子宫内膜非典型增生行全子宫切除术104例临床分析-现代医学

子宫内膜非典型增生行全子宫切除术104例临床分析

单位：南京大学医学院附属鼓楼医院妇产科, 江苏南京 210000

分类号：R713.4

出版年·卷·期（页码）：2023·51·第二期（151-155）

摘要：

目的：研究子宫内膜非典型增生患者的临床特征及行全子宫切除术后并发子宫内膜癌的危险因素。方法：收集2012年1月至2022年6月南京鼓楼医院收治的因子宫内膜非典型增生入院行全子宫切除术患者104例，其中21例（20.2%）术后病理为子宫内膜非典型增生合并癌变（癌变组），其余83例（79.8%）为单纯子宫内膜非典型增生（非典型组），回顾性分析患者的临床特征，并对两组患者临床资料进行比较，包括年龄、孕产次、体重指数（BMI）、绝经及阴道流血流液情况、合并症等，采用Logistic回归分析子宫内膜非典型增生术后病理升级为子宫内膜癌的高危因素。结果：（1）所有患者平均年龄为（52.4±9.3）岁，其中40~60岁79例（76%），两组年龄比较差异无统计学意义（P=0.840）；（2）两组患者孕次、产次比较，差异无统计学意义（P=0.427，P=0.239）；（3）癌变组BMI （27.4±4.0） kg·m^-2，非典型组（26.2±5.0） kg·m^-2，两组比较差异无统计学意义（P=0.504）；癌变组肥胖（BMI≥28 kg·m^-2）患者占47.6%（10/21），明显高于非典型组的24.1%（20/83），差异有统计学意义（P=0.034）；（4）癌变组患者诊刮比例为66.7%（14/21），高于非典型组的42.2%（35/83），差异有统计学意义（P=0.045）；（5）癌变组绝经后患者占66.7%（14/21），高于非典型组的36.1%（30/83），差异有统计学意义（P=0.011）；（6）两组在阴道流血流液、合并症和诊刮确诊到切除子宫时间方面，差异均无统计学意义；（7）二分类Logistic回归分析显示肥胖、诊刮和绝经后状态是子宫内膜非典型增生术后病理升级为子宫内膜癌的高危因素。结论：对于围绝经期异常阴道流血流液患者，应积极进行宫腔镜诊刮取得内膜活检病理，子宫内膜非典型增生患者，特别是绝经后或者肥胖患者，应警惕合并子宫内膜癌的可能。

Objective: To investigate the clinical characteristics of patients with atypical endometrial hyperplasia, and explore the risk factors of endometrial cancer after hysterectomy. Methods: One hundred and four cases of women with atypical endometrial hyperplasia who underwent hysterectomy from January 2012 to June 2022 in Nanjing Drum Tower Hospital were recruited in this retrospective study. All patients were divided into cancerization group(n=21, 20.2%) and atypical group(n=83, 79.8%) according to their pathological results after hysterectomy. Clinical characteristics of the patients were retrospectively analyzed and clinical data of the two groups, including age, gestational times, body mass index(BMI), menopause, vaginal bleeding and complications, were compared. Logistic regression analysis was conducted to analyze the risk factors of pathology upgrading to endometrial carcinoma after the operation of endometrial atypical hyperplasia. Results: The mean age of the 104 cases was(52.4±9.3) years old, of whom 76% aged 40 to 60 years old with no statistical difference between the two groups(P=0.840). No differences of gravidity and delivery frequencies were found between the two groups(P=0.427, P=0.239). The BMI was(27.4±4.0) and (26.2±5.0) kg·m^-2 in cancerization group and atypical group respectively with no statistical difference(P=0.504). The rate of fat patients(BMI ≥ 28 kg·m^-2) in cancerization group was significantly higher than that in atypical group[47.6%(10/21)vs 24.1%(35/83), P=0.034]. The proportion of dilatation and curettage in canceriation group was significantly higher than that in atypical group[66.7%(14/21)vs. 42.2%(35/83), P=0.045]. Postmenopausal patients in the cancer group were 66.7%(14/21), which was higher than 6.1%(30/83) in the atypical group with significant difference(P=0.011). There were no statistical differences between the two groups in terms of vaginal bleeding, complications and the time from diagnosis to hysterectomy. Binary Logistic regression analysis showed that obesity, curettage and postmenopausal status were independent risk factors for pathology upgrading to endometrial cancer after the operation of endometrial atypical hyperplasia. Conclusion: Hysteroscopy curettage should be chosen for those peri-menopausal patients with abnormal vaginal bleeding or fluid, while atypical endometrial hyperplasia patients with obesity or postmenopausal status may possibly be considered as concurrent endometrial cancer.

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