围绝经及绝经期非子宫内膜病变妇科良性疾病患者术前常规内膜活检的价值评估  

Evaluation of Preoperative Routine Endometrial Biopsy in Gynecological Benign Diseases with Non-Endometrial Lesions in Perimenopause and Menopause

作　　者：李凯丽 徐晓涵 杨萍[1] 白瑞 阮阳阳 LI Kaili;XU Xiaohan;YANG Ping(Department of Gynecology,The First Affiliated Hospital of the Medical College, Shihezi University,Shihezi Xinjiang 832008, China)

机构地区：[1]石河子大学医学院第一附属医院妇科

出　　处：《实用妇产科杂志》2019年第10期760-764,共5页Journal of Practical Obstetrics and Gynecology

基　　金：国家重大慢性非传染性疾病防控研究(编号:2016YFC1302901);新疆生产建设兵团重点领域科技攻关计划项目(编号:2017DB012)

摘　　要：目的:探讨围绝经期及绝经期非子宫内膜病变妇科良性疾病患者术前常规行子宫内膜活检的必要性.方法:收集2017年1月至2018年12月石河子大学医学院第一附属医院妇科围绝经期及绝经期因非子宫内膜病变妇科良性疾病行全子宫切除术的378例患者的一般资料及术前和术后子宫内膜病理检查结果等,并比较患者术前有无异常子宫出血史(AUB组与无AUB组)发生子宫内膜不典型增生(AH)和子宫内膜癌(EC)的几率.结果:①378例患者术前病理检查提示AH及EC者5例(1.32%),术后病理检查提示新增AH 5例和EC 4例.漏诊的9例均为术前行诊断性刮宫取内膜活检者,术前宫腔镜下内膜活检者无一例漏诊.②AUB组发生AH的几率高于无AUB组(5.26% vs 1.41%,P<0.05).③无AUB组发生EC及AH患者的平均年龄、行经年限显著高于子宫内膜病检正常及良性病变的患者(P<0.05),尤其当患者年龄≥50岁或者行经年限≥33年或阴道超声提示子宫内膜厚度≥11 mm时(P<0.05).结论:围绝经期及绝经期非子宫内膜病变妇科良性疾病患者,有AUB史者术前应常规行内膜活检.对于无AUB患者,符合年龄≥50岁或行经年限≥33年或子宫内膜厚度≥11 mm任一条件时,术前应常规取子宫内膜活检.宫腔镜下子宫内膜活检可明显降低AH和EC的漏诊率.Objective:To explore the necessity of routine endometrial biopsy in patients with gynecological benign diseases and non-endometrial lesions in perimenopause and menopause. Methods:The general data,preoperative and postoperative endometrial biopsy of 378 patients in perimenopause and menopause who underwent total hysterectomy for gynecological benign diseases and non-endometrial lesions in The First Affiliated Hospital of the Medical College in Shihezi University from January 2017 to December 2018 were collected. The incidence of endometrial atypical hyperplasia( AH) and endometrial cancer( EC) were compared in patients with or without abnormal uterine bleeding( AUB group and non-AUB group) before operation. Results:(1) There were 5 cases( 1. 32%) with AH and EC in preoperative pathological examination of 378 patients. There were 5 new cases with AH,4 new cases with EC in postoperative pathological examination. 9 cases were misdiagnosed by diagnostic curettage and endometrial biopsy before operation. None of the patients were misdiagnosed by hysteroscopic endometrial biopsy.(2)The incidence of AH in the AUB group was significantly higher than that in the non-AUB group( 5. 26% vs 1. 41%,P <0. 05).(3)The average age and lasted years of menstruation in patients with EC and AH in the non-AUB group were significantly higher than those in the normal and benign lesions of the endometrium group( P < 0. 05),especially when the age of patient was≥50 years old or lasted years of menstruation was≥33 years,or endometrial thickness was≥11 mm by the vaginal ultrasound( P < 0. 05). Conclusions:Routine endometrial biopsy should be done in patients with AUB history and in gynecological benign disease with non-endometrial lesions in perimenopause and menopause. For patients without AUB history,endometrial biopsy should be done before operation if the age is≥50 years or the lasted years of menstruation is≥33 years or the endometrial thickness is≥11 mm. Hysteroscopic endometrial biopsy can significantly reduce the rate of

关 键 词：非内膜病变妇科良性疾病 异常子宫出血 子宫内膜癌 诊断性刮宫 宫腔镜检查 

分 类 号：R711[医药卫生—妇产科学]