| Objective:The clinical data of postmenopausal vaginal bleeding patients admitted to the First Hospital of Jilin University in recent 5 years were retrospectively analyzed.The relationship between the disease types of postmenopausal vaginal bleeding patients and the lesion site,age,menopause time and residence was discussed.Method:A total of 1661 patients with "postmenopausal vaginal bleeding" as the chief complaint admitted to the First Hospital of Jilin University from January 1,2016 to December 31,2020 were collected.Relevant data of 1661 patients were collected based on pathological results.SPSS 25.0 software was used for statistical analysis.（1）Analysis of basic data of postmenopausal patients with vaginal bleeding;（2）Pathological site classification of postmenopausal patients with vaginal bleeding;（3）Relationship between disease distribution and age in postmenopausal patients with vaginal bleeding;（4）The relationship between disease distribution and menopause time in postmenopausal patients with vaginal bleeding;（5）The distribution of benign and malignant lesions with age in postmenopausal patients with vaginal bleeding;（6）The distribution of benign and malignant lesions with age in postmenopausal patients with vaginal bleeding;（7）Correlation analysis of benign and malignant endometrial lesions in postmenopausal patients with vaginal bleeding;（8）Correlation analysis of cervical intraepithelial lesions in postmenopausal patients with vaginal bleeding.Results:（1）The total number of patients with postmenopausal vaginal bleeding showed an increasing trend from 2016 to 2018,and a decreasing trend from 2019 to 2020.The largest number of patients was 375 in 2018,followed by 352 in 2019.The minimum onset age of postmenopausal vaginal bleeding patients was 40 years,the maximum onset age was 90 years,and the onset age was mainly 55-59 years.In patients with postmenopausal vaginal bleeding,the shortest duration of menopause is 1 year,and the longest duration is 40 years,and the main duration of menopause is 1-5 years.（2）In the lesions of postmenopausal patients with vaginal bleeding,the proportion of uterine lesions was significantly higher than that of other lesions,followed by cervical lesions.（3）The distribution difference of benign and malignant lesions in different lesion sites was statistically significant（X2=88.537,P<0.001）.Benign and malignant lesions are mainly located in the uterine body and cervix,benign lesions,uterine lesions accounted for a significantly higher proportion than the cervical,and malignant lesions,cervical lesions accounted for a significantly higher proportion than the uterine body.The proportion of benign endometrial polyps was significantly higher than that of other pathological types,followed by uterine fibroids and cervical polyps.The proportion of endometrial cancer and cervical cancer in malignant lesions was significantly higher than that of other pathological types.（4）The distribution of benign and malignant lesions in different age groups was significantly different（X2=34.649,P<0.001）.Benign lesions tended to decrease with age,while malignant lesions tended to increase with age.Cervical polyp and endometrial hyperplasia showed a decreasing trend with age（P=0.034;P<0.001）,uterine fibroids,benign ovarian tumors,cervical cancer and endometrial cancer showed an increasing trend with age（P=0.027;P=0.042;P<0.001;P<0.001）.（5）The distribution difference of benign and malignant lesions at different menopause time was statistically significant（X2=34.291,P<0.001）.With the extension of menopause time,the overall benign lesions showed a downward trend,while the overall malignant lesions showed an upward trend.The incidence of cervical polyps,uterine fibroids and endometrial hyperplasia decreased with the prolongation of menopause time（P=0.004;P<0.001;P<0.001）.The incidence of ovarian cancer and uterine sarcoma was increasing（P=0.002;P=0.040）.（6）The difference in the distribution of benign and malignant lesions in years was statistically significant（X2=9.989,P=0.041）.From 2016 to 2020,with the increase of years,the overall benign lesions showed a downward trend,while the overall malignant lesions showed an upward trend.（7）There was statistically significant difference in regional distribution of benign and malignant lesions（X2=143.840,P<0.001）,and the incidence of malignant lesions in rural patients was significantly higher than that in urban patients.（8）Color doppler ultrasonography of 280 cases of patients with intrauterine polyps was divided into two categories:（1）Abnormal echo in uterine cavity was found in 177 cases（63.21%）;（2）103 cases（36.79%）had thick intima and uneven echo.For postmenopausal patients with endometrial polyps,color ultrasound is more likely to indicate: endometrial thickness ≤5mm,abnormal echo in the uterine cavity.（9）There were statistically significant differences between endometrial cancer and benign endometrial lesions in age of onset,menopause time,endometrial thickness and diabetes,but there were no statistically significant differences in hypertension and menopause age.（10）Univariate and multivariate Logistic regression analysis showed that the OR value of age at onset was 1.049[95%CI（1.026,1.072）],and the OR value of endometrial thickness was 1.091[95%CI（1.091,1.065）],indicating that age at onset and endometrial thickness were common risk factors for endometrial cancer.（11）There were statistically significant differences in strong echo and mixed echo between benign and malignant lesions（X2=11.42,P=0.003;X2=25.069,P<0.001）.The proportion of strong echo in normal endometrium and benign lesions was significantly higher than that in malignant lesions.The proportion of mixed echoes in malignant lesions was significantly higher than that in normal endometrium and benign lesions.（12）The distribution of strong echo,low echo and fluid echo in different benign intrauterine lesions was statistically significant.Endometrial hyperplasia（90.91%）and endometrial polyp（83.25%）were mainly characterized by strong echo.Uterine fibroids（61.90%）were mainly hypoechoic.Endometritis（83.33%）was mainly characterized by fluid echo.（13）TCT results showed statistically significant difference in the distribution of low-grade lesions and high-grade lesions.The positive rate of pathological examination was83.58%,which was significantly higher than that of liquid-based cytology.Conclusion:（1）After menopause,the most bleeding lesions were in the uterus,followed by cervical lesions.The benign lesions were endometrial polyps,uterine fibroids and cervical polyps.The main malignant lesions were endometrial cancer and cervical cancer.（2）For patients with postmenopausal vaginal bleeding,the older the age,the longer the menopause,the higher the probability of disease malignancy.Need to pay attention to postmenopausal women’s health physical examination,especially the endometrial thick vaginal bleeding patients.（3）Post-menopausal endometrial polyps should be reviewed regularly,and if necessary,surgical treatment should be performed to guard against the possibility of malignant polyps.（4）Color ultrasound is a common diagnostic tool for gynecological diseases.It has high sensitivity to the changes of blood flow in the intima and the echo of lesions.（5）Pathological examination is the gold standard of disease,and its positive rate of high-grade cervical lesions is significantly higher than that of TCT.（6）The incidence of malignant lesions in rural patients was significantly higher than that in urban patients.On the one hand,it is necessary to increase the screening of diseases,improve the health awareness of rural patients;On the other hand,it is necessary to improve the cancer screening network of postmenopausal women,carry out the general survey of gynecological malignant tumors and gynecological tumor education regularly,and improve the prognosis of patients. |
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