子宫肉瘤的术前诊断评分系统及误诊分析

发布时间：2018-05-26 03:19

本文选题：子宫肉瘤 + 术前诊断　；参考：《青岛大学》2017年硕士论文

【摘要】：背景及目的:子宫肉瘤为临床上少见的妇科恶性肿瘤。目前尚缺乏特异的肿瘤标志物及辅助检查方法,早期或术前诊断困难,常被误诊为子宫良性肿瘤,如子宫肌瘤、子宫腺肌症(瘤),延误病情及手术方式不当造成手术病理分期提高或多次手术创伤,严重影响患者预后和生活质量。本文通过对子宫肉瘤组及对照组(子宫良性肿瘤组)的术前不同指标的统计学分析,建立子宫肉瘤术前诊断评分系统(Preoperative Sarcoma Score,PSS),以期提高子宫肉瘤术前诊断率;并通过分析误诊病例的临床资料,争取避免诊疗误区、避免错误的治疗手段。方法:1.采用回顾性、分组对照的方法,收集2003年1月~2016年6月在青岛大学附属医院妇科住院经病理诊断明确的子宫肉瘤、子宫良性肿瘤病例。经严格入组筛选标准,选取入组病例研究组子宫肉瘤组48例,对照组子宫良性肿瘤组90例,对两组的临床表现、实验室指标、影像学检查等临床资料进行单因素及多因素Logistic相关回归分析,建立相应预测评分系统,通过受试者工作特性(ROC)曲线得出鉴别子宫良恶性最佳分界值,并计算ROC曲线下面积检验该评分系统效能。2.选取本院2003年1月~2016年6月间首诊或外院转入的子宫肉瘤误诊病例15例,将误诊病例分为腹腔镜组和开腹组,并分析临床资料及随访预后。结果:1.共纳入48名子宫肉瘤患者和90例子宫良性肿瘤,比较两组相关临床资料,经单因素分析有意义指标是年龄、CA125、LDH、彩超检查特征(内部血流、血流信号丰富、边界、内部回声、肿瘤最大直径),进一步行二元Logistic相关回归分析得出LDH、彩超检查提示的边界欠清及内部回声呈不均质或混合回声是诊断子宫肉瘤的独立危险因素,制定子宫肉瘤术前诊断评分系统。该评分系统分值为0~4分,其预测的一致性较好(P=0.438)。受试者工作特征(ROC)曲线下面积是0.961(95%CI[0.922,0.999]),说明该评分系统区分度较好,最佳分界值为1.5分,特异度97.8%,敏感度83.3%,准确度92.8%,阴性预测值91.7%,阳性预测值95.2%。2.误诊患者年龄结构主要集中于育龄期女性;15例误诊患者术前均考虑“子宫肌瘤”,术后病理有5例(33%)报告错误;腹腔镜组在子宫肉瘤盆腔种植转移率(75%,3/4)及复发率(75%,3/4)方面均高于开腹组(27.3%,50%)。结论:1.子宫肉瘤的术前诊断评分系统(PSS),能够较好地对子宫肿瘤患者进行良恶性风险分层,可以为子宫肉瘤与子宫良性肿瘤的临床鉴别诊断提供初步依据。2.造成误诊及后果的原因有病理报告错误、忽视年轻未育患者、绝经后患者手术方式选择不恰当等;另外腹腔镜下分碎器的应用可能有引起未预料子宫肉瘤盆腹腔内种植转移及增加术后复发机会的风险,应引起临床医师重视。
[Abstract]:Background & objective: uterine sarcoma is a rare gynecologic malignant tumor. At present, there are no specific tumor markers and auxiliary examination methods. It is difficult to diagnose early or pre-operatively, and is often misdiagnosed as a benign uterine tumor, such as uterine leiomyoma. Adenomyosis of uterus (adenomyosis) caused by delayed condition and improper operation mode resulted in the improvement of surgical pathological stage or multiple surgical trauma, which seriously affected the prognosis and quality of life of the patients. In order to improve the preoperative diagnosis rate of uterine sarcoma, a preoperative Sarcoma score system was established by statistical analysis of different preoperative indexes in uterine sarcoma group and control group (uterine benign tumor group). By analyzing the clinical data of misdiagnosed cases, we try to avoid misdiagnosis and treatment. Method 1: 1. Cases of uterine sarcoma and benign uterine tumor in gynecological hospital of Qingdao University from January 2003 to June 2016 were collected by retrospective and controlled methods. According to strict screening criteria, 48 cases of uterine sarcoma and 90 cases of benign tumor of uterus were selected in the study group and the control group respectively. The clinical manifestations and laboratory indexes of the two groups were analyzed. The clinical data such as imaging examination were analyzed by univariate and multivariate Logistic correlation regression analysis, and the corresponding predictive scoring system was established. The best value of differentiation between benign and malignant uterus was obtained by using the operating characteristics of the subjects. The area under the ROC curve was calculated to test the effectiveness of the scoring system. Fifteen misdiagnosed cases of uterine sarcoma from January 2003 to June 2016 were divided into laparoscopy group and open group. The clinical data and prognosis were analyzed. The result is 1: 1. A total of 48 patients with uterine sarcoma and 90 patients with benign uterine tumors were enrolled. The clinical data of the two groups were compared. The significant indexes of univariate analysis were age CA125 LDH, color Doppler ultrasonography (internal blood flow, abundant blood flow signal, boundary, internal echo). The maximum diameter of the tumor was determined by binary Logistic correlation regression analysis. The results of color Doppler ultrasonography showed that the boundary was unclear and the internal echo was heterogeneous or mixed echo was an independent risk factor for the diagnosis of uterine sarcoma. To establish a preoperative diagnostic scoring system for uterine sarcoma. The score of this scoring system is 0 ~ 4, and the prediction consistency is good. The area under the operating characteristic curve of the subjects was 0.961(95%CI [0.922 卤0.999], which indicated that this scoring system had a good degree of differentiation, the best threshold was 1.5, the specificity was 97.8, the sensitivity was 83.3 and the accuracy was 92.8b, the negative predictive value was 91.7, and the positive predictive value was 95.2.2. The age structure of misdiagnosed patients was mainly focused on 15 misdiagnosed women of childbearing age. "uterine leiomyoma" was considered before operation. The rate of pelvic implantation and metastasis of uterine sarcoma in laparoscopic group (75 / 4) and recurrence rate (75 / 4) were higher than that in laparotomy group (27.3%). Conclusion 1. The preoperative diagnostic scoring system of uterine sarcoma (PSS) can better stratify the risk of benign and malignant uterine tumors and provide a preliminary basis for clinical differential diagnosis between uterine sarcoma and benign uterine tumors. The causes of misdiagnosis and its consequences were wrong pathological report, neglect of young unfertile patients, improper choice of surgical methods for postmenopausal patients, etc. In addition, the application of laparoscopic shredder may lead to unexpected intraperitoneal implantation metastasis of uterine sarcoma and increase the chance of recurrence after operation, which should be paid attention to by clinicians.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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