国际妇产科学杂志 ›› 2020, Vol. 47 ›› Issue (4): 413-416.

• 综述 • 上一篇    下一篇

绝经后无症状子宫内膜增厚女性的临床评估

师赞,薛雪,石盼盼,贺永艳,王晓林,吕淑兰△   

  1. 710061  西安交通大学第一附属医院妇产科(师赞,薛雪,石盼盼,贺永艳,王晓林,吕淑兰);西北妇女儿童医院生殖中心(师赞)
  • 收稿日期:2019-11-04 修回日期:2020-03-17 出版日期:2020-08-15 发布日期:2020-08-15
  • 通讯作者: 吕淑兰,E-mail:shulanlu819@163.com E-mail:shulanlu819@163.com
  • 基金资助:
    陕西省西安市科技计划项目[2017117SF/YX011(3)];白求恩·中青年医生优才培养计划-女性健康科研项目(HX202046)

The Clinical Evaluation for Women with Asymptomatic Endometrial Thickening after Menopause

SHI Zan,XUE Xue,SHI Pan-pan,HE Yong-yan,WANG Xiao-lin,Lyu Shu-lan   

  1. Department of Obstetrics and Gynecology,The First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China(SHI Zan,XUE Xue,SHI Pan-pan,HE Yong-yan,WANG Xiao-lin,Lyu Shu-lan);ART Center,Northwest Women′s and Children′s Hospital,Xi′an 710000,China(SHI Zan)
  • Received:2019-11-04 Revised:2020-03-17 Published:2020-08-15 Online:2020-08-15
  • Contact: Lyu Shu-lan,E-mail:shulanlu819@163.com E-mail:shulanlu819@163.com

摘要: 子宫内膜癌发病率逐年上升,早期准确的诊断能够极大地改善患者预后。绝经后子宫内膜增厚的女性,如有阴道出血等症状,应积极按照子宫内膜病变的筛查流程;而无症状的女性是否应该积极筛查、如何进行筛查仍有争议。多数研究结果证明经阴道超声(TVUS)结合子宫内膜组织病理学检查时,可评估内膜病变,但是TVUS下内膜厚度与子宫内膜癌及癌前病变的关系仍存争议。TVUS在绝经后无症状子宫内膜增厚人群中的低特异性给临床处理造成困扰,且绝经后无症状人群行TVUS筛查能否提高子宫内膜癌总体5年生存率仍被质疑。随着医疗检查手段的不断发展,经阴道注水超声、子宫内膜细胞学检查等新兴子宫内膜病变筛查手段似乎能够替代TVUS用来评估该人群的子宫内膜情况,或弥补TVUS的不足。分析临床常用的几种检查手段在绝经后无症状子宫内膜增厚女性中的应用现状,总结现有绝经后无症状子宫内膜增厚的病理内膜厚度阈值,综述该人群的临床处理评估策略。

关键词: 绝经后期;, 无症状疾病;, 子宫内膜;, 子宫内膜肿瘤;, 癌前状态;, 危险性评估

Abstract: The incidence of endometrial cancer is increasing year by year. Early and accurate diagnosis can greatly improve the prognosis of patients. Women with postmenopausal endometrial thickening should actively go through the screening process of endometrial lesions when they have symptoms such as vaginal bleeding. However, it is still controversial whether it is necessary and how to actively conduct the screening process for asymptomatic women. Most studies have proved that endometrial lesions can be assessed using the combination of transvaginal ultrasound (TVUS) and endometrial histopathological examination, but the relationship between endometrial thickness and endometrial cancer or precancerous lesions remains controversial. For people with asymptomatic endometrial thickening after menopause, the specificity of TVUS is low, which causes clinical problems and it is still being argued whether TVUS screening can improve the overall 5-year survival rate of endometrial cancer. With the development of medical examination techniques, some new endometrial lesion screening methods, such as transvaginal water injection ultrasound and endometrial cytology test seem to be able to replace TVUS to evaluate the endometrial condition of this population, or make up for the shortage of TVUS. This article analyzes the implementation status of several commonly used clinical examination methods in women with asymptomatic endometrial thickening after menopause, summarizes the pathological endometrium thickness threshold of postmenopausal asymptomatic endometrial thickening, and reviews the evaluation strategy of clinical treatment for these people.

Key words: Postmenopause, Asymptomatic diseases, Endometrium;, Endometrial neoplasms;, Precancerous conditions, Risk assessment