绝经后子宫内膜息肉经宫腔镜手术切除后转归的回顾性分析  

Retrospective analysis of the outcome of postmenopausal endometrial polyps after hysteroscopy

作　　者：桂婷 黄睿[2] 邓姗 GUI Ting;HUANG Rui;DENG Shan(Department of Obstetrics and Gynecology,National Clinical Research Center for Obstetric&Gynecologic Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730;Department of Obstetrics and Gynecology,the First Affiliated Hospital for Xiamen University,Xiamen 361003)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科学系,妇科内分泌与生殖中心,国家妇产疾病临床医学研究中心,北京100730 [2]厦门大学附属第一医院妇产科,厦门361003

出　　处：《生殖医学杂志》2023年第12期1832-1837,共6页Journal of Reproductive Medicine

摘　　要：目的探讨绝经后子宫内膜息肉经宫腔镜手术切除后的复发情况及复发的高危因素。方法回顾性分析2017年1月至2019年12月因“绝经后子宫内膜息肉或绝经后子宫内膜增厚”在北京协和医院行宫腔镜手术的455例患者的临床资料。收集患者的年龄、超声检查情况、宫腔镜术中情况、术后病理诊断、既往病史、肿瘤标记物、性激素水平、术后随访情况等临床资料,记录患者宫腔镜手术后的息肉复发情况,并采用Logistic回归分析术后息肉复发的危险因素。结果本研究纳入的455例患者的平均年龄为(61.13±6.78)岁(51~85岁),平均绝经年龄(50.91±3.43)岁(40~54岁)。455例患者的术后病理结果显示:子宫内膜息肉431例(94.73%)[含腺肌瘤样息肉15例(3.30%)],子宫内膜病变24例(5.27%)[其中恶性病变(包括子宫内膜不典型增生和子宫内膜癌)15例(3.30%)]。绝经后良性子宫内膜息肉患者随访3年,27例患者复发,整体复发率为6.26%,其中子宫内膜息肉伴有/不伴有萎缩性内膜术后复发率最低(5.47%),腺肌瘤样息肉术后复发率较高(13.33%),子宫内膜息肉伴有增殖期内膜术后复发率最高(21.43%),且3类患者的复发率比较,差异有统计学意义(P<0.05)。复发高峰期在术后1~2年间。Logistic回归分析显示,绝经前有子宫内膜息肉病史和子宫内膜息肉及其内膜的病理类型是术后复发的高危因素。27例复发患者中有4例再次行息肉切除术,术后病理结果仍为良性。结论绝经后子宫内膜息肉患者行宫腔镜手术切除后,整体复发率较低,且复发时仍以良性为主。腺肌瘤样息肉和伴有增殖期内膜的患者更容易复发,需要加强随访。Objective:To explore the recurrence risk and the high risk factors of postmenopausal endometrial polyps.Methods:A total of 455 patients who underwent hysteroscopy due to postmenopausal endometrial polyps or endometrial thickening in Peking Union Medical College Hospital between January 2017 and December 2019 were retrospectively analyzed.Clinical characteristics,including age,ultrasound image,hysteroscopy,the post-operative pathological diagnosis,previous medical history,tumor markers,sex hormones,and follow-up,were collected.The recurrence rate of postmenopausal endometrial polyp after hysteroscopy were evaluated and the potential high risk factors were analyzed by Logistic regression.Results:The average age of patients was 61.13±6.78(51-85)years old.The average menopausal age was 50.91±3.43(40-54)years old.The post-operative pathological diagnoses of 455 patients were as follows:431(94.73%)endometrial polyps wih 15(3.30%)adenomyoma-like polyps and 24(5.27%)endometrial lesions among which 15(3.30%)were malignant including endometrial atypical hyperplasia and endometrial cancer.After 3-year follow-up,the recurrence rate of benign polyps was 6.26%(27/431).Polyps with/without atrophic endometrium had the lowest recurrence rate of 5.47%,followed by adenomyoma-like polyps of 13.33%,and recurrence rate of polyps with proliferative endometrium was the highest(21.43%),showing significant differences(P<0.05).The recurrence peak was 1-2 years after hysteroscopy.The results of Logistic regression analyses showed that history of endometrial polypectomies before menopause and pathological type of the polyp and its accompanying endometrium were the two independent high risk factors of recurrence.Among 27 patients with polyp recurrence,4 patients experienced hysteroscopic resection again,and the post-operative pathological results remained benign.Conclusions:The recurrence rate of postmenopausal endometrial polyps after hysteroscopy was relatively lower,and the recurrent polyps mainly remained benign.Patients with adenomyoma

关 键 词：绝经后 子宫内膜息肉 复发 恶变 高危因素 

分 类 号：R711.74[医药卫生—妇产科学]