术前宫腔镜检查诊断子宫内膜癌安全性的系统评价

摘要

目的 探讨术前宫腔镜检查与子宫内膜癌癌细胞播散的相关性.方法 检索2000年4月至2015年4月中外文数据库(PubMed、Medline、EBSCOhost期刊数据库、CNKI和万方数据库)中有关合格对照临床试验的文献.根据文献纳入和排除标准筛选文献,依据Cochrane软件开展文献质量评估,使用RevMan 5.3.3统计软件开展Meta分析.结果 纳入此次荟萃分析的文献共13篇,其中英文文献7篇,中文文献6篇;Meta分析结果显示普通刮诊组和术前诊断性宫腔镜组腹腔积液(包括腹腔冲洗液)肿瘤细胞阳性间差异有统计学意义(OR=1.61,95%CI:1.19~2.16,P<0.05),森林图的菱形图案全部在中线右边,测试整体效果Z=3.12,P=0.002,采用术前诊断性宫腔镜检查患者相关腹腔积液肿瘤细胞阳性(包括可疑阳性)的风险为无术前诊断性宫腔镜检查患者的1.61倍.结论 术前宫腔镜检查可增加子宫内膜癌患者腹腔冲洗液肿瘤细胞学阳性风险,引起子宫内膜癌癌细胞播散.%Objective To evaluate the correlation between pre-operative hysteroscopy and early intraperitoneal dis-semination of endometrial cancer cells. Method PubMed, Medline, EBSCOhost, CNKI and Wanfang database were searched for related literature published from April 2000 to April 2015 according to predefined inclusion and exclusion standard, while the quality of literature was evaluated using Cochrane software, and Meta analysis was performed with RevMan 5.3.3 software. Result A total of 13 literature, including 7 English and 6 Chinese studies were included in the analysis;Meta analysis showed that there was significant difference in the positive rate of tumor cells in peritoneal ascites (including peritoneal washings) between patients underwent general curettage or pre-operative hysteroscopy (OR=1.61, 95%CI:1.19-2.16, Z=3.12, P=0.002);The risk of positive tumor cells (or suspected positivity) in patients with preopera-tive diagnostic hysteroscopy is 1.61 times as much as that in patients without it. Conclusion Pre-operative hysteroscopy can increase the risk of positive peritoneal washings cytology in endometrial carcinoma patients, and cause early dissemi-nation of endometrial cancer cells.