53例子宫内膜息肉恶变趋势的危险因素

doi:10.6040/j.issn.1671-7554.0.2019.555

摘要/Abstract

摘要： 目的探讨子宫内膜息肉患者宫腔镜下特征表现及其临床特征对子宫内膜息肉恶变的诊断价值。方法收集2012年8月至2019年1月在山东大学第二医院妇科就诊、行超声及宫腔镜检查诊断为子宫内膜息肉并行息肉活检或宫腔镜下息肉切除患者资料共567例,根据病理检查结果将其分为两组,其中良性组514例,恶性及癌前病变组53例。对患者子宫内膜息肉宫腔镜下特征表现及患者年龄、妊娠史、超声表现等进行统计分析。结果对可能与子宫内膜息肉恶变相关的临床特征进行统计学分析发现,恶性及癌前病变组患者处于绝经期人数及出现异常子宫出血症状人数多于良性组,其差异有统计学意义(47.16% vs 21.79%,P<0.001;92.45% vs 70.82%,P<0.001)。对可能与子宫内膜息肉恶变相关的宫腔镜下特征表现进行统计学分析发现,息肉表面血管增生是息肉发生恶变的危险因素,恶性及癌前病变组高于良性组(60.37% vs 9.33%,P<0.001)。多因素二元Logistic回归分析结果显示,息肉表面血管增生(OR=14.73,95%CI:7.88~27.53)、异常子宫出血(OR=5.05,95%CI:1.79~14.24)、绝经(OR=3.21,95%CI:1.80~5.72)是息肉恶变的危险因素,其中以息肉表面血管增生的危险性最高。结论绝经状态、异常子宫出血及息肉表面血管增生的子宫内膜息肉患者恶变及癌前病变可能性大,临床医生应更加警惕。

关键词: 子宫内膜息肉, 子宫内膜恶性肿瘤, 宫腔镜检查, 异常子宫出血

Abstract: Objective To explore the hysteroscopic features of endometrial polyps and the diagnostic value. Methods The study collected the clinical information of 567 patients during Aug. 2012 and Jan. 2019 who were diagnosed with ultrasound and hysteroscopy as endometrial polyps, and then received biopsy or resection of polyps under hysteroscopy. According to the pathological results, the patients were divided into two groups, 514 cases in the benign group and 53 caes in the malignant and pre-malignant group. The characteristics of endometrial polyps under hysteroscopy, the patients’ age, pregnancy history and ultrasound results were analyzed. Results The malignant and pre-malignant group were more likely to be menopausal and have symptoms of abnormal uterine bleeding than the benign group(47.16% vs 21.79%, P<0.001; 92.45% vs 70.82%, P<0.001). Surface vascular hyperplasia was the risk factor of malignant transformation of polyps, whose incidence was higher in the malignant and pre-malignant group than in the benign group(60.37% vs 9.33%, P<0.001). Multivariate binary Logistic regression analysis showed that surface vascular hyperplasia(OR=14.73, 95%CI:7.88-27.53), abnormal uterine bleeding(OR=5.05, 95%CI:1.79-14.24)and menopause(OR=3.21, 95%CI:1.80-5.72)were risk factors of polyp malignant transformation, and surface vascular hyperplasia had the highest risk. Conclusion Due attention should be paid to menopause, abnormal uterine bleeding and surface vascular hyperplasia as they are risk factors of malignant transformation of endometrial polyps.

Key words: Endometrial polyps, Endometrial malignancies, Hysteroscopy, Abnormal uterine bleeding

中图分类号:

R711.59

刘娅,王雅芬,朱琳,张萍,马德美. 53例子宫内膜息肉恶变趋势的危险因素[J]. 山东大学学报 (医学版), 2020, 58(1): 39-42.

LIU Ya, WANG Yafen, ZHU Lin, ZHANG Ping, MA Demei. Risk factors of malignant transformation trend of 53 cases of endometrial polyps[J]. Journal of Shandong University (Health Sciences), 2020, 58(1): 39-42.

参考文献

[1] Sasaki LMP, Andrade KRC, Wanderley MDS, et al. Factors associated with malignancy in hysteroscopically resected endometrial polyps: a systematic review and meta-analysis [J]. J Minim Invasive Gynecol, 2018, 25(5): 777-785.
[2] Van Hanegem N, Breijer M, Slockers S, et al. Diagnostic workup for postmenopausal bleeding: a randomised controlled trial [J]. BJOG, 2017, 124(2): 231-240.
[3] Lubián López, Daniel Ma, Orihuela López, et al. Endometrial polyps in obese asymptomatic pre and postmenopausal patients with breast cancer: Is screening necessary? [J]. Gynecol Oncol, 2014, 133(1): 56-62.
[4] Jiménezlopez JS, Miguel GS, Tejerizogarcia A, et al. Effectiveness of transcervical hysteroscopic endometrial resection based on the prevention of the recurrence of endometrial polyps in post-menopausal women [J]. Bmc Womens Health, 2015, 15(1): 20.
[5] 龚美琴, 高雪梅. 子宫内膜息肉恶变的研究进展[J]. 实用妇产科杂志, 2017, 33(1): 24-27.
[6] 张颖, 陈梅, 郭银树, 等. 绝经后妇女子宫内膜息肉样癌及其癌前病变的临床特点及宫腔镜诊断价值[J]. 中华妇产科杂志, 2016, 51(5): 366-370. ZHANG Ying, CHEN Mei, GUO Yinshu, et al. Clinical characters of pre-malignant and malignant polyp in postmenopausal women and the diagnostic value of hysteroscopy [J]. Chinese Journal of Obstetrics and Gynecology, 2016, 51(5): 366-370.
[7] Gambadauro P, Martínez-Maestre MA, Torrejón R. When is see-and-treat hysteroscopic polypectomy successful? [J]. Eur J Obstet Gynecol Reprod Biol, 2014, 178: 70-73. doi: 10.1016/j.ejogrb.2014.03.048.
[8] Elfayomy AK, Habib FA, Elkablawy MA. Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium [J]. Arch Gynecol Obstet, 2012, 285(3): 839-843.
[9] Luerti M, Vitagliano A, Di Spiezio Sardo A, et al. Effectiveness of hysteroscopic techniques for endometrial polyp removal: the Italian multicenter trial [J]. J Minim Invasive Gynecol, 2019, 26(6): 1169-1176.
[10] Clark TJ, Stevenson H. Endometrial polyps and abnormal uterine bleeding(AUB-P)—what is the relationship; how are they diagnosed and how are they treated? [J]. Best Pract Res Clin Obstet Gynaecol, 2017, 40: 89-104. doi: 10.1016/j.bpobgyn.2016.09.005.
[11] Ghoubara A, Sundar S, Ewies AAA. Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women [J]. Climacteric, 2018, 21(4): 391-396.
[12] Wong M, Crnobrnja B, Liberale V, et al. The natural history of endometrial polyps [J]. Hum Reprod, 2017, 32(2): 340-345.
[13] Zhu H, Fu J, Lei H, et al. Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women [J]. Exp Ther Med, 2016, 12(2): 1196-1200.
[14] Zhu H, Fu J, Lei H, et al. Do postmenopausal women with thickened endometrium on trans-vaginal ultrasound in the absence of vaginal bleeding need hysteroscopic assessment? a pilot study [J]. J Obstet Gynaecol, 2015, 36(2): 223-226.
[15] Chowdary P, Maher P, Ma T, et al. The role of the mirena intrauterine device in the management of endometrial polyps: a pilot study [J].J Minim Invasive Gynecol, 2019, 26(7): 1297-1302.
[16] Lieng M, Istre O, Qvigstad E. Treatment of endometrial polyps: a systematic review [J]. Acta Obstet Gynecol Scand, 2010, 89(8): 992-1002.
[17] Ghoubara A, Sundar S, Ewies AAA. Predictors of malignancy in endometrial polyps: study of 421 women with postmenopausal bleeding [J]. Climacteric, 2018, 21(1): 82-87.
[18] Dias DS, Bueloni-Dias FN, Dias R, et al. Usefulness of clinical, ultrasonographic, hysteroscopic, and immunohistochemical parameters in differentiating endometrial polyps from endometrial cancer [J]. J Minim Invasive Gynecol, 2014, 21(2): 296-302.
[19] Bel S, Billard C, Godet J, et al. Risk of malignancy on suspicion of polyps in menopausal women [J]. Eur J Obstet Gynecol Reprod Biol, 2017, 216: 138-142. doi: 10.1016/j.ejogrb.2017.07.013.
[20] Golan A, Cohen-Sahar B, Keidar R, et al. Endometrial polyps: symptomatology, menopausal status and malignancy [J]. Gynecol Obstet Invest, 2010, 70(2): 107-112.
[21] Torres ML, Weaver AL, Kumar S, et al. Risk factors for developing endometrial cancer after benign endometrial sampling[J]. Obstet Gynecol, 2012, 120(5): 998-1004.
[22] Shor S, Pansky M, Maymon R, et al. Prediction of premalignant and malignant endometrial polyps by clinical and hysteroscopic features [J]. J Minim Invasive Gynecol, 2019, 26(7): 1311-1315.
[23] Gu F, Zhang H, Ruan S, et al. High number of endometrial polyps is a strong predictor of recurrence: findings of a prospective cohort study in reproductive-age women [J]. Fertil Steril, 2018, 109(3): 493-500.
[24] Yang JH, Chen CD, Chen SU, et al. Factors influencing the recurrence potential of benign endometrial polyps after hysteroscopic polypectomy [J]. PLoS One, 2015, 10(12): e0144857. doi: 10.1371/journal.pone.0144857. eCollection 2015.
[25] Lasmar BP, Lasmar RB. Endometrial polyp size and polyp hyperplasia [J]. Int J Gynaecol Obstet, 2013, 123(3): 236-239.

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