Izetbegovic Sebija, Stojkanovic Goran, Ribic Nihad, Mehmedbasic Eldar
General hospital "Prim. dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina.
Clinic for Gynecology and Obstetrics, Clinical center of Sarajevo University, Sarajevo, Bosnia and Herzegovina.
Med Arch. 2013 Dec;67(6):431-4. doi: 10.5455/medarh.2013.67.431-434. Epub 2013 Dec 28.
Postmenopausal uterine bleeding is a "cancer until proven otherwise". Endometrial cancer is a typical disease among postmenopause woman, because every bleeding in this age etiology associated with endometrial cancer (10-30%). The lifespan of women today has been extended and post menopause today last one third of a woman's life. Early diagnosis of endometrial cancer has a very high cure rate. Screening for this cancer has limits in practice and is necessary given the definition of high-risk groups would be subject to primary and secondary prevention.
Primary to evaluate the leading causes of postmenopausal uterine bleeding among patients at risk for endometrial cancer (diabetes, obesity, nulliparity, late menopause (after 55 years) and compared them with the causes of postmenopausal uterine bleeding patients without this risk.
A retrospective, descriptive study with a targeted sample of 50 consecutive patients who had registered postmenopausal uterine bleeding in high-risk groups (cohorts) and the same number of patients with postmenopausal uterine bleeding that does not belong to the risk group (control group). Each patient underwent clinical examination, then fractionated curettements and its histopathological verification and assessment of treated clinical stage of disease with PH analysis of the resected specimens.
The patients of the studied risk group were significantly affected by endometrial cancer compared with the control group (RR=2.45, 95% CI 1.2 4.6, p=0.005). Endocervical pathology did not differ between groups. Clinical forms of bleeding: for those that are profuse bleeding cancer was present in 54.6% of cases. With intermittent bleeding cancer is verified in the 33.3% of patients. Risk patient groups with cancer frequently suffer from clinically more advanced stages of histologically aggressive endometrial cancer (serous adenocarcinoma-type II, low differentiated cancer).
绝经后子宫出血在未确诊之前“等同于癌症”。子宫内膜癌是绝经后女性的典型疾病,因为这个年龄段的每次出血都有10% - 30%的病因与子宫内膜癌相关。如今女性的寿命延长了,绝经后的时间占女性一生的三分之一。子宫内膜癌的早期诊断治愈率很高。对这种癌症进行筛查在实际操作中有局限性,鉴于高危人群的定义,进行一级和二级预防是必要的。
主要评估子宫内膜癌高危患者(糖尿病、肥胖、未生育、绝经晚(55岁以后))绝经后子宫出血的主要原因,并将其与无此风险的绝经后子宫出血患者的病因进行比较。
一项回顾性描述性研究,目标样本为50例连续在高危组(队列)登记有绝经后子宫出血的患者以及相同数量不属于风险组的绝经后子宫出血患者(对照组)。每位患者均接受临床检查,然后进行分段刮宫及其组织病理学验证,并通过对切除标本的PH分析评估所治疗疾病的临床阶段。
与对照组相比,研究的高危组患者受子宫内膜癌影响更为显著(相对危险度=2.45,95%可信区间1.2 - 4.6,p = 0.005)。两组间宫颈病理无差异。出血的临床类型:对于大出血患者,54.6%的病例存在癌症。对于间歇性出血患者,33.3%的患者确诊有癌症。有癌症的高危患者组临床上常患有组织学上侵袭性更强的子宫内膜癌(浆液性腺癌II型、低分化癌)更晚期阶段。