125例绝经后子宫出血临床资料分析

发布时间：2019-03-31 12:25

【摘要】：目的:探讨青海地区125例绝经后子宫出血的原因,以及患者年龄、绝经年限、子宫内膜厚度、宫腔深度、出血持续时间等与子宫内膜病变的关系,分析绝经后子宫出血的相关因素。方法:收集2015年01月-2016年12月因绝经后子宫出血在青海大学附属医院就诊的患者125例,排除阴道、宫颈病变、卵巢输卵管肿瘤所致的出血,以及1年内应用激素类药物的患者,记录患者一般情况,查患者血中性激素水平,经阴超测定子宫内膜厚度,宫腔镜检查子宫内情况,所有患者行诊刮术或宫腔镜下活检术,取出组织送病理学检查。结果:绝经后子宫出血病例125例中,出血原因以良性病变为主,占77.6%(97/125),其次为恶性病变28例,占22.4%。绝经后子宫出血大多发生在60岁以前,占61.6%(77/125),此时良性病变53.6%(67/125),恶性病变8.0%(10/125),随着年龄增长,恶性肿瘤发病率有逐渐增高趋势;绝经后子宫出血多发生于绝经1-5年,占48.0%(60/125),此时的病变以良性器质性病变为主,随着绝经时间的延长,恶性肿瘤所占的比例有逐渐升高的趋势,绝经10年以上恶性肿瘤的发生率高达15.2%(19/125);增生性内膜子宫内膜厚度多≤8mm,子宫内膜癌内膜厚度多8mm,两者存在统计学差异(P0.05)。良恶性病变的宫腔深度、出血持续时间有差异(P0.05)。子宫内膜癌27例中雌激素升高的12例占44.4%,高血压10例占32.3%,糖尿病8例占30.0%,超重或肥胖14例占51.9%。结论:(1)125例绝经后子宫出血原因中以良性病变为主,恶性病变次之;(2)随着绝经年龄的增长、绝经年限的延长、子宫内膜厚度的增加,子宫内膜癌的发生率逐渐升高;(4)宫腔体积明显增大、出血持续时间明显延长时,要高度怀疑子宫内膜癌;(6)高血压、糖尿病、肥胖在子宫内膜的发生发展中具有一定作用,积极治疗可能预防内膜癌的发生。
[Abstract]:Objective: to investigate the causes of postmenopausal uterine bleeding in 125 cases in Qinghai, and the relationship between the age, menopause years, endometrial thickness, uterine cavity depth, bleeding duration and endometrial lesions. To analyze the related factors of postmenopausal uterine bleeding. Methods: 125 cases of postmenopausal uterine bleeding were collected from January 2015 to December 2016 in the affiliated Hospital of Qinghai University. The bleeding caused by vaginal, cervical and ovarian fallopian tube tumors was excluded. And the patients who used hormone drugs within 1 year, recorded the general condition of the patients, checked the level of serum sex hormone, measured the thickness of endometrium by vaginal ultrasound, examined the condition of uterus by hysteroscopy, and all the patients underwent curettage or biopsy under hysteroscopy, and all the patients were treated with curettage or hysteroscopic biopsies. Take out the tissue and send it for pathological examination. Results: among 125 cases of postmenopausal uterine bleeding, benign lesions accounted for 77.6% (97 / 125), followed by malignant lesions (22.4%). The majority of postmenopausal uterine bleeding occurs before the age of 60, accounting for 61.6% (77 / 125). At this time, the benign lesion is 53.6% (67 / 125), and the malignant lesion is 8.0% (10 / 125). With the age, the rate of uterine bleeding is 61.6% (77 / 125). The incidence of malignant tumor increased gradually. Most of the postmenopausal uterine bleeding occurred 1-5 years after menopause, accounting for 48.0% (60 / 125). At this time, benign organic lesions were the main pathological changes, and with the prolongation of menopause time, the proportion of malignant tumors increased gradually. The incidence of malignant tumors over 10 years after menopause was 15.2% (19 / 125). The endometrial thickness of proliferative endometrium was less than 8 mm, and the endometrial thickness of endometrial carcinoma was 8 mm. There was statistical difference between the two groups (P0.05). There were significant differences in uterine cavity depth and bleeding duration between benign and malignant lesions (P0.05). Among 27 cases of endometrial carcinoma, 12 cases (44.4%) had elevated estrogen, 10 cases (32.3%) had hypertension, 8 cases (30.0%) had diabetes, and 14 cases (51.9%) were overweight or obesity. Conclusion: (1) among 125 cases of postmenopausal uterine bleeding, benign lesions are the main causes, followed by malignant lesions. (2) with the increase of menopause age, the prolongation of menopause years and the increase of endometrial thickness, the incidence of endometrial carcinoma increased gradually. (4) the endometrial carcinoma should be highly suspected when the volume of uterine cavity is obviously enlarged and the duration of bleeding is prolonged. (6) Hypertension, diabetes and obesity play a certain role in the occurrence and development of endometrium. Active treatment may prevent the occurrence of endometrial carcinoma.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R711

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