超声宫腔异常的老年女性子宫内膜病变和增龄的关系

摘要

目的 探讨阴道超声(T V S)宫腔异常的老年女性子宫内膜病变特点和增龄性变化.方法 回顾性分析我院2010年1月至2017年12月因T VS提示宫腔异常并接受宫腔镜诊断刮宫的1052例老年女性的临床资料,年龄60～90岁,结合年龄的三分位法进行分层分析,观察不同年龄组老年女性子宫内膜病变的临床特征.结果 1052例老年女性单纯内膜增厚为最常见的原因560例(53.2％),其次为宫腔回声异常388例(36.9％)和宫腔积液104例(9.9％).病理类型以单纯息肉为主,占57.8％(608例),内膜癌占4.2％(44例).按年龄分层结果显示,低龄组、中龄组、高龄组宫腔积液为20例(6.1％)、20例(5.9％)、64例(16.7％),差异有统计学意义(χ2=23.40,P<0.01);随增龄,癌前病变的比例增加,分别为0.0％(0例)、2.4％(8例)、3.1％(12例)(χ2=9.04,P<0.01),子宫内膜癌呈下降趋势,分别为6.1％(20例)、4.7％(16例)和2.1％(8例)(χ2=7.23,P<0.01).结论 T VS是老年女性子宫内膜病变有效的筛查手段,随年龄增加,T VS检查提示宫腔积液的比例增加,进一步宫腔镜病理结果中子宫内膜癌的比例下降,而癌前病变的比例增加.%Objective To explore the characteristics of endometrial lesions and uterine cavity abnormality by transvaginal sonography(TVS)and the potential impact of aging on those. Methods 1052 elderly women(aged ≥60 years)underwent hysteroscopy endometrial curettage based on TVS providing an indication of abnormal uterine cavity at our hospital from January 2010 to December 2017 ,and their clinical and pathological data were analyzed.1052 patients were divided by age into a <65 years group and a ≥65 years group. And age tertile stratifications of lower tertile group ,middle tertile group ,and upper tertile group were used to investigate the correlation between ageing and endometirum diseases. Results A total of 1052 elderly women were included ,and the simple endometrial thickening was the most common etiological factor (53.2％ ) ,followed by abnormal endometrial echoes(36.9％ )and endometrial cavity fluid(9.9％ ).All the pathological results of polyps and endometrial cancer accounted for 57.8％ and 4.2％ ,respectively.Age tertile stratification analysis suggested that the proportions of endometrial cavity fluid was 6.1％ (n=20)in the lower tertile group , 5.9％ (n=20)in the middle tertile group ,and 16.7％ (n=64)in the upper tertile group(χ2 =23.40 ,P<0.01). An increasing proportion along with aging for precancerous lesions was 0.0％ (n=0) ,2.4％(n= 8) ,3.1％ (n = 12)(χ2 = 9.04 ,P < 0.01)in lower/middle/upper age tertile groups.But the proportion of endometrial cancer was decreased with ageing [lower/middle/upper tertiles :6.1％ (n=20) ,4.7％ (n=16) ,2.1％ (n=8)(χ2 =7.23 ,P<0.01]. Conclusions TVS is an effective methodfor screening uterine cavity lesions in elderly women. The TVS-detected prevalence of endometrial cavity fluid increases with ageing. The hysteroscopy endometrial pathological examination shows that endometrial cancer decreases and precancerous lesions increase with ageing.