子宫内膜细胞学检查在筛查子宫内膜病变中的临床价值

发布时间：2018-03-15 21:44

本文选题：子宫内膜癌　切入点：SAP-I型子宫内膜细胞采集器　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的:子宫内膜病变是一组以子宫内膜发生改变而导致的病变,在临床上常见的有子宫内膜增生、子宫内膜息肉、子宫内膜不典型增生、子宫内膜癌。子宫内膜癌(Endometrial Carcinoma,EC)是一组源发于子宫内膜的上皮性恶性肿瘤。EC为女性常见的恶性肿瘤之一,占全身恶性肿瘤的7%,占生殖道恶性肿瘤20-30%。主要表现为不规则阴道流血及阴道排液,尤其是绝经后女性。近年来,随着人们健康保健意识的提高、饮食及生活习惯的改变、老龄化人口的增加以及外源性激素滥用等因素,EC的发病率逐年呈上升趋势,并且趋于年轻化。传统的诊断“金标准”——分段诊刮为盲目性取材,属于有创性检查,对患者的创伤较大,不适合进行重复操作,患者耐受性、依从性差,所以不适用于广大人群的筛查。随着EC发病率的升高,临床医生迫切需要一种简单易行,患者耐受性、依从性较好,可以适用于大规模人群的筛查方法,这样EC就可以得到早期发现、早期诊断、早期治疗,从而改善患者的预后、提高生活质量。因此,本研究选取2015年9月至2016年11月因子宫内膜息肉、子宫肌瘤、子宫内膜不典型增生、子宫内膜癌等在吉林大学中日联谊医院行子宫内膜息肉切除术、子宫次全切除术及全子宫切除术患者共146例,在术前对所有患者进行子宫内膜细胞学检查(Endometrial Cytological Test,ECT),分析对比细胞学检查结果与术后组织病理学检查结果,从而评价ECT筛查子宫内膜病变的临床价值及应用前景。方法:选取2015年9月至2016年11月因子宫内膜息肉、子宫肌瘤、子宫内膜不典型增生、子宫内膜癌等在吉林大学中日联谊医院行宫腔镜下子宫内膜息肉切除术、子宫次全切除术及全子宫切除术患者共146例。对患者从绝经状态、子宫大小、子宫内膜厚度三个方面进行分组,其中未绝经患者101例、绝经患者45例;子宫孕3个月患者20例、子宫孕3个月患者126例;子宫内膜厚度1.2cm的患者48例、子宫内膜厚度1.2cm的患者98例。在术前对所有患者使用SAP-I型子宫内膜细胞采集器采集子宫内膜细胞,进行子宫内膜细胞学检查。以赵健的子宫内膜细胞取材满意标准作为评判标准,分析对比绝经状态、子宫大小、子宫内膜厚度是否会影响SAP-I型子宫内膜细胞采集器的取材满意度;以术后组织病理学结果为“金标准”,分析对比得出ECT筛查子宫内膜病变的灵敏度、特异度、阳性预测值及阴性预测值。本研究采用SPSS18.0统计软件。计数资料采用χ2检验。以P0.05作为差别显著性判断标准。结果:1取材满意度SAP-I型子宫内膜细胞采集器用于子宫内膜细胞采集的取材满意度为94.52%(138/146)。1.1绝经状态对取材满意度的影响未绝经患者共101例,取材满意者为96例;绝经患者共45例,取材满意者为42例。绝经状态对于SAP-I型子宫内膜细胞采集器取材满意度的影响,差异无统计学意义(P0.05)。1.2子宫大小对取材满意度的影响子宫孕3个月的患者共20例,取材满意者为5例;子宫孕3个月的患者共126例,取材满意者为123例。子宫大小对于SAP-I型子宫内膜细胞采集器取材满意度的影响,差异有统计学意义(P0.05)。1.3子宫内膜厚度对取材满意度的影响子宫内膜厚度1.2cm的患者共48例,取材满意者为44例;子宫内膜厚度1.2cm的患者共98例,取材满意者为94例。子宫内膜厚度对于SAP-I型子宫内膜细胞采集器取材满意度的影响,差异无统计学意义(P0.05)。2 ECT诊断结果与术后病理组织学结果在146例患者中,去除取材不满意的8例患者,对于取材满意的138例患者进行子宫内膜细胞学检查结果与术后组织病理学结果的对比分析,以术后组织病理学结果为诊断“金标准”。对比子宫内膜细胞学检查结果与术后组织病理学检查结果得出,ECT的诊断符合率为88.41%(122/138)。ECT筛查子宫内膜癌的灵敏度、特异度、假阴性率、假阳性率、阳性预测值、阴性预测值分别为97.22%、95.10%、2.78%、4.90%、87.50%、98.98%;ECT筛查子宫内膜良性病变的灵敏度、特异度、假阴性率、假阳性率、阳性预测值、阴性预测值分别为87.93%、96.25%、12.07%、3.75%、94.44%、91.67%。结论:1、SAP-I型子宫内膜细胞采集器采集子宫内膜细胞简便易行,痛苦小,取材满意度较高,证明该方法是可行的。2、SAP-I型子宫内膜细胞采集器采集子宫内膜细胞的取材满意度不受绝经状态、子宫内膜厚度的影响,但是受子宫大小的影响。3、子宫内膜细胞学检查用于筛查子宫内膜病变有较高的诊断符合率、灵敏度及特异度,在筛查子宫内膜病变中具有一定的临床价值。
[Abstract]:Background and objective: endometrial lesions are a group of endometrial changes caused by lesions in clinical common endometrial hyperplasia, endometrial polyps, endometrial atypical hyperplasia and endometrial cancer. Endometrial carcinoma (Endometrial Carcinoma EC) is a group of malignant epithelial tumors originated from.EC the endometrium is one of the most common malignant tumors in women, accounting for 7% of all malignant tumors, accounting for genital tract malignant tumor 20-30%. showed irregular vaginal bleeding and vaginal discharge, especially in postmenopausal women. In recent years, people with health care awareness, diet and lifestyle changes, the aging population and the increase of exogenous hormone abuse and other factors, the incidence of EC is rising year by year, and tend to be young. The traditional "gold standard" of diagnosis for blindness curettage specimens are invasive Check, large trauma to the patient, not suitable for repeated operation, patient tolerance, poor compliance, so the screening is not suitable in the crowd. With the increase of the incidence of EC, clinicians need a simple, patient tolerance, good compliance, screening method can be applied to large populations, such EC can be early detection, early diagnosis and early treatment, so as to improve the prognosis of patients, improve the quality of life. Therefore, this study from September 2015 to November 2016 due to endometrial polyps, uterine fibroids, endometrial atypical hyperplasia and endometrial carcinoma in China Japan Union Hospital of Jilin University for endometrial polyp resection of uterus total resection and total hysterectomy for patients with a total of 146 cases of endometrial cytology for all patients in the preoperative (Endometrial Cytological, Test, ECT), comparative analysis of cells Examination results and postoperative pathological examination results, and evaluation of ECT screening of endometrial lesions of the clinical value and application prospect. Methods: from September 2015 to November 2016 due to endometrial polyps, uterine fibroids, endometrial atypical hyperplasia and endometrial carcinoma in China Japan Union Hospital of Jilin University underwent hysteroscopic resection of endometrial polyps, subtotal hysterectomy and total hysterectomy in patients with a total of 146 cases of patients with menopausal status. From three aspects, the size of uterus, endometrial thickness were divided into two groups, including 101 cases of premenopausal patients, 45 patients with vast uterine pregnancy patients 3 months; 20 cases of uterine pregnancy, 3 months in 126 cases; 48 cases of patients with endometrial thickness 1.2cm, 98 cases of patients with endometrial thickness 1.2cm. Before surgery for all patients with type SAP-I endometrial cells acquisition endometrial cells, endometrial fine Cellular pathology. In endometrial cells of Zhao Jian were satisfactory standards as evaluation criteria, analysis of uterine size comparison, menopausal status, whether endometrial thickness would take satisfaction effect of type SAP-I endometrial cell collection; the postoperative histopathologic results as the "gold standard", the sensitivity analysis and comparison of ECT screening for endometrial in the specificity, positive predictive value and negative predictive value. This study uses SPSS18.0 statistical software. Enumeration data with 2 test. With P0.05 as the difference significant criteria. Results: 1 were satisfaction type SAP-I endometrial cell collector for endometrial cells collected from satisfaction was 94.52% (138/146).1.1 menopausal status influence based on the satisfaction of premenopausal patients with a total of 101 cases were satisfactory in 96 cases; menopause patients with a total of 45 cases were satisfactory in 42 cases. The menopausal status in SAP-I Effect of endometrial cell collector material satisfaction, there was no statistically significant difference (P0.05).1.2 uterine size effect on material satisfaction uterine pregnancy 3 months a total of 20 patients were satisfactory in 5 cases of uterine pregnancy; 3 months a total of 126 patients were satisfactory in 123 cases. The effect of the size of the uterus type SAP-I endometrial cell collector material satisfaction, the difference was statistically significant (P0.05).1.3 endometrial thickness effect on the material satisfaction of endometrial thickness in 1.2cm patients with a total of 48 cases were satisfactory in 44 cases; the thickness of endometrium of 1.2cm patients with a total of 98 cases were satisfactory in 94 cases of endometrial thickness. For type SAP-I endometrial cell collector material satisfaction, there was no statistically significant difference (P0.05).2 ECT diagnosis and postoperative pathological results in 146 patients, 8 cases were not satisfied with the removal of patients, Comparative analysis of 138 cases were satisfactory for patients with uterine endometrial biopsy results and postoperative pathological results, postoperative histopathologic results in the "gold standard" for diagnosis. The results of endometrial biopsy and postoperative pathological examination results, ECT diagnosis coincidence rate was 88.41% (122/138.ECT) the sensitivity of screening for endometrial cancer specificity, false negative rate, false positive rate, positive predictive value, negative predictive value were 97.22%, 95.10%, 2.78%, 4.90%, 87.50%, 98.98%; the sensitivity of ECT screening for endometrial benign lesions specificity, false negative rate, false positive rate, positive predictive value, negative predictive value were 87.93%, 96.25%, 12.07%, 3.75%, 94.44%, 1, 91.67%.. Conclusion: SAP-I type endometrial cell acquisition of endometrial cells is simple, less pain, the degree of satisfaction is high, prove that the method is feasible The.2 type SAP-I endometrial cells acquisition of endometrial cells were not affected by satisfaction of menopausal status, endometrial thickness, but influenced by the size of uterine.3, endometrial cytology for diagnosis coincidence rate of screening for endometrial lesions have high sensitivity and specificity, and has certain clinical value in screening of uterus endometrial lesions.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33;R711.74

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