子宫内膜息肉恶变的临床因素分析及宫腔镜下特征性差异

Clinical factors analysis of endometrial polyps malignancy and characteristic difference under hysteroscopy

目的:探讨子宫内膜息肉(EP)患者的临床特点及宫腔镜下特征性差异,预测EP恶变的危险因素。方法:回顾性分析2016年1月—2019年12月天津医科大学总医院收治的EP患者684例,依据病理结果分为良性EP组655例,平均年龄(44.0±12.6)岁;恶性EP组29例,平均年龄(54.2±13.1)岁;对两组患者的临床特点及宫腔镜检查结果进行统计分析。结果:良性组与恶性组间年龄、体重指数、子宫不规则出血、绝经期、EP直径≥2 cm、EP合并宫颈病变、EP表面出血、EP表面血供丰富及表面形态不规则差异有统计学意义(t=-4.266、-5.038,χ^(2)=11.821、12.450、31.400、38.226、22.514、154.753、53.867,均P<0.05);二元Logistic分析显示,绝经期(OR=2.462,95%CI:1.114~5.442)、超重(OR=1.211,95%CI:1.116~1.314)、子宫不规则出血(OR=5.147,95%CI:1.256~21.096)、EP直径≥2 cm(OR=1.592,95%CI:1.172~2.164)、EP表面血供丰富(OR=24.209,95%CI:6.281~93.307)及EP表面形态不规则(OR=8.272,95%CI:2.038~33.580)与EP恶变显著相关(均P<0.05)。结论:绝经期、超重、子宫不规则出血、EP直径≥2 cm、EP表面血供丰富以及EP表面形态不规则为EP恶变的危险因素,临床特点和宫腔镜下EP的特征性差异能很好预测EP的良、恶性。

Objective:To investigate the clinical characteristics and hysteroscopic differences of endometrial polyps(EP)patients,and to predict the risk factors for the malignant degeneration of EP.Methods:Retrospective analysis was performed on 684 patients with EP who were admitted to General Hospital of Tianjin Medical University from January 2016 to December 2019.According to the pathological results,all the patients were divided into benign EP group[n=655,an average age of(44.0±12.6)years]and malignant EP group[n=29,an average age of(54.2±13.1)years].The clinical characteristics and hysteroscopy results between the two groups were statistically analyzed.Results:Age,body mass index,irregular uterine bleeding,menopause,diameter of EP≥2 cm,EP complicated with cervical lesions,EP surface bleeding,EP surface blood supply and irregular surface morphology between benign group and malignant group(t=-4.266,-5.038,χ^(2)=11.821,12.450,31.400,38.226,22.514,154.753,53.867,all P<0.05)have statistical significance;the binary Logistic analysis showed that menopause(OR=2.462,95%CI:1.114-5.442),overweight(OR=1.211,95%CI:1.116-1.314),irregular uterine bleeding(OR=5.147,95%CI:1.256-21.096),diameter of EP≥2 cm(OR=1.592,95%CI:1.172-2.164),abundant EP surface blood supply(OR=24.209,95%CI:6.281-93.307)and irregular surface morphology of EP(OR=8.272,95%CI:2.038-33.580)were significantly associated with malignant degeneration of EP.Conclusion:Menopause,overweight,irregular uterine bleeding,diameter of EP≥2 cm,abundant blood supply on EP surface and irregular surface morphology are the risk factors related with malignant degeneration of EP,so the clinical characteristics and the characteristic differences of hysteroscopic EP can well predict the benign and malignant of EP.