宫腔镜检对子宫内膜癌的诊断价值

发布时间：2018-12-26 19:24

【摘要】：目的： 评价宫腔镜检下诊刮术在术前诊断子宫内膜癌应用价值，以及能否将腹腔冲洗液的阳性率增加。 方法： 收集大连医科大学附属第一、二医院中2010年1月-2013年12月的4年间收治的经手术治疗、术后病理证实为子宫内膜癌并且资料完整的患者190例。对其进行回顾性分析，并将患者根据术前确诊方法的不同分为宫腔镜下的诊刮术组（A组）92例、单纯诊刮术组（B组）98例；宫腔镜下诊刮术组年龄32-72岁，平均(50.9±8.7)岁，单纯诊刮术组年龄35-73岁，平均(52.6±10.2)岁，比较两组手术前后的临床分期、病理组织学类型、组织学分级、宫颈受累情况、腹腔冲洗液细胞学检查并对腹腔冲洗液阳性的影响因素进行了分析。 结果： 1.A组92例患者中只有2例手术前后病理类型诊断有所不同，，符合率为97.8%（90/92）；B组98例中，15例患者手术前后的病理类型诊断不同，符合率为84.7%（83/98），两组进行比较，统计学存在显著性差异（P0.01）。 2.A组（90例术前进行临床分期）手术前后诊断临床分期的总符合率为95.6%（86/90）,B组（92例术前进行临床分期）临床分期的总符合率为77.2%(71/92)，两组相比较，差异存在显著性（P0.01）。 3.A组28例患者术前进行组织学分级，B组42例患者术前进行组织学分级，两者在手术前后组织学分级的总符合率为78.6%和73.8%，差异没有统计学意义（P0.05）。 4.A组于手术前后病理诊断宫颈受累的灵敏度、阳性及阴性预测值、符合率分别为79.3%、100%及91.3%、93.5%,，B组分别为55.6%、45.5%及89.5%、79.6%。两组进行比较分析，A组阳性预测值和符合率均明显高于B组，且两者之间存在显著性差异(P0.05)。 5.A组患者的腹腔冲洗液中找到癌细胞的阳性率为23.9%(22/92），比B组阳性率20.4%（20/98）略高,但两者之间差异不存在统计学意义（P0.05）。 6.子宫内膜癌腹腔冲洗液阳性与手术-病理分期之间的关系，分期晚（Ⅱ-Ⅲ期）的阳性率为34%（17/50），比分期早（Ⅰ期）的阳性率17.9%（25/140）明显升高，且统计学存在显著性差异（P0.05）；但其与病理学类型、分级以及对肌层侵袭的深度等均没有差异存在（P0.05）。 结论： 1.宫腔镜检下诊刮术在术前对子宫内膜癌的病理类型、临床分期的诊断具有较高准确率，且能对宫颈侵及情况做出准确的判断。 2.宫腔镜检下诊刮术在术前诊断子宫内膜癌组织学分级的精确性与单纯诊刮术相比无明显差异。 3.宫腔镜手术并没有增加腹腔冲洗液的阳性率。 4.腹腔冲洗液阳性率的增加与手术-病理分期有关系，而与癌组织对肌层的浸润深度、癌组织的分类及癌细胞分化级别等之间没有相关性。
[Abstract]:Objective: to evaluate the value of hysteroscopic curettage in the preoperative diagnosis of endometrial carcinoma and whether the positive rate of peritoneal lavage can be increased. Methods: 190 patients with endometrial carcinoma proved pathologically by operation from January 2010 to December 2013 in the first and second affiliated hospitals of Dalian Medical University were collected. The patients were divided into hysteroscopic curettage group (group A, n = 92) and simple curettage group (group B, n = 98). The age of hysteroscopic curettage group was 32-72 years old (mean 50.9 卤8.7) years, and that of simple curettage group was 35-73 years old (mean 52.6 卤10.2 years). The clinical stages and histopathological types of the two groups before and after operation were compared. Histological grade, cervical involvement and cytological examination of celiac lavage fluid were analyzed. Results: 1. In group A, only 2 of 92 patients were diagnosed differently before and after operation, the coincidence rate was 97.8% (90 / 92). In group B, the pathological types of 15 patients were different before and after operation, the coincidence rate was 84.7% (83 / 98). There was significant difference between the two groups (P0.01). 2.The total coincidence rate of clinical staging before and after operation in group A (90 cases with preoperative clinical staging) was 95.6% (86 / 90), B) (92 cases with preoperative clinical staging) was 77.2% (71 / 92). There was significant difference between the two groups (P 0.01). 3. Histological grading was performed in 28 cases of group A and 42 cases of group B before operation. The total coincidence rates of histological grading before and after operation were 78.6% and 73.8%, respectively. The difference was not statistically significant (P0.05). 4. The sensitivity, positive and negative predictive values of pathological diagnosis of cervical involvement in group A before and after operation were 79.30.100% and 91.3393.5%, respectively. In group B, they were 55.655% and 89.5%, respectively. 79.6am. The positive predictive value and coincidence rate of group A were significantly higher than that of group B, and there was significant difference between the two groups (P0.05). 5.The positive rate of cancer cells found in peritoneal lavage fluid of group A was 23.9% (22 / 92), which was slightly higher than that of group B (20.4%) (20 / 98), but there was no significant difference between the two groups (P0.05). 6. The positive rate of abdominal lavage fluid in endometrial carcinoma was 34% (17 / 50) late in stage 鈪

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