探讨经阴道超声检查对绝经后女性正常与异常子宫内膜的评估价值。

回顾性分析2008年1月至2019年8月于首都医科大学附属复兴医院接受经阴道超声检查的绝经后女性1779例，将无阴道出血症状且未发现有子宫内膜病变的病例定义为观察组，共计1630例，随访时间＞1年；统计子宫内膜正常值范围及绝经时间与内膜厚径的关系。将病理检查结果证实为子宫内膜病变的病例和萎缩内膜伴有阴道出血的病例定义为研究组，共149例；对子宫内膜声像图表现与临床症状及病理结果进行分析。不同绝经时间（每5年一个组段）的子宫内膜厚径比较应用独立样本t检验，观察组与研究组之间宫腔积液的发生率比较采用χ²检验，不同年龄、不同绝经时间的子宫内膜病变分布比较（单因素ANOVA）采用非参数检验。

观察组1630例，子宫内膜厚径的正常值范围为1.7~4.5 mm；绝经5年内子宫内膜厚径测值大于绝经6~10年人群内膜厚径［（3.28±1.54）mm vs（2.83±1.28）mm］，差异具有统计学意义（t=4.873，P＜0.001）；绝经后萎缩子宫内膜厚径可大于正常值。研究组149例，内膜厚径范围为1.0~53.0 mm；绝经后内膜厚径≥4 mm伴有阴道出血症状者，子宫内膜癌发病率最高，为66.3%（59/89）；不伴有阴道出血症状者，子宫内膜息肉发病率最高，为56.3%（27/48）。观察组宫腔积液的总发生率（15.3%，249/1630）高于研究组（8.1%，12/149），差异具有统计学意义（χ²=5.689，P=0.017）。不同年龄段、不同绝经时间段的子宫内膜病变类型比较，差异均无统计学意义（P均＞0.05）。

绝经后内膜厚径≥4 mm伴有阴道出血症状是临床进一步检查的指征；绝经后无症状内膜增厚者，定期经阴道超声检查是动态观察内膜变化的首选方法。宫腔积液多为正常绝经后女性的声像图表现之一。

To evaluate the value of transvaginal ultrasonography in the assessment of normal and abnormal endometrium in postmenopausal women.

A retrospective analysis of 1779 postmenopausal women who underwent transvaginal ultrasound Capital University of Medical Sciences at Fuxing Hospital from January 2008 to August 2019 was performed, cases without vaginal bleeding and without endometrial lesion were defined as observation group (1630 cases), and the follow-up time was over 1 year. The study group consisted of 149 cases with endometrial lesions and 149 cases with vaginal bleeding in atrophic endometrium The ultrasonographic features, clinical symptoms and pathological results of endometrium were analyzed. The comparison of endometrial thickness at different menopausal time (every 5 years) was performed by independent t test, and the incidence of hydrops was compared between the Observation Group and the study group by 2 test, nonparametric test was used to compare the distribution of endometrial lesions at different ages and different menopausal times (one-way Anova).

In the Observation Group (N=1630) , the normal value of endometrial thickness ranged from 1.7 mm to 4.5 mm, and the measured value of endometrial thickness within 5 years after menopause was larger than that of the population within 6 to 10 years after menopause [(3.28±1.54) mm vs (2.83±1.28) mm], there was significant difference between the two groups (t=4.873, P<0.001), and the endometrial thickness of postmenopausal atrophy was larger than that of normal. The study group included 149 women with endometrial thickness ranging from 1.0 mm to 53.0 mm, and the postmenopausal women with endometrial thickness ≥4 mm and vaginal bleeding had the highest endometrial cancer rate (66.3%, 59/89), the incidence of endometrial polyp was the highest (56.3%). The total incidence of uterine effusion in the observation group was significantly higher than that in the study group [15.3% (249/1630) vs 8.1% (12/149); χ²=5.689, P=0.017]. There was no significant difference in the types of endometrial lesions among different age groups and different menopausal time periods.

Postmenopausal endometrial thickness ≥4 mm with vaginal bleeding is an indication for further clinical examination. Regular transvaginal sonography is the first choice to observe the intimal changes dynamically in asymptomatic postmenopausal women with intimal thickening. Uterine effusion is one of the sonographic manifestations in normal postmenopausal women.