中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2011年
1期
19-23
,共5页
王志启%杨筱青%王建六%谢俊玲%沈丹华%魏丽惠
王誌啟%楊篠青%王建六%謝俊玲%瀋丹華%魏麗惠
왕지계%양소청%왕건륙%사준령%침단화%위려혜
子宫内膜增生%子宫内膜肿瘤
子宮內膜增生%子宮內膜腫瘤
자궁내막증생%자궁내막종류
Endometrial hyperplasia%Endometrial neoplasms
目的 分析子宫内膜非典型增生患者的临床病理特征.方法 选择2007年3月至2010年7月北京大学人民医院收治的诊断为子宫内膜非典型增生患者79例,其中49例(62%)为单纯子宫内膜非典型增生(增生组),30例(38%)为子宫内膜非典型增生合并癌变(癌变组).回顾性分析子宫内膜非典型增生患者的临床病理特征[包括年龄、孕产次、体质指数(BMI)、绝经及阴道流血情况、合并症、B超检查等],并对两组患者进行比较.分析了分段诊刮及宫腔镜检查在子宫内膜非典型增生诊断中的价值.结果 (1)年龄:患者平均年龄为(50±11)岁,其中癌变组为(51±11)岁,增生组为(50±10)岁,两组比较,差异无统计学意义(P=0.994).(2)孕产次:两组患者孕产次分别比较,差异均无统计学意义(P＞0.05).(3)合并症:增生组和癌变组有合并症的患者分别为23例(47%)和13例(43%),两组比较,差异无统计学意义(P=0.755).(4)BMI:癌变组明显高于增生组[分别为(27.9±5.4)和(25.2±2.9)kg/m2,P=0.024].(5)绝经及阴道流血情况:绝经后患者癌变组为50%(15/30),增生组为31%(15/49),两组比较,差异无统计学意义(P=0.085);绝经后阴道流血患者癌变组为13/15,增生组为8/15,两组比较,差异无统计学意义(P=0.109);未绝经有月经改变患者癌变组为12/15,增生组为68%(23/34),两组比较,差异无统计学意义(P=0.590).(6)B超检查:癌变组阳性(指官腔有回声团)率明显高于增生组[分别为73%(22/30)和51%(25/49),P=0.050].(7)分段诊刮和官腔镜检查的诊断价值:行分段诊刮活检患者23例(29%)、宫腔镜活检44例(56%),两者对非典型增生的初次诊断率分别为87%(21/23)和93%(41/44),对非典型增生伴癌变的初次诊断率分别为6/12和12/16,诊断为非典型增生的患者中癌变的漏诊率分别为6/13和19%(4/21),分别比较,差异均无统计学意义(P＞0.05).结论 对于围绝经期异常阴道流血患者,应积极进行分段诊刮及官腔镜检查,分段诊刮或官腔镜活检诊断为子宫内膜非典型增生患者中,若其BMI较高或B超提示官腔有回声团,应警惕合并子宫内膜癌的可能.
目的 分析子宮內膜非典型增生患者的臨床病理特徵.方法 選擇2007年3月至2010年7月北京大學人民醫院收治的診斷為子宮內膜非典型增生患者79例,其中49例(62%)為單純子宮內膜非典型增生(增生組),30例(38%)為子宮內膜非典型增生閤併癌變(癌變組).迴顧性分析子宮內膜非典型增生患者的臨床病理特徵[包括年齡、孕產次、體質指數(BMI)、絕經及陰道流血情況、閤併癥、B超檢查等],併對兩組患者進行比較.分析瞭分段診颳及宮腔鏡檢查在子宮內膜非典型增生診斷中的價值.結果 (1)年齡:患者平均年齡為(50±11)歲,其中癌變組為(51±11)歲,增生組為(50±10)歲,兩組比較,差異無統計學意義(P=0.994).(2)孕產次:兩組患者孕產次分彆比較,差異均無統計學意義(P＞0.05).(3)閤併癥:增生組和癌變組有閤併癥的患者分彆為23例(47%)和13例(43%),兩組比較,差異無統計學意義(P=0.755).(4)BMI:癌變組明顯高于增生組[分彆為(27.9±5.4)和(25.2±2.9)kg/m2,P=0.024].(5)絕經及陰道流血情況:絕經後患者癌變組為50%(15/30),增生組為31%(15/49),兩組比較,差異無統計學意義(P=0.085);絕經後陰道流血患者癌變組為13/15,增生組為8/15,兩組比較,差異無統計學意義(P=0.109);未絕經有月經改變患者癌變組為12/15,增生組為68%(23/34),兩組比較,差異無統計學意義(P=0.590).(6)B超檢查:癌變組暘性(指官腔有迴聲糰)率明顯高于增生組[分彆為73%(22/30)和51%(25/49),P=0.050].(7)分段診颳和官腔鏡檢查的診斷價值:行分段診颳活檢患者23例(29%)、宮腔鏡活檢44例(56%),兩者對非典型增生的初次診斷率分彆為87%(21/23)和93%(41/44),對非典型增生伴癌變的初次診斷率分彆為6/12和12/16,診斷為非典型增生的患者中癌變的漏診率分彆為6/13和19%(4/21),分彆比較,差異均無統計學意義(P＞0.05).結論 對于圍絕經期異常陰道流血患者,應積極進行分段診颳及官腔鏡檢查,分段診颳或官腔鏡活檢診斷為子宮內膜非典型增生患者中,若其BMI較高或B超提示官腔有迴聲糰,應警惕閤併子宮內膜癌的可能.
목적 분석자궁내막비전형증생환자적림상병리특정.방법 선택2007년3월지2010년7월북경대학인민의원수치적진단위자궁내막비전형증생환자79례,기중49례(62%)위단순자궁내막비전형증생(증생조),30례(38%)위자궁내막비전형증생합병암변(암변조).회고성분석자궁내막비전형증생환자적림상병리특정[포괄년령、잉산차、체질지수(BMI)、절경급음도류혈정황、합병증、B초검사등],병대량조환자진행비교.분석료분단진괄급궁강경검사재자궁내막비전형증생진단중적개치.결과 (1)년령:환자평균년령위(50±11)세,기중암변조위(51±11)세,증생조위(50±10)세,량조비교,차이무통계학의의(P=0.994).(2)잉산차:량조환자잉산차분별비교,차이균무통계학의의(P＞0.05).(3)합병증:증생조화암변조유합병증적환자분별위23례(47%)화13례(43%),량조비교,차이무통계학의의(P=0.755).(4)BMI:암변조명현고우증생조[분별위(27.9±5.4)화(25.2±2.9)kg/m2,P=0.024].(5)절경급음도류혈정황:절경후환자암변조위50%(15/30),증생조위31%(15/49),량조비교,차이무통계학의의(P=0.085);절경후음도류혈환자암변조위13/15,증생조위8/15,량조비교,차이무통계학의의(P=0.109);미절경유월경개변환자암변조위12/15,증생조위68%(23/34),량조비교,차이무통계학의의(P=0.590).(6)B초검사:암변조양성(지관강유회성단)솔명현고우증생조[분별위73%(22/30)화51%(25/49),P=0.050].(7)분단진괄화관강경검사적진단개치:행분단진괄활검환자23례(29%)、궁강경활검44례(56%),량자대비전형증생적초차진단솔분별위87%(21/23)화93%(41/44),대비전형증생반암변적초차진단솔분별위6/12화12/16,진단위비전형증생적환자중암변적루진솔분별위6/13화19%(4/21),분별비교,차이균무통계학의의(P＞0.05).결론 대우위절경기이상음도류혈환자,응적겁진행분단진괄급관강경검사,분단진괄혹관강경활검진단위자궁내막비전형증생환자중,약기BMI교고혹B초제시관강유회성단,응경척합병자궁내막암적가능.
Objective To explore the clinicopathological characteristics in atypical endometrial hyperplasia patients. Methods A retrospective study was carry out on 79 cases with atypical endometrial hyperplasia patients admitted to Department of Gynecology, Peking University People's Hospital from Mar.2007 to Jul. 2010. All patients were divided into two groups, hyperplasia group (merely atypical endometrial hyperplasia, 49 cases, 62%) and cancerization group (atypical endometrial hyperplasia accompanying endometrial carcinoma, 30 cases, 38%). Results The mean age of 79 cases were (50 ± 11) years old ,while they were (50 ± 10) and (51 ± 11) years old for hyperplasia group and cancerization group, there were not difference (P = 0.994). The gravidity and delivery frequencies were also not differently between two groups. The rates of complicated other diseases were 47% (23/49) and 43% (13/30), which was not significantly different (P = 0.755). The body mass index (BMI) of cancerization group was higher than that of hyperplasia group [(27.9 ± 5.4) vs. (25.2 ± 2.9) kg/m2, P = 0.024]. There were 50% (15/30) and 31% (15/49) menopause cases in two groups, respectively. Among them there were 13/15 and 8/15 cases showed vaginal bleeding. Among premenopausal patients, there were 12/15 and 68% (23/34) showed abnormal vaginal bleeding, but there were not significantly different between two groups (all P ＞ 0.05). The uterine cavity mass found by ultrasonography in the cancerization group patients was more than that in hyperplasia group [73% (22/30) vs. 51% (25/49), P = 0.050]. There were 23 cases (29%), 44 cases (56%) and 12 cases (15%) were diagnosed by dilatation and curettage (D&G), hysteroscopy and hysterectomy, respectively. The rates of diagnosing atypical endometrial hyperplasia by D&G and hysteroscopy were 87 % (21/23) and 93 % (41/44), respectively. The rate of diagnosis of canceration were 6/12 and 12/16, respectively. While, the rate of missed diagnosis of canceration in the atypical endometrial hyperplasia patients by D&G and hysteroscopy were 6/13 and 19% (4/21) ,respectively. Which all did not shown significantly different (P ＞ 0.05). Conclusion Hysteroseopy or D&G should be chosen on those peri-menopausal patients with abnormal bleeding, while those atypical endometrial hyperplasia patients with high BMI and uterine cavity mass diagnosed with D&G and ultrasonography should consider the possibility of canceration.
