无症状绝经后子宫阴道脱垂患者中子宫肌瘤的患病率及风险因素

无症状绝经后妇女中子宫肌瘤的患病率尚不明确。目前尚无统一的临床共识关于如何管理这一群体中的子宫肌瘤，以及这些肌瘤是否真正构成临床关注的原因。本研究旨在估算未出现出血症状的绝经后妇女中子宫肌瘤的患病率，并评估与其存在相关的风险因素。本横断面研究评估了在华盛顿州单一机构接受子宫阴道脱垂子宫切除术的无症状绝经后妇女中子宫肌瘤的患病率。排除接受其他指征（包括绝经后出血）子宫切除术的患者。通过病历回顾，纳入2009年至2018年在该机构接受治疗的符合条件的患者。主要结局为病理学发现的子宫肌瘤。随后，采用单变量分析和多变量回归分析评估与肌瘤患病率相关的风险因素。在被识别的317名符合条件的女性中，106名（33.4%）发现有子宫肌瘤。肌瘤的平均大小和子宫内膜厚度分别为13±10 mm和1.4±1.5 mm。大部分病例（78%）为单发肌瘤。发现2例（1.89%）具有癌前或恶性病变；其中1例为子宫内膜癌，1例为子宫内膜上皮内瘤变。基线临床和人口学特征在有无子宫肌瘤的患者之间无显著差异，包括肌瘤、子宫内异位症和子宫腺肌症的存在。多变量逻辑回归显示，子宫肌瘤的存在与高体重指数（OR=1.06，95% CI：1.01-1.12，P=0.02）以及使用绝经期激素治疗（OR=1.67，95% CI：1.02-2.72，P=0.04）呈独立相关。

The prevalence of endometrial polyps among asymptomatic, postmenopausal women is not well defined. There is no clear clinical consensus on how to manage endometrial polyps in this population and whether these polyps truly are a cause for clinical concern.This study aimed to estimate the prevalence of endometrial polyps among asymptomatic (without bleeding), postmenopausal women and to evaluate risk factors associated with their presence.This cross-sectional study assessed the prevalence of endometrial polyps among asymptomatic, postmenopausal women who underwent a hysterectomy for uterovaginal prolapse. Patients were excluded if they underwent a hysterectomy for other indications, including postmenopausal bleeding. Following chart review, eligible patients who received care at a single site in Washington state from 2009 to 2018 were included. The primary outcome was the presence of endometrial polyps on pathology. Risk factors associated with polyp prevalence were subsequently assessed using univariate analysis and multivariate regression.Of the 317 eligible women identified, endometrial polyps were identified in 106 women (33.4%). The average polyp size and endometrial thickness was 13±10 mm and 1.4±1.5 mm, respectively. Most cases (78%) had solitary polyps. Premalignant and malignant lesions were found in 2 cases (1.89%); 1 had endometrial carcinoma and 1 had endometrial intraepithelial neoplasia. Baseline clinical and demographic characteristics were similar between patients with and those without endometrial polyps, including the presence of fibroids, endometriosis, and adenomyosis. A multivariate logistic regression showed that the presence of polyps was independently associated with a high body mass index (odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P=.02) and use of menopausal hormone therapy (odds ratio, 1.67; 95% confidence interval, 1.02-2.72; P=.04).Asymptomatic postmenopausal women who underwent hysterectomy for uterovaginal prolapse exhibited a high prevalence of endometrial polyps. Those who used menopausal hormone therapy and who had a high body mass index were at a higher risk for developing endometrial polyps. Although the risk for malignancy seems to be low, more investigation is warranted to truly quantify the lifetime risk. For now, expectant management may be a reasonable approach for incidentally found, asymptomatic polyps.