Clinical Analysis Of Endometrial Lesions In 449 Postmenopausal Vaginal Bleeding

Objective : To investigate the types of endometrial lesions in Postmenopausal vaginal Bleeding(PMB)patients and the risk factors of endometrial malignant lesions in postmenopausal vaginal bleeding patients,and to evaluate the value of segmental curettage and hysteroscopy in the diagnosis of endometrial cancer.To provide clinical basis for PMB patients to choose a reasonable diagnostic mode.Methods:A retrospective analysis was performed on 449 patients who underwent curettage or hysteroscopy in Affiliated Hospital of Qingdao University from January 1,2020 to December 31,2020 due to postmenopausal vaginal bleeding,and the patients were divided into 1～5 years,6～10 years,11～15 years,16～20 years,≥21 years group according to menopause years.According to the nature of the lesion,it is divided into benign lesion group and malignant lesion group.According to the diagnostic methods,the patients were divided into two groups: segmental curettage group and hysteroscopy group.SPSS26.0 statistical software was used to analyze the data.Results:1.The pathological types of endometrial lesions in PMB patients were mainly benign lesions,including 285 cases(63.5%),including endometrial polyps in 179 cases(39.8%),submucosal fibroids in 30 cases(6.7%),endometrial hyperplasia in 49 cases(10.9%),and endometritis in 27 cases(6.1%).Non-organic endometrium disease(atrophic endometrium)in28 cases(6.2%);Endometrial precancerous lesions(endometrial atypical hyperplasia)in 25cases(5.5%);Endometrial carcinoma in 111 cases(24.7%).2.There were statistically significant differences in the incidence of submucosal fibroids,endometrial polyps,endometritis,endometrial hyperplasia and endometrial cancer among patients at different menopause times(P < 0.05);The incidence of endometrial polyps,endometrial hyperplasia and submucosal uterine fibroids decreased with the increase of menopause time(all P < 0.05),while the incidence of endometrial cancer increased with the increase of menopause time(P=0.000).3.Analysis of risk factors for endometrial cancer in PMB patients: Univariate analysis results showed that there were statistically significant differences in age,menopausal years,endometrial thickness,pregnancy,vaginal bleeding time,hypertension and diabetes in patients with benign and malignant endometrial lesions,(P < 0.05).Multivariate Logistic regression analysis showed that hypertension,diabetes mellitus and endometrial thickening were independent risk factors for endometrial cancer in PMB patients.4.ROC curve analysis showed that endometrial thickness of 8.25 mm was used as the best threshold for predicting endometrial atypical hyperplasia and endometrial cancer in PMB patients.The area under ROC curve(AUC)was 0.778,the sensitivity was 69%,and the specificity was 78.3%.5.129 patients postoperative pathology of endometrial carcinoma,blow curettage surgery group of 19 cases of 101 cases of patients before and after surgery the pathology diagnosis,coincidence rate was 81.2%,hysteroscopy group of 28 cases(both in hysteroscopy examination after 4 days ～ 25 days to complete the surgery),1 case of patients before and after surgery pathological diagnosis is different,coincidence rate was 96.4%,The two groups were compared and the difference was statistically significant.There were 9 and 3 patients with positive cytology of abdominal effusion or lotion in the segmentated curettage group and hysteroscopy group,respectively,with a positive rate of 8.9% and 10.7%,but the difference was not statistically significant.Conclusion:1.The pathological types of endometrial lesions in postmenopausal patients with vaginal bleeding are mainly benign lesions,but it is necessary to guard against endometrial malignant lesions.2.Patients with advanced age,long duration of menopause,endometrial thickening,infertility,long duration of vaginal bleeding,hypertension and diabetes should be alert to the occurrence of endometrial cancer.Endometrial thickening,hypertension and diabetes mellitus were independent risk factors for endometrial cancer.3.Hysteroscopy has a high coincidence rate of pathological diagnosis and does not increase the positive rate of cytological examination of abdominal effusion or lotion,showing high safety.