B超联合宫腔镜诊断子宫内膜癌的临床价值  

Clinical value of b-ultrasonography combined with hysteroscopy in endometrial carcinoma

作　　者：杨淑玲[1] 申爱荣[1] 娄华[1] 白桦[1] 吕桂荣[1] 

机构地区：[1]郑州大学第三附属医院河南省妇科内镜中心,河南郑州450052

出　　处：《中国内镜杂志》2005年第9期910-912,916,共4页China Journal of Endoscopy

摘　　要：目的评估宫腔镜与B超联合检查诊断子宫内膜癌及判断癌灶浸润肌层与宫颈情况的临床价值。方法对768例异常子宫出血或(和)溢液的病人,应用B超联合宫腔镜检查并定点活检,标本送病理检查,确诊内膜癌者手术治疗、术后病理结果与术前进行对比,并与单纯分段诊刮进行对比。结果诊断符合率:B超与宫腔镜联合检查诊断子宫内膜癌的符合率为96.4%、漏诊率为3.6%,其诊断符合率明显高于诊刮组(68.7%)P<0.01;漏诊率明显低于诊刮组(31.3%),P<0.01。对肌层及宫颈浸润程度的判断:B超联合宫腔镜检查判断宫颈浸润的阳性预测值100%,阴性预测值98.0%,明显高于诊刮组63.6%和88.2%,P<0.001;判断子宫肌层未受浸润、浅肌层浸润、深肌层浸润的符合率分别为92.7%、81.8%和66.7%。而诊断性刮宫则无法判断宫壁浸润情况。结论宫腔镜与B超联合检查结合病理可明显提高子宫内膜癌的诊断率;术前B超联合宫腔镜检查对肌层浸润及宫颈浸润判断的准确性高,为选择合理的手术范围提供了依据。[Objective] To evaluate the clinical value by hysteroscopy combined with B-uhrasonography in the diagnosis of endometrial carcinoma and the estimation of myometrial and cervical invasion in endometrial carcinoma. [Methods] 768 patients with abnormal uterine bleeding were examined by B-tdtrasonography and hysteroscopy. Those patients diagnosed endometrial carcinoma through biopsy and pathological findings performed operation. The pathological findings of after surgery compared with pre-surgery and D＆C respectively. [Results] The coincident rate for diagnosis of endometrial carcinoma was higher by hysteroscopy combined with B-uhrasonography （96.4%） than by D＆C （68.7%） P 〈0.01, and the false positive rate for diagnosis of endometrial carcinoma was lower in experiment group （3.6%） than in control group （31.3%） P 〈0.01. The sensitivity of the estimation of myometrial and cervical invasion is higher by hysteroscopy combined with B-ttltrasonogrophy （100%） than by D＆C （63.6%） P 〈 0.001, the specificity is higher in experiment group （98.0%） than in control group （88.2%） P 〈0.001. The coincident rates of myometrial uninvasion, superficial invasion and deep invasion were 92.7%, 81.8% and 66.7% respectively. But D＆C cannot estimate the invasion in myometrial. [Conclusions] By hysteroscopy and B-ttltrasonography combined with pathological findings can improve the accurate rate for diagnosis of endometrial carcinoma. Hysteroscopy combined with B-tdtrasonography has high accuracy in predicting myometrial and cervical invasion before surgical intervention, which can provide evidence to select the reasonable scope of operation.

关 键 词：B型超声 宫腔镜检查 病理检查 子宫内膜癌 

分 类 号：R737.33[医药卫生—肿瘤]