宫腔镜检查诊断子宫内膜癌的价值及与腹腔冲洗液阳性的关系探讨

摘要

目的:探讨官腔镜检查对子宫内膜癌的诊断价值,以及是否增加腹腔冲洗液细胞学阳性率.方法:回顾性分析在本院行手术治疗后病理检查确诊为子宫内膜癌患者113例的临床资料,其中术前行单纯分段诊断性刮宫71例(分段诊刮组),行官腔镜检查后再行分段诊刮42例(官腔镜组).比较两组手术前后的诊断、组织学分级、组织学类型符合率,腹腔冲洗液细胞学的阳性率,并同时分析组织学类型、组织学分级、肌层浸润深度、病灶分布、附件转移等与腹腔冲洗液细胞学的关系.结果:宫腔镜组42例患者,病理诊断符合率97.62％ (41/42),高于分段诊刮组的病理诊断符合率83.10％ (59/71),差异有统计学意义(P＜0.05).官腔镜组腹腔冲洗液阳性率28.57％ (12/42),高于分段诊刮组的阳性率25.35％(18/71),但两组比较差异无统计学意义(P＞0.05).113例子宫内膜癌患者腹腔冲洗液阳性与官腔病灶范围大小有关(P＜0.05),与附件转移、子宫肌层浸润深度、组织学类型、组织学分级无关(P＞0.05).结论:官腔镜检查诊断子宫内膜癌准确性优于单纯分段诊刮,并且不增加腹腔冲洗液阳性率.腹腔冲洗液阳性率与官腔病灶范围大小有关.%Objective:To explore the clinical significance of diagnostic hysteroscope in the diagnosis of en-dometrial carcinoma and the relationship of diagnostic hysteroscopy and positive peritoneal cytology. Methods: A retrospective study was carried out on 113 cases of endomettial carcinoma. Among them, 71 patients were diagnosed by dilatation and curettage ( D&C), 42 patients were diagnosed by hysteroscopy. The pre-and post-operation diagnoses, histological type, the coincidence rate of histology and positive rate of peritoneal cytology in the two groups were compared, and correlation of positive peritoneal cytology with histology type, differentiation (grade), depth of myometrial invasion, adnexal metastasis and tumor distribution in the uterine cavity were analyzed. Results:The pathological coincidence rate before and after operation in hysteroscopy group was 97.62%, which was significantly different from that of 83.10% in D&C group (P< 0. 05). The positive peritoneal cytology rate was 28.57% in hysteroscopy group, which was higher than that in D&C group(25.35%), but no statistical difference was found(P>0.05). The positive peritoneal cytology rate was significantly correlated with tumor distribution in the uterine cavity(P<0.05), but not correlated with histology type, differentiation(grade), depth of myometrial invasion and adnexal metastasis ( P > 0.05). Conclusions:Hysteroscopy has higher diagnostic accuracy in endometrial carcinoma than D&C, and does not increase the positive rate of peritoneal cytology, which only has a correlation with tumor diffuse distribution in uterine cavity.