他莫昔芬对绝经后乳腺癌术后患者子宫内膜的影响及宫腔镜的诊断价值

目的 通过评估宫腔镜下内膜活检的病理结果,以评价他莫昔芬对绝经后乳腺癌患者子宫内膜的影响。方法 回顾性分析大连市妇幼保健院2011年1月～2018年1月92例服用他莫昔芬的绝经后乳腺癌患者的临床资料,其中包括无症状仅有子宫内膜增厚者62例,阴道不规则出血者30例。所有患者行阴式超声检查和宫腔镜下子宫内膜活检术,术中使用鳄口型活检钳钳夹异常内膜组织进行病理学检查。结果 宫腔镜检查和病理结果两者的符合率较高,尤其是对于子宫内膜息肉的诊断符合率达100%。出现阴道不规则出血症状的患者发生内膜恶变几率较高(20%),而无症状患者癌变率仅为3.2%。随着用药时间的延长,患者子宫内膜厚度增加,同时内膜病理类型增多。结论 绝经后乳腺癌患者长期口服他莫昔芬可引起子宫内膜病变。临床上对服用他莫昔芬的绝经后乳腺癌患者应常规行阴式超声检查来随访子宫内膜情况,若子宫内膜增厚或出现阴道不规则出血的症状,应采取宫腔镜检查和活检术辅助诊断。

The effect of tamoxifen on the endometrium of postmenopausal breast cancer patients and the diagnostic value of hysteroscopy

Objective To evaluate the pathology of the endometrium in outpatient clinics using hysteroscopy biopsy,and to evaluate the effect of tamoxifen on the endometrium of postmenopausal breast cancer patients.Methods Ninetytwo cases of postmenopausal breast cancer patients who took tamoxifen in Dalian Maternal and Child Health Hospital from January 2011 to January 2018 were retrospectively analyzed,including 62 patients with asymptomatic thickening of the endometrium and 30 cases of irregular vagina bleeding.All patients underwent vaginal ultrasound examination and hysteroscopy endometrial biopsy.During the operation,jaw-mouth biopsy forceps were used to clamp abnormal endometrial tissues for pathology.Results The coincidence rate between hysteroscopy and pathological results was high,especially the diagnosis of endometrial polyps (100%).Patients with irregular vaginal bleeding have a higher rate of en dometrial malignancy(20%),while asymptomatic patients have a cancer rate of only 3.2%.With the prolongation of medication,the thickness of the endometrium increases,and the types of endometrial pathology also increase.Conclusion Long-term oral administration of tamoxifen in postmenopausal breast cancer patients can cause endometrial lesions.Clinically,breast cancer patients who take tamoxifen after menopause should undergo routine vaginal ultrasound examination to follow up the endometrium.If the endometrium thickens or has abnormal bleeding symptoms,hysteroscopy and biopsy are very helpful in diagnosis.