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目的探讨1999年1月～2010年12月近12年来绝经前后异常子宫岀血(abnormal uterine bleeding,AUB)的中老年妇女子宫内膜病变的特点与变化趋势。方法 1999年1月～2010年12月,327例45～89岁中老年妇女因AUB入院,经宫腔镜检查与病理诊断为子宫内膜病变。169例年龄45～59岁为中年组,158例60～89岁为老年组,分析2组子宫内膜病变特点并进行比较;1999年1月～2004年12月为前6年组,2005年1月～2010年12月为后6年组,对中老年妇女子宫内膜癌(endometrial carcinoma,EC)的检出率进行比较。结果良性病变77.7%(254/327),恶性病变22.3%(73/327)。良性病变包括:子宫内膜息肉(endometrial polyps,EP)99例(30.3%),子宫内膜增殖症57例(17.4%),黏膜下子宫肌瘤57例(17.4%),子宫内膜炎41例(12.6%);恶性病变73例均为EC。中年组主要病变为黏膜下子宫肌瘤、子宫内膜增殖症和EP;老年组主要病变为EP和EC。中年组黏膜下子宫肌瘤占27.8%(47/169),子宫内膜增殖症占24.3%(41/169),显著高于老年组6.3%(10/158),10.1%(16/158)(χ2=26.181,P=0.000;χ2=11.334,P=0.001);老年组EP占36.1%(57/158),显著高于中年组24.9%(42/169)(χ2=4.873,P=0.027);老年组EC占31.0%(49/158),显著高于中年组14.2%(24/169)(χ2=13.309,P=0.000)。近12年来中老年妇女EC检出率呈上升趋势,后6年组26.4%(64/242)显著高于前6年组10.6%(9/85)(χ2=9.123,P=0.003);老年患者后6年组35.2%(44/125)显著高于前6年组15.2%(5/33)(χ2=4.905,P=0.027)。结论绝经后AUB的老年妇女子宫内膜病变主要是EP和EC,中年妇女是黏膜下子宫肌瘤;后6年与前6年相比,老年妇女EC的检出率呈上升趋势,应引起重视。
Objective To investigate the characteristics and trends of endometrial lesions in middle-aged and elderly women with abnormal uterine bleeding (AUB) before and after menopause in the past 12 years from January 1999 to December 2010. Methods From January 1999 to December 2010, 327 middle-aged and elderly women aged 45 to 89 were admitted to hospital for AUB. Hysteroscopy and pathology were used to diagnose endometriosis. 169 cases aged 45-59 years were middle-aged group and 158 cases aged 60-89 years old group. The characteristics of endometrial lesions in the two groups were analyzed and compared. The patients in the first six years from January 1999 to December 2004 were enrolled in this study. From January to December 2010 for the next 6 years, the detection rate of endometrial carcinoma (EC) in middle-aged and elderly women was compared. Results Benign lesions 77.7% (254/327), malignant lesions 22.3% (73/327). Benign lesions include 99 cases (30.3%) of endometrial polyps (EP), 57 cases (17.4%) of endometrial hyperplasia, 57 cases (17.4%) of submucous myoma, endometritis 41 Cases (12.6%); 73 cases of malignant lesions are EC. The main pathological changes in the middle-aged group were submucosal uterine fibroids, endometrial hyperplasia and EP. The main pathological changes in the elderly group were EP and EC. Middle-aged group, submucosal uterine fibroids accounted for 27.8% (47/169), endometrial hyperplasia accounted for 24.3% (41/169), significantly higher than the elderly group 6.3% (10/158), 10.1% (16/158 (χ2 = 26.181, P = 0.000; χ2 = 11.334, P = 0.001). The elderly group had 36.1% (57/158) of EP, which was significantly higher than that of 24.9% = 0.027). EC in elderly group was 31.0% (49/158), significantly higher than that in middle age group (14.2%, 24/169) (χ2 = 13.309, P = 0.000). In the past 12 years, the detection rate of EC in middle-aged and elderly women showed an upward trend, 26.4% (64/242) in the latter 6 years was significantly higher than 10.6% (9/85) in the first 6 years (χ2 = 9.123, P = 0.003) 35.2% (44/125) in the 6-year follow-up group was significantly higher than 15.2% (5/33) in the 6th year group (χ2 = 4.905, P = 0.027). Conclusion The elderly women with postmenopausal AUB mainly have endometrial lesions of EP and EC, while middle-aged women are submucous uterine fibroids. In the latter 6 years, the detection rate of EC in elderly women is on an upward trend compared with that of the first 6 years Pay attention.