子宫内膜增厚老年患者的临床及病理分析

目的 总结子宫内膜增厚老年患者的临床和宫腔镜活检病理特点.方法 回顾性分析北京老年医院2003年1月至2015年6月收治的阴道超声检查提示子宫内膜增厚≥5 mm并行宫腔镜活检及病理学检查的93例老年妇女的临床及病理资料.依据病理结果(正常/良性增生组和癌前病变/癌变组)及有无症状(有症状组和无症状组),分别比较患者的临床和病理情况.结果 子宫内膜正常21例;良性病变54例,包括子宫内膜息肉18例(25.0％),萎缩性内膜炎15例(20.8％),增殖期内膜14例(19.4％),黏膜下子宫肌瘤4例(5.6％),单纯性增生3例(4.2％);子宫内膜癌前病变/癌变18例,包括单纯性伴非典型性增生2例(2.8％),复杂性伴非典型性增生2例(2.8％),子宫内膜样腺癌12例(16.7％),癌肉瘤1例(1.4％),透明细胞癌1例(1.4％).正常/良性增生组(75例)与癌前病变/癌变组(18例)的绝经年龄≥55岁、绝经年限≥10年、子宫内膜厚度≥10 mm、有症状、合并高血压或肥胖患者比例的差异有统计学意义(P＜0.05).无症状组(35例)与有症状组(58例)的癌前病变/癌变构成比的差异有统计学意义(P=0.041).宫腔镜检查诊断的灵敏度为94.4％(68/72),特异度为95.2％(20/21),准确度为94.6％(88/93).结论 老年女性子宫内膜增厚主要是子宫内膜息肉、萎缩性内膜炎、增殖期内膜.但子宫内膜癌也占有一定比例,需引起高度重视.老年女性应用宫腔镜活检安全可行,宜作为老年子宫内膜病变有效的诊断方法之一.

Analysis on the clinical and pathological characteristics of elderly patients with endometrial thickening

Objective To study the clinical and pathological characteristics of biopsy in elderly patients with endometrial thickening.Methods Ninety-three cases of elderly women with endometrium ≥ 5 mm in Beijing Geriatric Hospital from January 2003 to June 2015 were included and their data were analyzed.All women were examined by transvaginal ultrasongraphy,hysteroscopy and pathological biopsy.The clinical and pathological characteristics were respectively compared between groups with different pathological results (benign and premalignant/malignant) and symptoms (symptomatic and asymptomatic).Results In the 54 benign endometrial lesions,endometrial polyps was detected in 18 cases(25.0％),endometritis in 15 cases (20.8％),proliferative phase endometrium in 14 cases (19.4％),submucous myomas in 4 cases (5.6％),and simple hyperplasia in 3 cases (4.2％);in thel8 premalignant/malignant cases,simple with atypical hyperplasia was confirmed in 2 cases (2.8％),complicated with atypical hyperplasia in 2 cases (2.8％),endometrial adenocarcinoma in 12 cases (16.7％),carcinosarcoma in 1 case (1.4％),and clear-cell carcinoma in 1 case(1.4％).The proportion of menopausal age ≥ 55 years,menopausal time ≥ 10 years,endometrial thickness ≥ 10mm,symptomatic patient,hypertension and obesity were significantly different between the two groups(P＜0.05).The proportion of premalignant/malignant patient was significantly different between the symptomatic group and the asymptomatic group(P=0.041).The sensitivity was 94.4％,the specificity was 95.2％,the accuracy rate was 94.6％ of hysteroscopy for the diagnosis of endometrial lesions.Conclusion Most of endometrial thickness in elderly women is due to endometrial polyps,endometritis and proliferative phase endometrium,but endometrial cancer also accounts for a certain percentage.Application of hysteroscopy with directed biopsy in elderly women is safe and feasible,and should be used as an effective method for the diagnosis of endometrial lesions in elderly women.