目的 探讨1999年1月～2010年12月近12年来绝经前后异常子宫出血(abnormal uterine bleeding,AUB)的中老年妇女子宫内膜病变的特点与变化趋势. 方法 1999年1月～2010年12月,327例45～ 89岁中老年妇女因AUB入院,经宫腔镜检查与病理诊断为子宫内膜病变.169例年龄45～59岁为中年组,158例60 ～ 89岁为老年组,分析2组子宫内膜病变特点并进行比较；1999年1月～2004年12月为前6年组,2005年1月～2010年12月为后6年组,对中老年妇女子宫内膜癌( endometrial carcinoma,EC)的检出率进行比较. 结果 良性病变77.7％ (254/327),恶性病变22.3％(73/327).良性病变包括:子宫内膜息肉( endometrial polyps,EP) 99例(30.3％),子宫内膜增殖症57例(17.4％),黏膜下子宫肌瘤57例(17.4％),子宫内膜炎41例(12.6％)；恶性病变73例均为EC.中年组主要病变为黏膜下子宫肌瘤、子宫内膜增殖症和EP；老年组主要病变为EP和EC.中年组黏膜下子宫肌瘤占27.8％ (47/169),子宫内膜增殖症占24.3％(41/169),显著高于老年组6.3％ (10/158),10.1％(16/158)(x2=26.181,P=0.000;x2=11.334,P=0.001)；老年组EP占36.1％ (57/158),显著高于中年组24.9％ (42/169) (x2 =4.873,P=0.027)；老年组EC占31.0％ (49/158),显著高于中年组14.2％ (24/169)(x2=13.309,P=0.000).近12年来中老年妇女EC检出率呈上升趋势,后6年组26.4％ (64/242)显著高于前6年组10.6％(9/85)(x2 =9.123,P=0.003)；老年患者后6年组35.2％ (44/125)显著高于前6年组15.2％( 5/33)(x2=4.905,P=0.027).结论 绝经后AUB的老年妇女子宫内膜病变主要是EP和EC,中年妇女是黏膜下子宫肌瘤；后6年与前6年相比,老年妇女EC的检出率呈上升趋势,应引起重视.%Objective To explore the characteristics and change trends of endometrium in middle-aged and elderly women with abnormal uterine bleeding (AUB) in the recent 12 years (January 1999 - December 2010). Methods From January 1999 to December 2010, 327 women ( aged 45 - 89) who suffered from AUB in pre- and post- menopausal period were enrolled into this study. All of the patients underwent hysteroscopy and histopathological diagnosis, and were diagnosed with endometrial lesions. We divided the 327 cases into two groups according to the age and different period respectively: middle-aged group with 169 cases ( aged 45 -59) , and elderly group with 158 cases ( aged 60 - 89) ; and previous 6 years group (January 1999 - December 2004 ) , and latter 6 years group (January 2005 - December 2010). We retrospectively analyzed the endometrial characteristics of the 327 cases and compared them between the middle-aged and elderly groups. We also compared the proportions of endometrial carcinoma ( EC ) between the previous and latter 6 years groups. Results In 254 (77.7% , 254/327) benign endometrial lesions, endometrial polyps ( EP) was detected in 99 cases (30. 3% ) , endometrial hyperplasia in 57 ( 17.4% ) , submucous myoma in 57 ( 17.4% ) , and endometritis in 41 (12. 6% ) ; the other 73 (22. 3% ) cases were malignant lesions and all of them were endometrioid carcinoma. The main lesions included submucous myoma, endometrial hyperplasia, EP in the middle-aged group and EP, EC in the elderly group. The rate of submucous myoma and endometrial hyperplasia in the middle-aged group were both significantly higher than those in the elderly group [27.8% (47/169) vs. 6.3% (10/158) , χ2 =26. 181, P =0.000 and 24. 3% (41/169) vs. 10. 1% (16/158) , χ2 = 11. 334, P = 0.001 ] ; the rate of EP in the elderly group was higher than that in the middle-aged group [36. 1% (57/158) vs. 24.9% (42/169) , χ2 =4. 873, P =0.027] j and the rate of EC in the elderly group was significantly higher than that in the middle-aged group [31.0% (49/158) vs. 14.2% (24/169) ,χ2 = 13. 309, P =0.000]. The proportions of EC in the latter 6 years group was significantly higher than that in the previous 6 years group [ 26. 4% ( 64/242 ) vs. 10.6% (9/85 ) , χ2 = 9.123 , P = 0.003 ]. The rate of EC in the latter 6 years group was higher than that in the previous 6 years group in elderly women [35.2% (44/125) vs. 15.2% (5/33) , χ2 = 4. 905, P = 0. 027 ]. Conclusions The main endometrial lesions include EP and EC in postmenopausal elderly women and submucous myoma in middle-aged women. During the recent 12 years, the proportions of EC in elderly women is on the rise and we should pay more attention to it.
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