661例异常子宫出血病因分析及处理探讨

发布时间：2019-01-30 19:55

【摘要】：目的 :对661例异常子宫出血(abnomal uterine bleeding,AUB)按PALM-COEIN病因分类进行相关诊断并探讨排卵障碍相关的AUB(AUB-O)和子宫内膜局部异常(AUB-E)治疗效果。方法:回顾性分析2013年1月至2016年3月江宁区妇幼保健所妇科门诊符合AUB诊断的661例患者临床资料,记录所有研究对象的年龄、体重、月经史、生育史等一般情况,采用PALM-COEIN分类系统进行病因分析,并统计对AUB-O和AUB-E患者行激素治疗的有效率。结果 :661例患者中结构异常性AUB为219例,占33.1%(其中AUB-子宫内膜息肉71例,占10.7%,AUB-子宫腺肌病68例,占10.3%,AUB-子宫平滑肌瘤51例,占7.7%,AUB-内膜恶变和不典型增生29例,占4.4%);非结构异常性AUB 442例,占66.9%(其中AUB-全身凝血相关疾病3例,占0.4%,AUB-O 245例,占37.1%,AUB-E 159例,占24.1%,AUB-医源性31例,占4.7%,AUB-未分类4例,占0.6%)。259例行诊刮术;AUB-O及AUB-E中155例给予雌孕激素(或孕激素)治疗3个月,其有效率分别为95.8%及97.1%,189例给予短效口服避孕药(OC)3个月的有效率分别为97.6%及96.9%,无明显不良反应。结论:临床上AUB的PALM-COEIN病因诊断中非结构异常较结构异常多见,且前者中AUB-O和AUB-E发生率占主导,对此类患者临床应用雌孕激素或口服避孕药治疗均有效,值得基层医院推广应用。
[Abstract]:Objective: to investigate the clinical effects of AUB (AUB-O) and endometrial local abnormality (AUB-E) in the diagnosis of abnormal uterine bleeding (abnomal uterine bleeding,AUB) according to the etiological classification of PALM-COEIN. Methods: from January 2013 to March 2016, we retrospectively analyzed the clinical data of 661 patients who were diagnosed by AUB in the gynecological outpatient department of Jiangning District Maternal and Child Health Institute from January 2013 to March 2016, and recorded the age, weight, menstrual history, birth history of all the subjects in the study. PALM-COEIN classification system was used to analyze the etiology and the effective rate of hormone therapy for AUB-O and AUB-E patients was analyzed. Results: among the 661 patients, 219 cases (33.1%) had abnormal structural AUB (71 cases of AUB- endometrial polyps, 68 cases of AUB- adenomyosis, 51 cases of AUB- leiomyoma, 7. 7%). 29 cases (4.4%) of endometrial malignancy and atypical hyperplasia in AUB-; There were 442 cases (66.9%) of non-structural abnormal AUB (including 3 cases of AUB- systemic coagulation related diseases, 0.4 cases of AUB-O, 37.1 cases of AUB-E, 24.1 cases of AUB- iatrogenic 31 cases, 4.7 cases of iatrogenic. AUB- was not classified in 4 cases (0.6%). 155 cases of AUB-O and AUB-E were treated with estradiol (or progesterone) for 3 months, the effective rates were 95.8% and 97.1%, respectively. The effective rates of (OC) for 3 months were 97.6% and 96.9%, respectively. There was no significant adverse reaction. Conclusion: the etiological diagnosis of non-structural abnormality of PALM-COEIN in AUB is more common than that of structural abnormality, and the incidence of AUB-O and AUB-E is dominant in the former. It is effective to use estrogen and progesterone or oral contraceptive in this kind of patients. It is worth popularizing and applying in basic hospital.
【作者单位】：南京市江宁区妇幼保健所妇科;
【分类号】：R711

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