防止子宫内膜癌漏诊的临床分析  

Prospective clinic study of decreasing the rate of missed diagnosis of endometrial cancer

作　　者：朱琳[1] 辛刚[1] 杜鹃[2] 

机构地区：[1]山东大学第二医院妇科,济南250033 [2]济南市妇幼保健院妇产科

出　　处：《中华医学杂志》2010年第43期3084-3086,共3页National Medical Journal of China

摘　　要：目的 探讨对子宫内膜增生症患者术中先行子宫挖芯术,切除子宫肌层及内膜层做快速病理防止子宫内膜癌漏诊的意义.方法 选取因子宫内膜复杂性增生或不典型增生行手术治疗的患者.对象分为子宫挖芯术组（39例术中先行子宫挖芯术,再根据快速病理结果决定下一步手术范围）,官腔镜下活检组30例和对照组（依据术前诊刮病理结果而决定手术范围的病例57例）.比较3组漏诊率的差异,分析3组手术治疗情况,探讨子宫挖芯术对防止子宫内膜癌漏诊的意义.结果 子宫挖芯术组术中快速冰冻病理发现5例子宫内膜癌,术后病理证实术中快速病理仪1例漏诊,漏诊率2.6%;宫腔镜组子宫内膜癌漏诊率为3.3%;对照组漏诊率为14.0%;前两组与对照组比较差异有统计学意义（χ2=4.78,P＜0.05 χ2=4.73,P＜0.05）.结论 子宫挖芯术做快速病理检查及宫腔镜检查均可有效减少子宫内膜癌的漏诊,对子宫内膜增生症患者手术方式的选择具有指导意义.Objective To analyze the clinical significance of a novel operating approach of cutting the core of uterus to perform freezing section histological examination intra-operatively for the patients with endometrial hyperplasia （EH）. Methods The patients ready to undergo total hysterectomy with a histological diagnosis of EH were selected. In the cutting core group （ n = 39 ）, the core of uterus was resected firstly according to the freezing histological diagnosis. Thirty cases received hysteroscopy with directed biopsies while the control group had 57 cases. Their differences of missed diagnosis rate of endometrial cancer and operative approaches were compared. And the clinic significance of cutting firstly the core of uterus intra-operatively was discussed. Results In the cutting core, hysteroscopy with directed biopsies and control groups, the missed diagnosis rate was 2. 6%, 3.3% and 14. 0% respectively. The missed diagnosis rate of first two groups had significant difference as compared with the controls （χ2 =4. 78,P 〈 0. 05 ;χ2 = 4. 73, P 〈 0. 05 ）. Conclusion The novel operating approach can effectively prevent the missed diagnosis of endometrial cancer. It helps a surgeon to choose suitable operative extent for the patients with endometrial hyperplasia.

关 键 词：子宫内膜增生症 子宫内膜癌 冰冻超薄切片术 漏诊 

分 类 号：R686[医药卫生—骨科学]