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目的探讨围绝经期及绝经后异常子宫出血的病因及相关因素。方法对2013年南京医科大学附属南京妇幼保健院366例围绝经期及绝经后异常子宫出血病例的临床资料进行回顾性分析。结果366例的病理诊断中,器质性病变50例(13.66%),功能性病变145例(39.62%),正常子宫内膜171例(46.72%)。40~<45岁及45~<50岁年龄组人数最多,占总人数的70.49%。40~<45岁组常见的病理类型依次是增生期子宫内膜、单纯型增生和分泌期内膜;45~<50岁、50~<55岁组常见的病理类型依次是单纯型增生、增生期内膜和萎缩型内膜;55~<60岁、≥60岁常见病理类型依次是萎缩型内膜、子宫内膜癌。随着年龄增大,功能性病变和正常子宫内膜在不同年龄组的构成比逐渐减小,器质性病变在不同年龄组的构成比逐渐增大(χ2=8.38,P﹤0.05)。结论无排卵性功血是围绝经期子宫出血的主要原因,子宫内膜癌是绝经后子宫出血的主要原因。
Objective To investigate the etiology and related factors of peri-menopausal and postmenopausal women with abnormal uterine bleeding. Methods The clinical data of 366 cases of peri-menopausal and postmenopausal women with abnormal uterine bleeding in Nanjing MCH in Nanjing Medical University in 2013 were analyzed retrospectively. Results Among the 366 cases, 50 cases (13.66%) had organic disease, 145 cases (39.62%) had functional lesion, and 171 cases (46.72%) had normal endometrium. 40 ~ <45 years old and 45 ~ <50 years old group the largest number, accounting for 70.49% of the total number. The common pathological types between 40 ~ 45 years old were proliferative endometrium, simple hyperplasia and secretory endometrium. The common pathological types between 45 ~ <50 years and 50 ~ <55 years old were simple hyperplasia and hyperplasia Period of endometrial and atrophic endometrial; 55 ~ <60 years old, ≥ 60 years of common pathological type followed by atrophic endometrial, endometrial cancer. As age increased, the functional lesion and normal endometrium in different age groups gradually decreased, and the organic lesion in different age groups increased gradually (χ2 = 8.38, P <0.05). Conclusion Anovulatory dysfunctional uterine bleeding is the main cause of perimenopausal uterine bleeding. Endometrial cancer is the main cause of postmenopausal uterine bleeding.