Clinical Analysis Of 921 Nonparous Young Women With Endometrial Lesions

Objective:To provide clinical evidence for early and timely diagnosis,standardized and individualized treatment of endometrial lesions in the nonparous young women,and to preserve the reproductive function to maintain reproductive health of nonparous young women,the clinical data of nonparous young women with endometrial lesions were retrospectively reviewed to summary the morbidity status and morbidity trend,related factors,clinical features,complications and treatment.Results:1、From January 2014 to December 2018,a total of 4302 cases of endometrial lesions were treated by gynecological surgery in The First Hospital of JiLin University.Among them,there were 1756 cases（40.82%）of young women aged less than or equal to 40 years old.Among the 1756 young women of endometrial lesions,921 cases were nonparous young women,accounting for 52.45%.Among them,there were 346 cases of infertility,accounting for 37.57%of the nonporous young women.2、In recently 5 years,the incidence rate of endometrial lesions in nonparous young women increased from 5.07%in 2014 to 8.37%,9.17%and 13.61%year by year,by 2018,the incidence rate is as high as16.23%.The incidence of endometrial lesions in nonparous young women increased year by year.3、The age 26³0 years old is the age group of high incidence of endometrial lesions in noparous young women,accounting for 38.33%.It was followed by 31³5 years old and 21²5 years old,accounting for29.42%and 16.94%respectively.4、Among the 921 nonparous young women with endometrial lesions,834 were married（90.55%）and 87 were unmarried（9.45%）.It accounts for 15.13%（87/575）of women with no current fertility requirement and4.95%（87/1756）of young patients with endometrial lesions aged less than or equal to 40 years.5、The proportion of nonporous young women who were employed as non-staff members was 33.77%,the proportion of nonporous young women who were office clerk was 66.23%,significantly higher than that of parous young women（51.26%）(?^（17）=40.633,P<0.05).6、The incidence rate of endometrial lesions in nonparous young women ranged from high to low respectively were:endometrial polyps（50.38%）,endometrial hyperplasia（42.56%）,atypical hyperplasia（4.13%）and endometrial carcinoma（2.93%）.The rate of benign endometrial lesions in nonporous young women was 92.94%,the incidence of endometrial precancerous lesions and endometrial cancer was 7.06%,it was significantly higher than 4.19%in the parous young women(?^（17）=6.698,P<0.05).7、44.41%（409 cases）of the nonparous young endometrial lesions were found in the physical examination of gynecology,and 37.13%（342cases）of the patients had the first symptom of abnormal uterine bleeding（abnormal bleeding from the uterine cavity that is inconsistent with any item of normal menstrual cycle frequency,regularity,menstrual length and menstrual blood loss）,15.85%（146 cases）were found due to other gynecological diseases,and 2.61%（24 cases）presented with lower abdominal pain.58.21%（486 cases）of the patients in the parous group had the first symptom of abnormal uterine bleeding,32.34%（270 cases）of them were found in the physical examination of gynecology,8.26%（69 cases）of them showed lower abdominal pain,and less than 1.19%（10 cases）of them were found due to other gynecological diseases.There was a significant difference in the rate of first symptoms between nonporous group and parous group(?^（17）=190.081,P<0.05).8、Among the nonporous young women with endometrial lesions,70.25%had regular menstrual cycles,abnormal menstrual cycle accounted for 29.75%,this was significantly higher than the 13.29%of parous young women(?^（17）=69.289,P<0.05).The menstrual period of the nonparous young women with endometrial lesions is usually 5⁷ days（71.77%）,the proportion of patients with menstrual period longer than 7days was 20.41%,this was significantly higher than the 9.22%of parous young women(?^（17）=42.804,P<0.05).9、The thickness of endometrium under ultrasound in the nonparous young women with endometrial lesions was mostly 5¹0mm（53.64%）,next was 10¹5mm（22.04%）,no significant difference from the parous young women.Endometrial thickness<12mm in 74.48%of nonparous young women,the ratio was significantly higher than 51.50%of the parous young women(?^（17）=99.908,P<0.05).Ultrasound examination showed no abnormal blood flow signal in endometrium or uterine cavity in 77.92%of the nonparous young women,it was significantly higher than 66.59%of the parous young women(?^（17）=14.752,P<0.05).10、The rates of combined with endometriosis（12.05%）,uterine fibroids（18.24%）,ovarian cysts（18.78%）and pelvic inflammatory diseases（8.90%）in the nonparous young women with endometriosis were significantly higher than those in the parous young women（P<0.05）.The rate of combined with high blood pressure（2.06%）in the nonparous young women with endometrial lesions was significantly lower than that in the parous young women(?^（17）=11.365,P<0.05).The rate of combined with diabetes mellitus（1.30%）was significantly higher than that of parous young women(?^（17）=6.226,P<0.05).11、The main surgical treatment methods of endometrial lesions in young women are curettage,hysteroscopic surgery,laparoscopic surgery and laparotomy,each patient underwent a combination of two or more different procedures.The rate of hysteroscopic treatment for endometrial lesions in nonparous young women was 92.83%,significantly higher than84.67%of the parous young women(?^（17）=29.697,P<0.05).The rate of laparoscopic treatment among nonporous young women was 11.51%,significantly higher than 1.80%of the parous young women(?^（17）=64.396,P<0.05).The rate of nonporous young women receiving open surgery was only 4.99%,significantly lower than 11.74%of parous young women(?^（17）=26.443,P<0.05).The rate of postoperative hormone therapy for nonparous young women was 45.73%,significantly higher than 32.24%of parous young women(?^（17）=8.863,P<0.05).Conclusions:1、Nonparous young women have a high rate of benign endometrial lesions（endometrial polyps and endometrial hyperplasia）,and more than one third of them are already infertile.2、The incidence rate of endometrial dysplasia and endometrial carcinoma in the nonporous young women with endometrial lesions was higher than that in the parous young women.3、There was no obvious clinical change in the nonporous young women with endometrial lesions,mostly found in transvaginal ultrasonography,easily combined with hormone-dependent gynecological diseases.4、Hysteroscopic surgery combined with progesterone therapy is the preferred treatment for endometrial lesions in nonparous young women with endometrial lesions.