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目的探讨影响子宫内膜不典型增生(AEH)的诊断及术后病理升级为子宫内膜癌的相关因素及临床特点。方法因AEH行全子宫切除术的患者共74例,根据术后病理分为子宫内膜癌组(A组,28例)和AEH组(B组,46例),并进行回顾性分析。结果 1AEH手术前后诊断符合率为62.6%,37.8%(28/74)的患者在切除的子宫标本中发现并存有子宫内膜癌,但多数分化较好,分期早,92.9%(26/28)的患者均为Ⅰ期;2宫腔镜辅助诊刮诊断符合率88.5%,高于单纯诊刮组47.9%(P<0.05);3术中快速病理与术后石蜡病理有较高的诊断符合率(94.6%);4两组年龄、血脂、BMI、糖尿病史、子宫内膜厚度比较,差异均有统计学意义(P值均<0.05)。结论对于不正常阴道出血的女性、年龄>50岁,伴有血脂代谢异常、糖尿病史、子宫内膜增厚的患者,特别是绝经状态的患者,进行子宫内膜活检时应联合宫腔镜检查;全子宫切除需术中行冰冻快速病理检查,以提高诊断的准确性。
Objective To investigate the related factors and clinical features of the diagnosis of endometrial dysplasia (AEH) and the pathological upgrade to endometrial cancer. Methods Totally 74 patients undergoing hysterectomy for AEH were divided into endometrial cancer group (A group, 28 cases) and AEH group (B group, 46 cases) according to the postoperative pathology and retrospectively analyzed. Results The preoperative and postoperative diagnosis of 1AEH was consistent with the rate of 62.6%, 37.8% (28/74) of the patients found in the excised uterus specimens and endometrial cancer, but most of the better differentiation, staging, 92.9% (26/28) Of the patients were stage Ⅰ. The coincidence rate of 2 hysteroscopy assisted diagnosis was 88.5%, which was higher than that of the pure curettage group (47.9%) (P <0.05). The rapid pathological diagnosis of postoperative hysterectomy was associated with a higher diagnosis Rate (94.6%) .4 There were significant differences between the two groups in age, blood lipid, BMI, history of diabetes and endometrial thickness (P <0.05). Conclusions For women with abnormal vaginal bleeding, patients aged> 50 years with dyslipidemia, history of diabetes mellitus and endometrial thickening, especially those with menopausal status, should undergo endometrial biopsy in combination with hysteroscopy ; Hysterectomy required intraoperative frozen line rapid pathological examination to improve the diagnostic accuracy.