Objective: To explore the high risk factors of atypical endometrial hyperplasia (AEH) postoperative pathological upgraded to endometrial carcinoma (EC). Methods: We retrospectively analyzed the clinical data of 168 patients with AEH, evaluated the diagnostic value of diagnostic curettage, hysteroscopy biopsy and intraoperative frozen pathology according to the standard of postoperative paraffin pathology. According to the characteristics of the clinical cases, the risk of postoperative upgrading to cancer was evaluated and leakage of EC was avoided. Results: The diagnostic coincidence rate of hysteroscopy biopsy (72.72％) is higher than that of diagnostic curettage (66.67％), the difference was not statistically significant (P＞0.05). The intraoperative frozen pathology have higher diagnostic coincidence rate for AEH and EC, and the higher the preoperative pathology score, the higher the risk of upgrade to EC. Among the 54 patients with EC, 38 cases (70.37％) are with high differentiation cancer and 46 cases (85.19％) with Ia patients. Age, postmenopausal status, obesity, preoperative ultrasound and intraoperative section of the uterine cavity were the sensitive indexes for predicting EC. Conclusion: AEH has a tendency to become EC, especially the preoperative pathological score is high, and the patients who are menopausal, obese, preoperative ultrasound indicate abundant blood flow, and the endometrium is not smooth in the operation. Most of the cancers are well differentiated, mainly in the early stage. The intraoperative frozen pathology can improve the accuracy of diagnosis, however, the possibility of missed diagnosis cannot be ruled out.%目的:探讨子宫内膜不典型增生(atypical endometrial hyperplasia,AEH)患者术后病理升级为子宫内膜癌(endometrial carcinoma,EC)的高危因素.方法:回顾性分析168例AEH患者的临床病例资料,以术后石蜡病理为标准,评价诊断性刮宫、宫腔镜下病理活检及术中冰冻病理的诊断价值.根据其临床病例特点,评估术后升级为癌的风险,避免EC的漏诊.结果:宫腔镜下病理活检诊断符合率(72.72％)高于诊断性刮宫的诊断符合率(66.67％),但差异无统计学意义(P＞0.05).术中冰冻病理对AEH,EC均有较高的诊断符合率,术前病理分度越高,升级为癌的风险越高.54例(32.14％)患者术后升级为癌,其中高分化癌38例(70.37％),Ia期患者46例(85.19％).年龄、绝经状态、肥胖、术前超声、术中剖视宫腔情况等是预测术后病理升级的敏感指标.结论:AEH有癌变倾向,尤其是术前病理分度高,已绝经、肥胖、术前超声提示血流信号、术中剖视子宫内膜不光滑的患者,合并癌多数分化较好,以早期为主.术中行冰冻病理检查可提高诊断的准确性,但仍不能排除漏诊可能.
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