發(fā)布時(shí)間：2018-03-14 18:06

  本文選題：子宮內(nèi)膜息肉　切入點(diǎn)：臨床癥狀　出處：《安徽醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：【背景與目的】:子宮內(nèi)膜息肉（endometrial polyps，EP）是女性常見的子宮內(nèi)膜病變之一，其病理生理改變?yōu)?子宮內(nèi)膜基底層的局限性增生形成的有蒂或無蒂的突向?qū)m腔的贅生物，，由子宮內(nèi)膜腺體和間質(zhì)構(gòu)成。近年來國(guó)內(nèi)外報(bào)道其發(fā)病率呈上升趨勢(shì)。其臨床表現(xiàn)生育期主要為不規(guī)則陰道出血、月經(jīng)過多、經(jīng)期延長(zhǎng)、不孕等，也可無任何癥狀而在體檢或手術(shù)切除子宮時(shí)發(fā)現(xiàn)。EP在絕經(jīng)期女性則主要表現(xiàn)為陰道少量點(diǎn)滴狀出血，同時(shí)也有部分患者無臨床癥狀。隨著經(jīng)陰道超聲和宮腔鏡技術(shù)的發(fā)展，EP的診斷率大大提高。治療上EP可以借助宮腔鏡和診刮，但不同生理階段EP的臨床表現(xiàn)、惡變情況及復(fù)發(fā)情況等大有不同，推測(cè)EP不同生理階段的發(fā)病機(jī)制可能有所不同。 【資料與方法】：收集2009年1月至2013年1月期間在我院婦產(chǎn)科通過宮腔鏡子宮內(nèi)膜息肉電切術(shù)后經(jīng)病理確診的子宮內(nèi)膜息肉患者480例，根據(jù)不同生理階段分為生育期、圍絕經(jīng)期、絕經(jīng)期三組，分析不同生理階段EP患者的臨床癥狀、息肉的個(gè)數(shù)、大小、部位及惡變情況和術(shù)后復(fù)發(fā)情況。采用描述性對(duì)照分析方法進(jìn)行研究，旨在提高臨床醫(yī)生對(duì)子宮內(nèi)膜息肉的發(fā)病機(jī)制、臨床特征、診治方法及術(shù)后預(yù)防復(fù)發(fā)的認(rèn)識(shí)。 【結(jié)果】：1.480例EP患者中，生育期患者326例,占67.91%；圍絕經(jīng)期患者32例，占6.67%；絕經(jīng)期患者122例，占25.42%。其中子宮異常出血患者298例(生育期246例，占82.55%，圍絕經(jīng)期12例，占4.03%，絕經(jīng)期40例，占13.42%)；不孕患者23例（生育期）；慢性下腹痛患者8例(生育期7例，圍絕經(jīng)期1例，絕經(jīng)期0例)；合并其它婦科疾病治療中發(fā)現(xiàn)者18例(生育期10例，占55.56%，圍絕經(jīng)期2例，占11.11%，絕經(jīng)期6例，占33.33%)；臨床無任何癥狀在體檢時(shí)發(fā)現(xiàn)者133例(生育期57例，占42.86%，圍絕經(jīng)期14例，占10.53%，絕經(jīng)期62例，占46.62%)。480例患者中單發(fā)息肉患者202例，多發(fā)息肉患者278例。 2.宮腔鏡下子宮內(nèi)膜息肉切除術(shù)后子宮異常出血的緩解率，生育期患者為64.72%（211/326），圍絕經(jīng)期患者為87.50%(28/32)，絕經(jīng)期患者為88.52%(108/122)。 3.生育期患者多發(fā)息肉214例，單發(fā)息肉112例；圍絕經(jīng)期患者多發(fā)息肉20例，單發(fā)息肉12例；絕經(jīng)期患者多發(fā)息肉44例，單發(fā)息肉78例。3組患者息肉個(gè)數(shù)間比較總體上具有顯著性差異，χ2=32.16, p＜0.05。 4.三組患者息肉最大直徑的平均值（mm）分別為7.79±3.85，8.50±4.12，11.02±4.21。三組患者總體上比較差異具有統(tǒng)計(jì)學(xué)意義，F(xiàn)＝13.58，p＜0.05。三組患者單發(fā)息肉最大直徑≤1cm者中，生育期患者75例，圍絕經(jīng)期患者8例，絕經(jīng)期患者26例；單發(fā)息肉最大直徑＞1cm者中，生育期患者37例，圍絕經(jīng)期患者4例，絕經(jīng)期患者52例；3組患者息肉大小間比較總體上具有顯著性差異，χ2=21.76,p＜0.05。 5.三組患者息肉部位間比較，差異無統(tǒng)計(jì)學(xué)意義，χ2=4.91, p＞0.05。 6.本研究480例患者術(shù)后病理證實(shí)息肉惡變及惡變傾向者22例，（其中生育期患者8例、圍絕經(jīng)期患者2例、絕經(jīng)期患者12例），其中子宮內(nèi)膜非典型性增生11例，占2.29%；非典型息肉樣腺肌瘤5例占1.04%；子宮內(nèi)膜樣癌6例占1.25%。不同生理時(shí)期息肉的惡變及惡變傾向率分別為2.45%、6.25%、9.84%，三組患者比較總體上差異具有統(tǒng)計(jì)學(xué)意義(χ2=11.28， P＜0.05)。 7.480例患者術(shù)后446例進(jìn)行了隨訪，隨訪率為92.9%，（其中生育期患者304例，圍絕經(jīng)患者29例，絕經(jīng)期患者113例），失訪率為7.1%。分別于術(shù)后3個(gè)月、6個(gè)月、12個(gè)月對(duì)不同生理階段患者的復(fù)發(fā)情況進(jìn)行隨訪。術(shù)后3個(gè)月隨訪，生育期患者復(fù)發(fā)13例，圍絕經(jīng)期患者復(fù)發(fā)1例，絕經(jīng)期患者復(fù)發(fā)2例，3組患者復(fù)發(fā)率比較差異無統(tǒng)計(jì)學(xué)意義；術(shù)后6個(gè)月隨訪，生育期患者復(fù)發(fā)35例，圍絕經(jīng)患者復(fù)發(fā)4例，絕經(jīng)期患者復(fù)發(fā)4例，3組患者復(fù)發(fā)率比較差異具有統(tǒng)計(jì)學(xué)意義χ2=6.63, p＜0.05；術(shù)后12個(gè)月隨訪，生育期患者復(fù)發(fā)51例，圍絕經(jīng)期患者復(fù)發(fā)6例，絕經(jīng)期患者復(fù)發(fā)7例，3組患者復(fù)發(fā)率比較差異具有統(tǒng)計(jì)學(xué)意義χ2=8.52, p＜0.05。 【結(jié)論】： 1.不同生理階段子宮內(nèi)膜息肉的數(shù)量、大小、惡變率及復(fù)發(fā)率不同，推測(cè)其發(fā)病機(jī)制可能不同。 2.生育期子宮內(nèi)膜息肉患者臨床癥狀明顯，較易診斷，絕經(jīng)后EP患者多無明顯臨床癥狀，診斷較困難。 3.子宮內(nèi)膜息肉患者所致癥狀經(jīng)治療后消失，提示子宮內(nèi)膜息肉與該臨床癥狀存在因果關(guān)系。
[Abstract]:[Objective] background: endometrial polyps (endometrial polyps EP) is one of the most common endometrial lesions in women, change its pathophysiology: limitation of endometrial hyperplasia of the basal layer of the formation of pedunculated or sessile protruding into the uterine cavity neoplasm, composed of uterine endometrial glands and stroma. In recent years at home and abroad reported that its incidence is rising. The clinical manifestations of growth period are mainly irregular vaginal bleeding, menorrhagia, menostaxis, infertility, but also without any symptoms found.EP in menopausal women is mainly manifested as a small amount of vaginal bleeding in guttate examination or surgical removal of the uterus, and at the same time some patients had no clinical symptoms. With the development of transvaginal ultrasound and hysteroscopy technology, the diagnostic rate of EP is greatly improved. The treatment EP can use hysteroscopy and curettage, but clinical manifestations in different physiological stages of EP, and the complex variable evil The incidence of EP is different. It is presumed that the pathogenesis of different physiological stages may be different.
[materials and methods]: during the period from January 2009 to January 2013 in our hospital obstetrics and Gynecology by hysteroscopic resection of endometrial polyps after 480 patients with pathologically confirmed endometrial polyps, according to the different physiological stages of growth period, perimenopause, menopause three groups, the clinical symptoms of different physiological stages in patients with EP, a the number of polyp size, recurrence and canceration position and postoperative. Descriptive analysis comparison, in order to improve the pathogenesis of endometrial polyps, clinicians, clinical features, diagnosis and treatment methods and understanding of prevention of recurrence after operation.
[results]: 1.480 patients with EP, the growth period in 326 cases, accounting for 67.91%; 32 cases of peri menopausal patients, accounted for 6.67%; 122 cases of menopausal patients, which accounted for 25.42%. of abnormal uterine bleeding in 298 patients (stage 246 cases, accounting for 82.55%, 12 perimenopausal women, accounting for 4.03%, 40 cases of menopause, accounted for 13.42%); 23 cases of infertility patients (growth period); 8 cases of patients with chronic abdominal pain (7 cases of perimenopausal period, 1 cases, 0 cases of menopause); 18 cases were found combined with other treatment of gynecological diseases (10 cases, growth period accounted for 55.56%, 2 perimenopausal women, accounting for 11.11%, 6 cases. Menopause accounted for 33.33%); 133 cases had no clinical symptoms at the time of examination found no (growth period in 57 cases, accounting for 42.86%, 14 perimenopausal women, accounting for 10.53%, 62 cases of menopause, accounted for 46.62%) in 202 cases of polyps in patients with solitary.480 patients, 278 cases of patients with multiple polyps.
2., the remission rate of abnormal uterine bleeding after hysteroscopic endometrial polypectomy was 64.72% (211/326) in the growth period, 87.50% in the perimenopausal period (28/32), and 88.52% (108/122) in the climacteric patients.
3., there were 214 cases of multiple polyps, 112 cases of single polyps in the growth period, 20 cases of multiple polyps in the perimenopausal period, 12 cases of single polyps, 44 cases of multiple polyps in the menopausal women, and 78 cases of single polyps. There was a significant difference in the number of polyps between the.3 group, and the difference was statistically significant (2=32.16, P < 0.05.).
The average maximum diameter of 4. three groups of patients with polyps (mm) were statistically significant 7.79 + 3.85,8.50 + 4.12,11.02 + 4.21. three groups overall difference, F = 13.58, P < 0.05., three groups of patients with polyps maximum diameter less than 1cm in 75 infertile patients, 8 cases of patients with perimenopausal period, 26 cases of menopausal patients; single largest diameter > 1cm polyps, 37 cases of patients with perimenopausal period, 4 patients, 52 cases of menopausal patients; 3 groups of patients with polyp size comparison between overall significant differences, X 2=21.76, P < 0.05.
5. the difference between the three groups of polyps was not statistically significant, X 2=4.91, P > 0.05.
6. of the 22 cases of 480 patients pathologically confirmed malignant polyps and canceration tendency, (including 8 cases of patients with perimenopausal period, 2 patients, 12 cases of menopausal patients), including endometrial atypical hyperplasia in 11 cases, accounting for 2.29%; 5 cases of atypical polypoid adenomyoma of endometrioid carcinoma accounted for 1.04%; in 6 cases of uterine polyps accounted for 1.25%. in different physiological stages of malignant transformation and malignant tendency rate were 2.45%, 6.25%, 9.84%, three groups had significant difference compared (x 2=11.28, P < 0.05).
7.480 cases of 446 cases of patients after operation were followed up, the follow-up rate was 92.9%, (including 304 cases of patients with perimenopausal period, 29 patients, 113 patients with menopause), the dropout rate was 7.1%. respectively after 3 months, 6 months, 12 months after the recurrence of different physiological stages patients. After 3 months of follow-up, the recurrence period of 13 patients with peri menopausal patients, recurrence in 1 cases, 2 cases of recurrence of menopausal patients, 3 groups of patients with recurrence rate had no significant difference; after 6 months of follow-up, 35 cases of recurrence in patients with peri menopausal period, recurrence in 4 cases, 4 cases the recurrence of menopause patients, 3 groups of patients with recurrence rate were statistically significant in X 2=6.63, P < 0.05; after 12 months of follow-up, the recurrence period of 51 patients with peri menopausal patients with recurrence, 6 cases of recurrence, 7 cases of menopausal patients, 3 groups of patients with recurrence rate were statistically significant in X 2=8.52, P < 0.05.
[Conclusion]:
1. the number, size, malignant change rate and recurrence rate of endometrial polyps at different physiological stages are different, and it is presumed that the pathogenesis of endometrial polyps may be different.
The clinical symptoms of endometrium polyps in 2. childbearing period are obvious, and it is easier to diagnose. There are no obvious clinical symptoms in EP patients after menopause, and the diagnosis is difficult.
3. the symptoms of endometrium polyps disappeared after treatment, suggesting that there is a causal relationship between endometrial polyps and the clinical symptoms.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

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