绝经期无症状子宫腔内异常声像改变的病因与治疗

目的分析绝经期无症状子宫腔内异常声像改变的原因,探讨适宜的诊疗方法。方法 2007年9月～2009年4月对50例经腹/阴道超声提示子宫腔内异常回声改变但无临床症状的绝经期患者实施宫腔镜诊断和治疗。结果 50例宫腔异常回声中良性占位病变36例(包括内膜息肉31例,其中1例非典型子宫内膜腺瘤型息肉;黏膜下肌瘤5例);萎缩性子宫内膜6例(其中2例合并子宫内膜炎);子宫内膜不典型增生3例(包括轻度不典型增生1例,中度不典型增生2例);增殖期子宫内膜2例;宫腔粘连2例;残留宫内节育器1例。对宫腔内占位病变实施宫腔镜手术治疗,包括病灶切除、粘连分离及宫内节育器取出手术;子宫内膜不典型增生均行全子宫双附件切除,手术均顺利,无一例并发症。宫腔镜手术后50例随访9～27个月,平均19.4月,其中12～24个月30例,24个月11例,1例宫腔粘连复发,再次宫腔积液,1例子宫肌瘤宫腔仍为低回声改变,其余无特殊。结论绝经期无症状子宫腔异常声像改变以宫腔内良性占位性病变为主,应及时明确诊断,宫腔镜是绝经期宫腔异常声像改变安全、微创、有效的诊疗手段。

Causes and Treatment of Ultrasonographical Asymptomatic Intrauterine Abnormality

Objective To study the causes of asymptomatic intrauterine abnormality detected by ultrasonography in postmenopausal patients, and to investigate the proper therapeutic methods for the disease. Methods From September 2007 to April 2009, totally 50 postmenopausal patients with asymptomatic intrauterine abnormality, that was found by ultrasonography, underwent hysteroscopy for diagnosis and treatment in our hospital. Results Of the 50 cases, benign space-occupying lesions was detected in 36 cases, including 31 cases of endometrial polyp and 5 cases of submucous myoma; atrophic endometrium was found in 6 cases （with endometritis in 2 patients）; endometrial atypical hyperplasia was revealed in 3 patients （mild in 1 and medium in 2）; proliferative endometrium was observed in 2 cases; intrauterine adhesion was detected in 2; and IUD was found in 1 case. We performed hystersocopic operations, including resection of the lesions, separation of the adhesive tissues, removal of IUD, as well as resection of the uterus and adnexa （for patients with endometrial atypical hyperplasia） on 39 of the patients; none of the patients showed surgery-related complications. The 50 patients were followed up for a mean of 19.4 months （ranged from 9 to 27 months, 12-24 months in 30 patients, and 24 months in 11 cases）, during which 1 patients who had uterine adhesion showed recurrence, and 1 patient who had myoma still had low-echo lesions shown by ultrasonography. Conclusions The main cause for asymptomatic intrauterine abnormalities in postmenopausal patients is benign space-occupying disease. Further diagnosis and treatment are recommended to reduce the risk of precancerous masses. Hysteroscopy, as a minimally invasive approach, is safe for the patients.