Clinical Analysis Of Endometrial Polyps At Different Physiological Stages

Objective and background：Endometrial polyps is a tumor-like lesions because of thehyperplasia of endometrial glands and fibrous stroma. EP is a common disease forchildbearing women.According to the report at home and abroad in recent years, theincidence of EP tends to rise.The main clinical manifestations in reproductive period are irregular vaginalbleeding, menorrhagia, menstruation or infertility, etc;EP can also be found in theprocess of examinaion or uterus removal surgery but without any symptoms. Forpostmenopausal women, EP mainly has a small amount of vaginal bleedingguttate,however,some of them has no clinical symptoms. In recent years, with thedevelopment of transvaginal ultrasound and hysteroscopy techniques, EP diagnosticyield has greatly improved. Doctors can make use of the EP hysteroscopy and curettageto treat patients, but at different phyciological stages, clinical manifestations,malignantconditions and relapse are quite different.In that way,people have different ways toconjucture the pathogesis of EP.Materials and Methods： Collect480patients of EP who once experienedhysteroscopic resection in obstetrics and gynecology department of our hospital fromJanuary2009to January2013.Divided them into3grouop（reproductive period，perimenopauuse，menopause）according to the different physiological stages so as toanalyse patients′clinical symptoms,polyp number,polyp size,location,malignantconditions and relapse after surgery. Use Descriptive comparison analysis method toimprove clinicians′cognition in those ways such as endometrial polyps pathogenesis,clinical features, diagnosis, treatment and prevention of postoperative relapse. Result：1. According to the480cases of EP patients, there are326(67.91%) maternitypatients,32(6.67%)perimenopausal cases,122(25.42%)menopausal cases.For the480cases,298patients suffered abnomal uterus bleeding including246(82.55%)maternitypatients,12(4.03%)perimenopausal patients,40(13.44%)menopausal patients;23patientswith infertility in reproductive period;8chronic hypogastralgia patients (7cases ofreproductive period,1perimenopausal case,0menopausal case);18cases werediscovered when they were accepting other treatment of gynecblogical diseasesincluding10(55.56%)cases of reproductive period,2(11.11%) perimenopausalcases,6(33.33%)menopausal cases;133cases were discovered when they were examingincluding57(42.8%)cases of reproductive period,14(10.53%)perimenopausalcases,62(46.62%)menopausal cases.In the480cases,there are202cases of solitarypolyps and278cases of multiple polyps.2. Hysteroscopic resection of endometrial polyps and abnormal uterine bleedingremission rates include childbearing patients (211/326), perimenopausal patients (28/32),and menopausal patients (108/122).3.For the maternity patients,the number of multiple polyps and solitary polyps arerespectively214and112;For the permenopausal patients,the number of multiplepolyps and solitary polyps are respectively20and12;For the menopausal patients,thenumber of multiple polyps and solitary polyps is respectively44and78.Compared thenumber of the polyps among the three groups,there is a significant difference growingperiod214cases, χ2=32.16, p＜0.05.4The mean maximum diameter (mm) of polyps in the three groups are respectively7.79±3.84,8.50±4.12,11.02±4.21.the whole, the difference among the three groupsis statistically significant, F=13.58,p＜0.05. Single polyp maximum diameter≤1cm in the three groups includes75maternity patients,8perimenopausal patients,26menopausal patients.single polyp maximum diameter＞1cm includes37maternity patients,4perimenopausal patients,52menopausal patients; According to thecomparison among the3groups,the size of the polyps is overall significantdifference, χ2=21.76, p＜0.05.5. Compared the location of the polyps among the three groups, the difference was notstatistically significant, χ2=3.14, p＞0.05.6. In the480cases,it was proven that there were22patients who had sufferedmalignant polyps or had the tendency.Among them,11cases of atypical endometrialhyperplasia, accounting for2.29%;5cases of atypical polypoidadenomyoma,accounting for1.04%；6cases of endometrial cancer, accounted for1.25%.At same time,among the22cases,there are8maternity cases,2perimenopausalcases,12menopausal patients. According to compare the three groups, the malignantrate and trendency rate at different physiological stage are respectively2.45%,6.25%,9.84%and the difference has a statistical significance (χ2=11.28, P＜0.05).7. Among the480cases,we followed up446(92.9%) cases including304patients whoare with fertility;29post-menopausal patients,113menopausal patients.However, wealso lose34(7.1%)patients. According to different physiological stage, we respectivelyfollowed up the patients after3months,6months and12months to obtain the relapserate. As for the patients we followed up after3months,some of them relapse,including13patients of reproductive period,1perimenopausal patient,2menopausal patients.According to the comparison,the relapse rate shows no significant difference; As forthe patients we followed up after6months, the number of the relapse patients includes35patients in reproductive period,4perimenopausal patients,4menopausal patients.Compared the three groups, the difference among the three groups is statisticallysignificant, χ2=6.63, p＜0.05. As for the patients we followed after12months, thenumber of the relapse includes51patients in reproductive period,6perimenopausalpatients,7postmenopausal patients.According to the comparison among the threegroups, relapse rate is statistically significant difference χ2=8.52, p＜0.05. Couclution：1. Different physiological stages of endometrial polyps number of differences in size,malignancy rate and relapse rate, suggesting that its pathogenesis may be different.2. Pre-menopausal patients with clinical symptoms of endometrial polyps wassignificantly easier diagnosis, postmenopausal patients with no obvious clinicalsymptoms, diagnosis more difficult.3. Endometrial polyps patients after treatment, symptoms disappeared, a causalrelationship between the tip and the clinical symptoms of uterine endometrial polyps.