不同生理阶段子宫内膜息肉的临床分析

发布时间：2018-03-14 18:06

本文选题：子宫内膜息肉　切入点：临床症状　出处：《安徽医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：【背景与目的】:子宫内膜息肉（endometrial polyps，EP）是女性常见的子宫内膜病变之一，其病理生理改变为:子宫内膜基底层的局限性增生形成的有蒂或无蒂的突向宫腔的赘生物，，由子宫内膜腺体和间质构成。近年来国内外报道其发病率呈上升趋势。其临床表现生育期主要为不规则阴道出血、月经过多、经期延长、不孕等，也可无任何症状而在体检或手术切除子宫时发现。EP在绝经期女性则主要表现为阴道少量点滴状出血，同时也有部分患者无临床症状。随着经阴道超声和宫腔镜技术的发展，EP的诊断率大大提高。治疗上EP可以借助宫腔镜和诊刮，但不同生理阶段EP的临床表现、恶变情况及复发情况等大有不同，推测EP不同生理阶段的发病机制可能有所不同。【资料与方法】：收集2009年1月至2013年1月期间在我院妇产科通过宫腔镜子宫内膜息肉电切术后经病理确诊的子宫内膜息肉患者480例，根据不同生理阶段分为生育期、围绝经期、绝经期三组，分析不同生理阶段EP患者的临床症状、息肉的个数、大小、部位及恶变情况和术后复发情况。采用描述性对照分析方法进行研究，旨在提高临床医生对子宫内膜息肉的发病机制、临床特征、诊治方法及术后预防复发的认识。【结果】：1.480例EP患者中，生育期患者326例,占67.91%；围绝经期患者32例，占6.67%；绝经期患者122例，占25.42%。其中子宫异常出血患者298例(生育期246例，占82.55%，围绝经期12例，占4.03%，绝经期40例，占13.42%)；不孕患者23例（生育期）；慢性下腹痛患者8例(生育期7例，围绝经期1例，绝经期0例)；合并其它妇科疾病治疗中发现者18例(生育期10例，占55.56%，围绝经期2例，占11.11%，绝经期6例，占33.33%)；临床无任何症状在体检时发现者133例(生育期57例，占42.86%，围绝经期14例，占10.53%，绝经期62例，占46.62%)。480例患者中单发息肉患者202例，多发息肉患者278例。 2.宫腔镜下子宫内膜息肉切除术后子宫异常出血的缓解率，生育期患者为64.72%（211/326），围绝经期患者为87.50%(28/32)，绝经期患者为88.52%(108/122)。 3.生育期患者多发息肉214例，单发息肉112例；围绝经期患者多发息肉20例，单发息肉12例；绝经期患者多发息肉44例，单发息肉78例。3组患者息肉个数间比较总体上具有显著性差异，χ2=32.16, p＜0.05。 4.三组患者息肉最大直径的平均值（mm）分别为7.79±3.85，8.50±4.12，11.02±4.21。三组患者总体上比较差异具有统计学意义，F＝13.58，p＜0.05。三组患者单发息肉最大直径≤1cm者中，生育期患者75例，围绝经期患者8例，绝经期患者26例；单发息肉最大直径＞1cm者中，生育期患者37例，围绝经期患者4例，绝经期患者52例；3组患者息肉大小间比较总体上具有显著性差异，χ2=21.76,p＜0.05。 5.三组患者息肉部位间比较，差异无统计学意义，χ2=4.91, p＞0.05。 6.本研究480例患者术后病理证实息肉恶变及恶变倾向者22例，（其中生育期患者8例、围绝经期患者2例、绝经期患者12例），其中子宫内膜非典型性增生11例，占2.29%；非典型息肉样腺肌瘤5例占1.04%；子宫内膜样癌6例占1.25%。不同生理时期息肉的恶变及恶变倾向率分别为2.45%、6.25%、9.84%，三组患者比较总体上差异具有统计学意义(χ2=11.28， P＜0.05)。 7.480例患者术后446例进行了随访，随访率为92.9%，（其中生育期患者304例，围绝经患者29例，绝经期患者113例），失访率为7.1%。分别于术后3个月、6个月、12个月对不同生理阶段患者的复发情况进行随访。术后3个月随访，生育期患者复发13例，围绝经期患者复发1例，绝经期患者复发2例，3组患者复发率比较差异无统计学意义；术后6个月随访，生育期患者复发35例，围绝经患者复发4例，绝经期患者复发4例，3组患者复发率比较差异具有统计学意义χ2=6.63, p＜0.05；术后12个月随访，生育期患者复发51例，围绝经期患者复发6例，绝经期患者复发7例，3组患者复发率比较差异具有统计学意义χ2=8.52, p＜0.05。【结论】： 1.不同生理阶段子宫内膜息肉的数量、大小、恶变率及复发率不同，推测其发病机制可能不同。 2.生育期子宫内膜息肉患者临床症状明显，较易诊断，绝经后EP患者多无明显临床症状，诊断较困难。 3.子宫内膜息肉患者所致症状经治疗后消失，提示子宫内膜息肉与该临床症状存在因果关系。
[Abstract]:[Objective] background: endometrial polyps (endometrial polyps EP) is one of the most common endometrial lesions in women, change its pathophysiology: limitation of endometrial hyperplasia of the basal layer of the formation of pedunculated or sessile protruding into the uterine cavity neoplasm, composed of uterine endometrial glands and stroma. In recent years at home and abroad reported that its incidence is rising. The clinical manifestations of growth period are mainly irregular vaginal bleeding, menorrhagia, menostaxis, infertility, but also without any symptoms found.EP in menopausal women is mainly manifested as a small amount of vaginal bleeding in guttate examination or surgical removal of the uterus, and at the same time some patients had no clinical symptoms. With the development of transvaginal ultrasound and hysteroscopy technology, the diagnostic rate of EP is greatly improved. The treatment EP can use hysteroscopy and curettage, but clinical manifestations in different physiological stages of EP, and the complex variable evil The incidence of EP is different. It is presumed that the pathogenesis of different physiological stages may be different.
[materials and methods]: during the period from January 2009 to January 2013 in our hospital obstetrics and Gynecology by hysteroscopic resection of endometrial polyps after 480 patients with pathologically confirmed endometrial polyps, according to the different physiological stages of growth period, perimenopause, menopause three groups, the clinical symptoms of different physiological stages in patients with EP, a the number of polyp size, recurrence and canceration position and postoperative. Descriptive analysis comparison, in order to improve the pathogenesis of endometrial polyps, clinicians, clinical features, diagnosis and treatment methods and understanding of prevention of recurrence after operation.
[results]: 1.480 patients with EP, the growth period in 326 cases, accounting for 67.91%; 32 cases of peri menopausal patients, accounted for 6.67%; 122 cases of menopausal patients, which accounted for 25.42%. of abnormal uterine bleeding in 298 patients (stage 246 cases, accounting for 82.55%, 12 perimenopausal women, accounting for 4.03%, 40 cases of menopause, accounted for 13.42%); 23 cases of infertility patients (growth period); 8 cases of patients with chronic abdominal pain (7 cases of perimenopausal period, 1 cases, 0 cases of menopause); 18 cases were found combined with other treatment of gynecological diseases (10 cases, growth period accounted for 55.56%, 2 perimenopausal women, accounting for 11.11%, 6 cases. Menopause accounted for 33.33%); 133 cases had no clinical symptoms at the time of examination found no (growth period in 57 cases, accounting for 42.86%, 14 perimenopausal women, accounting for 10.53%, 62 cases of menopause, accounted for 46.62%) in 202 cases of polyps in patients with solitary.480 patients, 278 cases of patients with multiple polyps.
2., the remission rate of abnormal uterine bleeding after hysteroscopic endometrial polypectomy was 64.72% (211/326) in the growth period, 87.50% in the perimenopausal period (28/32), and 88.52% (108/122) in the climacteric patients.
3., there were 214 cases of multiple polyps, 112 cases of single polyps in the growth period, 20 cases of multiple polyps in the perimenopausal period, 12 cases of single polyps, 44 cases of multiple polyps in the menopausal women, and 78 cases of single polyps. There was a significant difference in the number of polyps between the.3 group, and the difference was statistically significant (2=32.16, P < 0.05.).
The average maximum diameter of 4. three groups of patients with polyps (mm) were statistically significant 7.79 + 3.85,8.50 + 4.12,11.02 + 4.21. three groups overall difference, F = 13.58, P < 0.05., three groups of patients with polyps maximum diameter less than 1cm in 75 infertile patients, 8 cases of patients with perimenopausal period, 26 cases of menopausal patients; single largest diameter > 1cm polyps, 37 cases of patients with perimenopausal period, 4 patients, 52 cases of menopausal patients; 3 groups of patients with polyp size comparison between overall significant differences, X 2=21.76, P < 0.05.
5. the difference between the three groups of polyps was not statistically significant, X 2=4.91, P > 0.05.
6. of the 22 cases of 480 patients pathologically confirmed malignant polyps and canceration tendency, (including 8 cases of patients with perimenopausal period, 2 patients, 12 cases of menopausal patients), including endometrial atypical hyperplasia in 11 cases, accounting for 2.29%; 5 cases of atypical polypoid adenomyoma of endometrioid carcinoma accounted for 1.04%; in 6 cases of uterine polyps accounted for 1.25%. in different physiological stages of malignant transformation and malignant tendency rate were 2.45%, 6.25%, 9.84%, three groups had significant difference compared (x 2=11.28, P < 0.05).
7.480 cases of 446 cases of patients after operation were followed up, the follow-up rate was 92.9%, (including 304 cases of patients with perimenopausal period, 29 patients, 113 patients with menopause), the dropout rate was 7.1%. respectively after 3 months, 6 months, 12 months after the recurrence of different physiological stages patients. After 3 months of follow-up, the recurrence period of 13 patients with peri menopausal patients, recurrence in 1 cases, 2 cases of recurrence of menopausal patients, 3 groups of patients with recurrence rate had no significant difference; after 6 months of follow-up, 35 cases of recurrence in patients with peri menopausal period, recurrence in 4 cases, 4 cases the recurrence of menopause patients, 3 groups of patients with recurrence rate were statistically significant in X 2=6.63, P < 0.05; after 12 months of follow-up, the recurrence period of 51 patients with peri menopausal patients with recurrence, 6 cases of recurrence, 7 cases of menopausal patients, 3 groups of patients with recurrence rate were statistically significant in X 2=8.52, P < 0.05.
[Conclusion]:
1. the number, size, malignant change rate and recurrence rate of endometrial polyps at different physiological stages are different, and it is presumed that the pathogenesis of endometrial polyps may be different.
The clinical symptoms of endometrium polyps in 2. childbearing period are obvious, and it is easier to diagnose. There are no obvious clinical symptoms in EP patients after menopause, and the diagnosis is difficult.
3. the symptoms of endometrium polyps disappeared after treatment, suggesting that there is a causal relationship between endometrial polyps and the clinical symptoms.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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