绝经后无症状子宫内膜增厚女性超声、宫腔镜及病理组织学检查结果的相关性研究-东南大学学报医学版

绝经后无症状子宫内膜增厚女性超声、宫腔镜及病理组织学检查结果的相关性研究

单位：1. 新疆医科大学第一附属医院妇科中心, 新疆乌鲁木齐 830054;
2. 新疆医科大学健康管理院, 新疆乌鲁木齐 830054

分类号：R711.7

出版年·卷·期（页码）：2023·42·第四期（602-606）

摘要：

目的:探讨绝经后无症状子宫内膜增厚女性B超所测的子宫内膜厚度、宫腔镜检查术中所见的结果及病理组织学检查结果三者之间的相关性。方法:收集绝经后超声提示子宫内膜厚度≥0.50 cm且无任何临床症状(阴道流血、流液、白带增多、腹痛、腹胀和发现盆腔包块等)的287例女性资料,分析其子宫内膜厚度、宫腔镜检查术中所见的结果及术后病理组织学检查结果,并探讨三者之间的相关性。结果:84.3%的绝经后子宫内膜增厚无症状的妇女有宫腔内病变。子宫内膜厚度为0.50~1.00 cm的患者中,子宫内膜癌癌前病变检出率1.7%,宫颈腺癌检出率0.7%。子宫内膜厚度＞1.00~1.50 cm患者中,恶性肿瘤(子宫内膜癌、宫颈腺癌)检出率2.1%。子宫内膜厚度＞1.50 cm的患者中,均有宫腔内病变,无阴性结果,子宫内膜癌检出率1.4%,子宫内膜癌前病变检出率0.3%;子宫内膜厚度＞2.00 cm的2例患者病理组织检查均为子宫内膜腺癌。子宫内膜厚度在宫腔内病变(无论良性、恶性)中的预测最佳阈值为0.65 cm,敏感度为81.1%,特异度为28.5%。结论:绝经后无症状子宫内膜增厚的女性(内膜厚度＞0.65 cm),其宫腔良、恶性疾病的患病率高,须引起重视,且常规超声随访仍是比较安全可靠的方法,必要时须行宫腔镜检查及病理组织学检查以排除恶性病变。当患者子宫内膜厚度0.50~0.65 cm,暂可排除宫内恶性病变,可予患者短期随访,若随访过程中出现内膜厚度无变薄或持续性增厚等,有行宫腔镜检查的指征。

Objective: To determine the correlation among endometrial thickness, hysteroscopic findings and pathological findings in asymptomatic postmenopausal women with endometrial thickening. Methods: 287 postmenopausal women with endometrial thickness more than or equal to 0.5 cm and without any clinical symptoms(vaginal bleeding, fluid flow, leucorrhea increase, abdominal pain and abdominal distention, pelvic mass, etc.) were analyzed retrospectively.The correlation of endometrial thickness, hysteroscopic examination and postoperative pathological examination results was analyzed. Results: 84.3% of postmenopausal women with asymptomatic endometrial thickening had intrauterine lesions.In patients with endometrial thickness of 0.50-1.00 cm, among which the detection rate of endometrial precancerous lesions was 1.7%, and the detection rate of cervical adenocarcinoma was 0.7%.In patients with endometrial thickness of ＞1.00-1.50 cm, the detection rate of malignant tumors(endometrial cancer, cervical adenocarcinoma) was 2.1%. In the patients with endometrial thickness greater than 1.50 cm, there were intrauterine lesions without negative results. The detection rate of endometrial cancer was 1.4%, and the detection rate of precancerous lesions was 0.3%.Two patients with endometrial thickness more than 2.00 cm were diagnosed as endometrial adenocarcinoma by pathological examination.The best prediction threshold of endometrial thickness in intrauterine lesions(benign and malignant) was 0.65 cm, the sensitivity was 81.1%, and the specificity was 28.5%. Conclusion: Asymptomatic women with postmenopausal endometrial thickening(endometrial thickness ＞0.65 cm) have a high incidence of uterine benign and malignant diseases, to which attention needs to be paid. Conventional ultrasound follow-up is still a safe and reliable method. If necessary, hysteroscopy and pathological examination should be performed to exclude malignant diseases. When the endometrial thickness of the patient is between 0.50-0.65 cm, the intrauterine malignant lesions can be temporarily excluded, and the patient can be given short-term follow-up. If the endometrial thickness has no thinning or persistent thickening during the follow-up, there is an indication for hysteroscopy.

参考文献：

[1] 吴倩华,李碧岚.子宫内膜癌免疫治疗的进展及现状[J].现代妇产科进展,2022,31(5):389-393.
[2] 卢潘萍,廖予妹,张喆琳.三维超声联合恶性风险模型在绝经后出血子宫内膜癌筛查中的应用价值研究[J].中国全科医学,2022,25(14):1724-1729.
[3] 申晓畅,孙一卿,颜磊,等.miR1290在子宫内膜癌发生发展中的作用及其机制[J].中华肿瘤杂志,2022,44(2):130-138.
[4] 牟利民,张文豪,张思平,等.绝经后女性退变性膝骨关节炎疼痛与性激素水平及关节液炎性因子的相关性研究[J].中国全科医学,2022,25(29):3652-3657.
[5] 丁宁,姜秀新,徐世杰.基于"女子以肝为先天"思想论治围绝经期无排卵性异常子宫出血[J].中国实验方剂学杂志,2021,27(13):191-198.
[6] 杨文惠,丁莉,唐飞.经阴道彩超与宫腔镜诊断子宫内膜病变的效能分析[J].影像科学与光化学,2022,40(3):490-493.
[7] 李灿,李慧,程静新.绝经后子宫内膜增厚与子宫内膜病变的相关性研究[J].实用妇产科杂志,2021,37(1):62-66.
[8] 李云飞,夏恩兰,黄晓武.绝经后异常子宫出血患者的临床与病理分析[J].首都医科大学学报,2021,42(6):1060-1064.
[9] 吕永利,耿力,万盈璐,等.子宫内膜癌患者术后下肢淋巴水肿风险预测模型的构建及效果验证[J].中华护理杂志,2021,56(8):1174-1180.
[10] 夏婷婷,李洁,张媛,等.反复种植失败患者子宫内膜"种植窗"时期催产素受体的表达[J].中山大学学报:医学科学版,2020,41(4):589-595.
[11] 陈寸,吉文倩,刘伟,等.经阴道超声测量子宫内膜厚度对老年患者子宫内膜癌的诊断作用[J].中国老年学杂志,2020,40(19):4106-4108.
[12] 卢潘萍,廖予妹,张喆琳.三维超声联合恶性风险模型在绝经后出血子宫内膜癌筛查中的应用价值研究[J].中国全科医学,2022,25(14):1724-1729.
[13] 中华医学会妇产科学分会妇科内镜学组.宫腔镜手术子宫颈预处理临床实践指南[J].中华妇产科杂志,2020,55(12):813-818.
[14] OZELCI R,DILBAZ B,AKPINAR F,et al.The significance of sonographically thickened endometrium in asymptomatic postmenopausal women[J].Obstet Gynecol Sci,2019, 62(4):273-279.
[15] 沈豪飞,王奕翔,陈华琴,等.宫腔镜检查对慢性子宫内膜炎的诊断价值[J].中国妇产科临床杂志,2020,21(6):616-617.
[16] ZHANG X, PANG Y, MA Y, et al. A comparison between laparoscopy and hysteroscopy approach in treatment of cesarean scar pregnancy[J].Medicine, 2020, 99(43):e22845.
[17] HAKKARAINEN J, PARTANEN V, ANTTILA A, et al.Setting the record straight-correcting uterine cancer incidence and mortality in the Nordic countries by reallocation of unspecified cases[J].Acta Obstetricia et Gynecologica Scandinavica, 2022, 101(3):323-333.
[18] 王永学,金滢,李燕,等.绝经后无症状子宫内膜增厚妇女的子宫内膜癌发生风险[J].现代妇产科进展,2019,28(2):109-111.
[19] 花茂方,姚军,蒋巧玲.宫腔镜定位刮宫术对围绝经期异常子宫出血的诊断价值[J].现代医学,2020,48(4):481-484.

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