分析育龄期妇女异常子宫出血的声像图表现与病理结果，探讨育龄期子宫内膜病变的诊断思路。

选取2001年10月至2016年9月在首都医科大学附属复兴医院就诊的子宫内膜病变育龄期妇女149例，分析其声像图表现与病理结果，分为子宫内膜增生过长组88例，子宫内膜息肉组41例，子宫内膜癌组20例；超声检查的时间为月经周期的增殖早期或阴道出血停止后3 d内，以宫腔回声厚径≥10 mm作为内膜增厚的标准。内膜息肉组与息肉样增生组患者间最大径比较采用独立样本t检验；子宫内膜增生过长组、子宫内膜息肉组与子宫内膜癌组之间年龄、子宫体三径之和、宫腔回声厚径比较采用方差分析，有统计学意义的组间两两比较采用Bonferroni检验；比较3组患者的声像图表现与病理结果；镜下病理观察卵巢的组织结构。

（1）子宫内膜增生过长组、子宫内膜息肉组及子宫内膜癌组患者的平均年龄比较，差异无统计学意义（P>0.05）。（2）超声检查：3组患者子宫体三径之和比较，差异无统计学意义（P>0.05）；内膜增生过长组的宫腔回声厚径与内膜息肉组及内膜癌组比较[（11.70±5.42）mm vs（10.59±3.83）mm vs（17.14±8.70）mm]，差异有统计学意义（F=9.779，P<0.001），内膜增生过长组与内膜癌组、内膜息肉组与内膜癌组宫腔回声厚径比较，差异均有统计学意义（P均<0.001）；内膜增生过长组与内膜息肉组宫腔回声厚径比较，差异无统计学意义（P>0.05）。88例内膜增生过长病例中53例表现为息肉样，息肉样隆起的最大径的平均值与内膜息肉组比较[（17.13±10.45）mm vs（12.14±4.67）mm]，差异有统计学意义（t=3.112，P=0.002）；41例内膜息肉及53例息肉样增生组出现点、条状血流信号的比例分别为75.61%（31/41），41.51%（22/53）。3组患者中宫腔回声的测值<10 mm占42.3%（63/149）。（3）病理检查：20例子宫内膜癌均为内膜样癌，11例子宫切除者中，高分化子宫内膜样癌7例，中分化3例，低分化1例；同时，切除卵巢的8例中，7例见多个闭锁卵泡，1例见单纯囊肿。88例子宫内膜增生过长组中单纯增生过长77例，1例伴不典型增生；复杂增生过长11例，3例伴不典型增生。41例子宫内膜息肉中非功能性息肉33例，功能性息肉3例，4例腺肌瘤性息肉中1例癌变。

在子宫内膜的增殖早期或阴道出血停止后3 d内，宫腔回声厚径≥10 mm提示子宫内膜异常；宫腔回声厚径<10 mm，不能排除子宫内膜异常；可监测是否排卵，超声动态监测是否排卵可提示有无子宫内膜异常生长的危险因素。

To investigate the relationship of ultrasonographic features and their pathologic basics in women of child-bearing period with abnormal uterine bleeding, and to explore the diagnostic ideas in detecting endometrial lesions.

A total of 149 women in childbearing age who had endometrial lesions with pathologically confirmed endometrial lesions, including 88 cases of endometrial hyperplasia, 41 cases of endometrial polyp, 20 cases of endometrial carcinoma, at Fuxing Hospital, Capital Medical University from October 2001 to September 2016 were selected. Ultrasound exams were performed on patients in early proliferative phase of menstrual cycle or within three days after vaginal bleeding stopped. We recorded patients′ age, measured sum diameters of length, width and thickness of uterine, mean thickness of endometrium and maximum diameter of polypoid lesions. We grouped the patients by pathologic results and compared ultrasound parameters between groups. The thickness of endometrium over 1.0 cm was considered as ″increased″. The pathologic exams also included ovarian structures.

(1) There was no significant difference in the average age of patients with endometrial hyperplasia, endometrial polyps and endometrial cancer (P>0.05). (2) Ultrasonography: there was no statistically significant difference in the sum of the diameters of the uterus in the three groups (P>0.05); the thicker diameter of the uterine cavity in the intimal hyperplasia group was compared with the endometrial polyp group and the endometrial cancer group [(11.70±5.42) mm vs (10.59±3.83) mm vs (17.14±8.70) mm], the difference was statistically significant (F=9.779, P<0.001), endometrial hyperplasia and endometrial cancer, endometrial polyps compared with the endometrial cancer group, the difference in uterine cavity echo thickness was statistically significant (both P<0.001); there was no significant difference in the uterine cavity echo thick diameter between the intimal hyperplasia group and the endometrial polyp group (P>0.05). Of the 88 cases of hyperplasia of intimal hyperplasia, 53 were polypoid, and the mean diameter of the polypoid uplift was compared with the endometrial polyp group [(17.13±10.45) mm vs (12.14±4.67) mm], the difference was statistically significant (t=3.112, P=0.002). The proportions of point and strip blood flow signals in 41 cases of endometrial polyps and 53 cases of polypoid hyperplasia were 75.61% (31/41), 41.51% (22/ 53). Of the 163 patients in the three groups, 63 patients had a uterine cavity echo of <10 mm (42.3%). (3) Pathological examination: 20 cases of endometrial cancer were endometrioid carcinomas, 11 cases of hysterectomies, 7 cases of well-differentiated endometrioid carcinoma, 3 cases of moderate differentiation, 1 case of poorly differentiated; at the same time, 8 cases of ovariectomy. In 7 cases, there were multiple atresia follicles, and one case was pure cyst. Of the 88 patients with endometrial hyperplasia, 77 were hyperplasia and hyperplasia, 1 had dysplasia, 11 had complicated hyperplasia, and 3 had dysplasia. Of the 41 cases of endometrial polyps, 33 were non-functional polyps, 3 were functional polyps, and in 4 cases of adenoid fibroid polyps, there was 1 case of canceration.

In the early stage of endometrial proliferation or within 3 days after vaginal bleeding cases, the uterine cavity echo thickness diameter ≥10 mm suggests abnormal endometrium; uterine cavity echo thickness diameter <10 mm, endometrial abnormalities cannot be excluded; dynamic monitoring of ovulation by ultrasound may indicate the presence or absence of risk factors for abnormal growth of the endometrium.