫内膜病理类型与子宫内膜厚度的关系。结果·257例患者平均年龄61.3岁,平均绝经时间122个月,平均子宫内膜厚度8.6 mm。无症状绝经后子宫内膜增厚有正常萎缩内膜、子宫内膜息肉、黏膜下子宫肌瘤、宫腔粘连、子宫纵隔、子宫内膜增生、子宫内膜癌等。最常见的病理类型为子宫内膜息肉,占所有患者的66.9%,占所有病理类型的83.9%(172/205)。共有子宫内膜癌3例(1.2%)。正常内膜、内膜息肉与子宫内膜癌患者的子宫内膜厚度差异有统计学意义(均P<0.05),子宫内膜癌患者的子宫内膜最厚,平均为(13.20±5.38)mm。各个病理类型的患者年龄之间差异有统计学意义(P=0.004)。结论·无症状绝经后子宫内膜增厚患者恶性病变发生率低,对这类患者的处理应倾向于采用较保守的观察随访。

To evaluate the clinical characteristics of endometrial pathology in postmenopausal women with asymptomatic thickened endometrium. Methods · A retrospective review was conducted of the patients between October 2013 and October 2015 in the International Peace Maternity & Child Health Hospital. The postmenopausal women with asymptomatic thickened endometrium of 5 mm or more found by transvaginal ultrasonography were recruited. They underwent hysteroscopy and endometrial sampling to analyze the relationship between endometrial pathology and endometrial thickness. Results · A total of 257 patients were recruited. The average age was 61.3 years old, the average menopause period was 122 months, and the average endometrium thickness was 8.6 mm. The endometrial pathology included normal atrophic endometrium, endometrial polyp,submucous myoma, intrauterine adhesion, uterine septum, endometrial hyperplasia and endometrial cancer. The most common pathological type was endometrial polyp, accounting for 66.9% of the all patients and 83.9% (172/205) of all pathological types. Three cases of adenocarcinoma (1.2%) were diagnosed. There was significant difference in endometrial thickness among normal endometrium, endometrial polyp and endometrial cancer (P<0.05).The endometrium in endometrial cancer was the thickest, which was (13.20±5.38) mm averagely. There was significant difference in ages among the pathological types (P=0.004). Conclusion · There are few patients of malignancy among asymptomatic postmenopausal women with thickened endometrium. Follow-up visits were recommended to these women.