53例子宫内膜息肉恶变趋势的危险因素  

Risk factors of malignant transformation trend of 53 cases of endometrial polyps

作　　者：刘娅[1] 王雅芬[1] 朱琳[1] 张萍[1] 马德美[1] LIU Ya;WANG Yafen;ZHU Lin;ZHANG Ping;MA Demei(Department of Gynaecology,The Second Hospital of Shandong University,Jinan 250031,Shandong,China)

机构地区：[1]山东大学第二医院妇科,山东济南250031

出　　处：《山东大学学报（医学版）》2020年第1期39-42,48,共5页Journal of Shandong University:Health Sciences

摘　　要：目的探讨子宫内膜息肉患者宫腔镜下特征表现及其临床特征对子宫内膜息肉恶变的诊断价值。方法收集2012年8月至2019年1月在山东大学第二医院妇科就诊、行超声及宫腔镜检查诊断为子宫内膜息肉并行息肉活检或宫腔镜下息肉切除患者资料共567例,根据病理检查结果将其分为两组,其中良性组514例,恶性及癌前病变组53例。对患者子宫内膜息肉宫腔镜下特征表现及患者年龄、妊娠史、超声表现等进行统计分析。结果对可能与子宫内膜息肉恶变相关的临床特征进行统计学分析发现,恶性及癌前病变组患者处于绝经期人数及出现异常子宫出血症状人数多于良性组,其差异有统计学意义(47.16%vs 21.79%,P<0.001;92.45%vs 70.82%,P<0.001)。对可能与子宫内膜息肉恶变相关的宫腔镜下特征表现进行统计学分析发现,息肉表面血管增生是息肉发生恶变的危险因素,恶性及癌前病变组高于良性组(60.37%vs 9.33%,P<0.001)。多因素二元Logistic回归分析结果显示,息肉表面血管增生(OR=14.73,95%CI:7.88~27.53)、异常子宫出血(OR=5.05,95%CI:1.79~14.24)、绝经(OR=3.21,95%CI:1.80~5.72)是息肉恶变的危险因素,其中以息肉表面血管增生的危险性最高。结论绝经状态、异常子宫出血及息肉表面血管增生的子宫内膜息肉患者恶变及癌前病变可能性大,临床医生应更加警惕。Objective To explore the hysteroscopic features of endometrial polyps and the diagnostic value. Methods The study collected the clinical information of 567 patients during Aug. 2012 and Jan. 2019 who were diagnosed with ultrasound and hysteroscopy as endometrial polyps, and then received biopsy or resection of polyps under hysteroscopy. According to the pathological results, the patients were divided into two groups, 514 cases in the benign group and 53 caes in the malignant and pre-malignant group. The characteristics of endometrial polyps under hysteroscopy, the patients’ age, pregnancy history and ultrasound results were analyzed. Results The malignant and pre-malignant group were more likely to be menopausal and have symptoms of abnormal uterine bleeding than the benign group(47.16% vs 21.79%, P<0.001;92.45% vs 70.82%, P<0.001). Surface vascular hyperplasia was the risk factor of malignant transformation of polyps, whose incidence was higher in the malignant and pre-malignant group than in the benign group(60.37% vs 9.33%, P<0.001). Multivariate binary Logistic regression analysis showed that surface vascular hyperplasia(OR=14.73, 95%CI:7.88-27.53), abnormal uterine bleeding(OR=5.05, 95%CI:1.79-14.24) and menopause(OR=3.21, 95%CI:1.80-5.72) were risk factors of polyp malignant transformation, and surface vascular hyperplasia had the highest risk. Conclusion Due attention should be paid to menopause, abnormal uterine bleeding and surface vascular hyperplasia as they are risk factors of malignant transformation of endometrial polyps.

关 键 词：子宫内膜息肉 子宫内膜恶性肿瘤 宫腔镜检查 异常子宫出血 

分 类 号：R711.59[医药卫生—妇产科学]