绝经后无症状子宫内膜增厚妇女内膜病变的临床分析

Clinical analysis of endometrial lesions in postmenopausal women with asymptomatic endometrial thickening

目的探讨绝经后无症状妇女偶尔超声检查提示子宫内膜增厚时,组织学评价的必要性,并且行超声测量的子宫内膜厚度、宫腔镜下诊断及组织病理学诊断三者的一致性评估。方法回顾性分析2016年1月1日至2019年12月31日就诊于太原市中心医院妇产科,因绝经后偶尔超声检查提示子宫内膜增厚(≥5 mm)行宫腔镜检查,同时在宫腔镜下诊刮或宫腔镜下手术治疗的176例患者的临床及病理资料。结果⑴在绝经后无症状子宫内膜增厚妇女中,最常见的宫内病变为子宫内膜息肉90例(51.1%),其次是正常子宫内膜57例(32.4%)。⑵绝经后无症状子宫内膜增厚妇女宫腔镜下表现和组织病理学诊断不是完全相符,子宫内膜息肉诊断符合率为95.8%。⑶随着子宫内膜厚度的增加,子宫内膜恶性病变的风险增高,正常子宫内膜、子宫内膜息肉、平滑肌瘤、不伴不典型子宫内膜增生及标本不足的内膜厚度与子宫内膜癌患者子宫内膜厚度比较差异有统计学意义(P<0.05)。结论绝经后无症状子宫内膜增厚妇女中,子宫内膜息肉是最常见的局部宫内病变,子宫内膜恶性病变的发生率相对低,所以进一步评估时不能总是依靠超声评估子宫内膜厚度,应结合临床因素及考虑恶性病变的高危因素,做出个体化的判断。结合宫腔镜和组织病理学检查得到一个最后准确的诊断非常重要。

Objective To explore the necessity of histological evaluation in asymptomatic postmenopausal women with thickened endometrium,and to evaluate the consistency of endometrial thickness,hysteroscopic diagnosis and histopathologic diagnosis.Methods The clinical and pathological data of 176 postmenopausal patients with endometrial thickening(≥5 mm)who were admitted to the Department of Obstetrics and Gynecology of Taiyuan Central Hospital from January 1,2016 to December 31,2019 were retrospectively analyzed.Results⑴In postmenopausal women with asymptomatic endometrial thickening,the most common intrauterine lesions were endometrial polyps in 90 cases(51.5%),followed by normal endometrium in 57 cases(32.4%).⑵The hysteroscopic manifestations of asymptomatic endometrial thickening women were not in accordance with histopathological diagnosis,and the coincidence rate of endometrial polyps was 95.8%.⑶With the increase of endometrial thickening,the risk of endometrial malignant lesions increased.There was a significant difference between the thickness of normal endometrium,endometrial polyps,leiomyoma,non typical endometrial hyperplasia and specimen insufficiency compared with that of endometrial carcinoma patients(P<0.05).Conclusions In postmenopausal women with asymptomatic endometrial thickening,endometrial polyps are the most common local intrauterine lesions,and the incidence of endometrial malignant lesions is relatively low.Therefore,further evaluation can not always rely on ultrasound to evaluate endometrial thickness,but should be combined with clinical factors and consider the high-risk factors of malignant lesions to make individualized judgment.It is very important to combine hysteroscopy and histopathology to get a final and accurate diagnosis.