子宫内膜不典型增生患者发现术后隐匿癌风险的研究

发布时间：2018-04-01 03:23

  本文选题：子宫内膜不典型增生　切入点：子宫内膜癌　出处：《大连医科大学》2017年硕士论文

【摘要】：目的:回顾性分析91例术前诊断为子宫内膜不典型增生患者的临床病理资料,预测术前子宫内膜不典型增生患者发生术后隐匿癌的高危因素。方法:选取2007年1月1日至2016年12月31日期间因子宫内膜不典型增生于大连医科大学附属第二医院行子宫切除手术的91例患者的临床病理资料。术前诊断为子宫内膜不典型增生的方式分为诊断性刮宫术或宫腔镜直视下定点活检术。根据术后石蜡切片病理结果将入组病例分为子宫内膜不典型增生组(65例)和子宫内膜癌组(26例),比较非癌组和癌组患者的年龄、绝经状态、身高体重、生育情况、合并高血压或者糖尿病、恶性肿瘤病史、肿瘤家族史、临床表现、病程、术前EAH分度、血清CA125值、子宫内膜取材前盆腔超声提示子宫内膜厚度及血流情况等相关因素,探寻子宫内膜不典型增生患者术后发生隐匿癌的高危因素。结果:1.以术后病理结果为依据将入组的91例患者分为子宫内膜不典型增生组(非癌组)和子宫内膜癌组(癌组),其中非癌组有65例,占71.43%;癌组有26例,占28.57%。发生的隐匿癌全为子宫内膜样腺癌。癌细胞高分化者(G1)有19例,占73.08%,中分化者(G2)有6例,占23.08%,低分化者(G3)有1例,占3.85%。隐匿癌中有20例是I a期,占76.92%,其中癌组织局限在子宫内膜的有9例(34.62%)、浅肌层浸润(1/2肌层)有11例(42.31%);4例是I b期,占15.38%;2例是II期,占7.69%。2.诊断性刮宫术诊断子宫内膜不典型增生的准确率为70.00%、隐匿癌发生率为30.00%;宫腔镜直视下定点活检术诊断子宫内膜不典型增生的准确率为76.19%、隐匿癌发生率为23.81%。诊刮组和宫腔镜组诊断子宫内膜不典型增生的符合率和术后隐匿癌的发生率差异无明显统计学意义。3.EAH患者术中行快速冰冻切片病理检查,其诊断子宫内膜癌的敏感性、特异性、阳性预测值、阴性预测值和总的诊断符合率分别为62.50%、70.59%、66.67%、66.67%和66.67%。4.绝经状态、BMI≥28kg/m~2、病程、术前EAH分度、子宫内膜厚度、子宫内膜血流情况进行单因素分析有统计学意义,将其行多因素Logistic回归分析得出结论:BMI≥28kg/m~2、EAH分度及子宫内膜血流丰富为子宫内膜不典型增生发生术后隐匿癌的高危因素。结论:1.EAH患者切除子宫术后隐匿癌的发生率为28.57%,隐匿癌大多数为分化程度好的早期子宫内膜腺癌;2.术前诊断性刮宫术和宫腔镜直视下定点活检术诊断Ec的漏诊率分别为30.00%和23.81%,术中行快速冰冻切片病理检查诊断Ec的符合率为66.67%,必要时需行其他辅助检查提高诊断的准确率;3.肥胖(BMI≥28kg/m~2)、重度子宫内膜不典型增生及子宫内膜血流丰富为子宫内膜不典型增生发生术后隐匿癌的高危因素。
[Abstract]:Objective: to retrospectively analyze the clinical and pathological data of 91 cases of endometrial atypical hyperplasia diagnosed before operation, and predict the high risk factors of occult carcinoma after operation in patients with atypical hyperplasia of endometrium.Methods: from January 1, 2007 to December 31, 2016, 91 patients with endometrial atypical hyperplasia underwent hysterectomy in the second affiliated Hospital of Dalian Medical University.Preoperative diagnosis of endometrial atypical hyperplasia can be divided into diagnostic curettage or hysteroscopy.According to the pathological results of paraffin section after operation, the patients were divided into two groups: 65 cases of atypical hyperplasia of endometrium and 26 cases of endometrial carcinoma. The age, menopausal status, height, weight, fertility of the patients in non-cancer group and cancer group were compared.Associated factors such as hypertension or diabetes, history of malignant tumor, family history of tumor, clinical manifestation, course of disease, preoperative EAH score, serum CA125 value, endometrial thickness and blood flow were revealed by pelvic ultrasound before endometrial sampling.To explore the risk factors of occult carcinoma in patients with atypical hyperplasia of endometrium after operation.The result is 1: 1.According to the postoperative pathological results, 91 patients were divided into two groups: atypical hyperplasia of endometrium (non-carcinoma group) and endometrial carcinoma group (cancer group), including 65 cases (71.43%) in non-cancer group and 26 cases (28.57%) in cancer group.All occult carcinomas are endometrial adenocarcinoma.There were 19 cases (73.08%) of cancer cells with high differentiation, 6 cases (23.08%) with moderate differentiation, and 1 case (3.85%) with low differentiation.Of them, 20 cases were stage I a (76.92%), of which 9 cases were located in endometrial tissue (34.62%), 11 cases had superficial muscle layer infiltrating 1 / 2 muscle layer (42.31 1%), 4 cases were stage I b, and 2 cases were stage II, accounting for 7.69.2%.The diagnostic accuracy of uterine curettage in the diagnosis of endometrial atypical hyperplasia was 70.00.The occult carcinoma rate was 30.00.The accuracy of hysteroscopy in diagnosing endometrial atypical hyperplasia was 76.19 and the occult cancer rate was 23.81.The accuracy of diagnosis of endometrial atypical hyperplasia by hysteroscopy was 76.19 and that of occult carcinoma was 23.81.There was no significant difference between the coincidence rate of diagnosis of atypical hyperplasia of endometrium and the incidence of occult carcinoma after operation. 3. The sensitivity and specificity of the diagnosis of endometrial carcinoma were detected by rapid frozen section pathological examination.The positive predictive value, the negative predictive value and the total diagnostic coincidence rate were 62.50% and 66.67%, 66.67% and 66.67%, respectively.In menopausal women, EAH 鈮，

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