磁共振成像与术中病灶探查诊断子宫内膜癌肌层浸润及盆腹腔淋巴结转移临床价值研究

发布时间：2018-11-19 21:06

【摘要】：目的探讨磁共振成像(MRI)和术中病灶探查在子宫内膜癌肌层浸润及盆腹腔淋巴结转移诊断中的临床应用价值。方法回顾性分析上海交通大学附属第九人民医院2010年1月至2014年3月收治的33例行全子宫+双侧附件切除术+盆腔及腹主动脉旁淋巴清扫术的子宫内膜癌患者临床资料,以手术病理诊断为标准,比较术前MRI检查、术中病灶探查在诊断肿瘤侵犯子宫肌层深度和淋巴结转移的符合率。结果 MRI检查发现有肌层浸润33例,其中浅肌层浸润8例,深肌层浸润25例;术中剖视子宫标本发现有肌层浸润33例,其中浅肌层浸润6例,深肌层浸润27例。术后病理结果浅肌层浸润6例,深肌层浸润27例。提示MRI诊断浅肌层浸润敏感度100.00%,特异度92.59%。诊断深肌层浸润敏感度92.59%,特异度100.00%;术中病灶剖视诊断深浅肌层浸润敏感度和特异度均为100.00%。33例患者中经病理组织学确诊,8例患者出现淋巴转移,其中仅有盆腔淋巴结转移4例,盆腔及腹主动脉旁淋巴结转移2例,仅有腹主动脉旁淋巴结转移2例;33例患者术前MRI检查提示2例淋巴结转移,漏诊6例,MRI诊断淋巴结转移的敏感度25%;病灶探查发现4例盆腔淋巴结肿大(病理证实2例阳性,2例阴性),2例腹主动脉旁淋巴结肿大(1例阳性,1例阴性)。3例患者因淋巴结转移分期升级,术后需要辅以化疗和(或)放疗。结论子宫内膜癌患者术前MRI检查对判断肌层浸润深度准确率较高,手术中子宫标本的剖视与病理组织学检查相同,具有重要价值;而MRI检查和术中淋巴结探查对判断子宫内膜癌患者淋巴结转移的意义不大。盆腔及腹主动脉旁(至肾静脉水平)淋巴清扫可以使手术病理分期更准确,为患者术后提供更合理的治疗指导。
[Abstract]:Objective to evaluate the clinical value of magnetic resonance imaging (MRI) and intraoperative focus exploration in the diagnosis of myometrial invasion and pelvic and peritoneal lymph node metastasis in endometrial carcinoma. Methods the clinical data of 33 patients with endometrial carcinoma treated in the Ninth people's Hospital affiliated to Shanghai Jiaotong University from January 2010 to March 2014 were retrospectively analyzed. According to the criteria of surgical and pathological diagnosis, compared with preoperative MRI, intraoperative focus exploration was used to diagnose the depth of myometrium invasion and the rate of lymph node metastasis. Results 33 cases of myometrium infiltration were found by MRI, including 8 cases of superficial myometrial infiltration and 25 cases of deep myometrial infiltration, and 33 cases of myometrium infiltration were found during operation, including 6 cases of superficial myometrial infiltration and 27 cases of deep myometrial infiltration. Postoperative pathological results showed superficial muscle infiltration in 6 cases, deep muscle infiltration in 27 cases. The results suggest that the sensitivity and specificity of MRI in the diagnosis of superficial myometrial invasion are 100.00g and 92.59g respectively. The sensitivity and specificity of the diagnosis were 92.59% and 100.00000 respectively. The sensitivity and specificity of depth myometrium infiltration were 100.00.33 cases were confirmed by histopathology, 8 cases had lymphatic metastasis, only 4 cases had pelvic lymph node metastasis. Pelvic and para-aortic lymph node metastasis were found in 2 cases, and only 2 cases in para-aortic lymph node metastasis. Preoperative MRI examination of 33 patients showed that 2 cases had lymph node metastasis, 6 cases missed diagnosis. The sensitivity of MRI in diagnosing lymph node metastasis was 25%. Pelvic lymphadenopathy was found in 4 cases (positive in 2 cases, negative in 2 cases by pathology), and in 2 cases of lymphadenomegaly (1 case positive, 1 negative) in abdominal aorta. Postoperative chemotherapy and / or radiotherapy are required. Conclusion preoperative MRI examination in patients with endometrial carcinoma is of high accuracy in judging the depth of myometrial invasion. The section of uterus is the same as that of histopathology, and it is of great value to evaluate the depth of myometrium invasion in patients with endometrial carcinoma. However, MRI and intraoperative lymph node exploration are of little significance in judging lymph node metastasis in endometrial carcinoma patients. Lymphatic dissection of pelvic and abdominal aorta (to renal vein level) can make operation and pathological staging more accurate, and provide more reasonable treatment guidance for patients after operation.
【作者单位】：上海交通大学医学院附属第九人民医院妇产科;
【分类号】：R737.33

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