宫腔镜直视下活检及分段诊刮术与单纯分段诊刮术在子宫内膜癌诊断中的应用价值  

Value of hysteroscopy with directed biopsy or dilatation and curettage in the diagnosis of endometrial carcinoma

作　　者：祝洪澜[1] 梁旭东[1] 王建六[1] 崔恒[1] 魏丽惠[1] 

机构地区：[1]北京大学人民医院妇产科,北京100044

出　　处：《中国实用妇科与产科杂志》2011年第6期439-442,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的对照研究宫腔镜直视下活检及分段诊刮术与单纯分段诊刮术在子宫内膜癌诊断中的应用价值。方法北京大学人民医院从2002年7月至2010年2月收治子宫内膜癌患者287例,分为宫腔镜直视下活检及分段诊刮(A)组90例,和单纯分段诊刮(B)组197例,比较两组术前病理诊断子宫内膜癌的准确性,判断宫颈受累的可靠性,比较两组腹腔冲洗液阳性率的差别及3年和5年总生存率的差异。结果 A组术前病理诊断的准确率为97.8%(88/90),B组为88.8%(175/197),差异有统计学意义(P<0.05)。A组宫颈受累估计的敏感度、准确率、阳性预测值、阴性预测值分别为77.8%,97.8%,100%和97.6%;B组分别为65.3%,85.8%,74.4%和89.0%。A组腹腔冲洗液阳性率为5.56%(5/90),B组为6.09%(12/197),差异无统计学意义(P>0.05)。A组3年总生存率为91.7%(33/36),5年总生存率为82.4%(14/17),B组分别为95.6%(87/91)和86.7%(39/45)。3年和5年总生存率间比较,差异均无统计学意义(P>0.05)。结论宫腔镜直视下活检及分段诊刮可提高术前子宫内膜癌的病理诊断准确率,可准确了解子宫内膜癌患者宫颈受累情况,不增加患者腹腔冲洗液的阳性率,不影响患者生存率及预后。Objective To explore the value of hysteroscopy with directed biopsy or dilatation and curettage in the diagnosis of endometrial carcinoma. Methods 287 patients with endometrial carcinoma who were treated in our hospital were distributed into 2 groups： Group A （90 patients） was examined using hystcroscopy with directed biopsy or dilatation and curettage, and Group B （197 patients） was examined using fractional dilation and curettage （D＆C）. The diagnostic veracity of the two methods, the rate of positive peritoneal cytology and the prognosis of the 2 groups were compared. Resuits In Group A, 97.8 % （88/ 90 ） of patients were diagnosed pathologically before surgery; the rate was 88.8% （175/197） for Group B. The difference between the 2 groups was statistically significant （P 〈 0.05）. The sensitivity, accuracy, positire predictive value （PPV） and negative predictive value （NPV） for the two methods for detecting cervical involvementwere 77.8% , 97.8% , 100% and 97.6% for Group A and 65.3% , 85.8% , 74.4% and 89. 0% for Group B, respectively. The positive peritoneal cytology rate was 5.56 % （5/90） in Group A and 6. 09% （12/197） in Group B. The difference was not statistically significant （ P 〉 0. 05 ）. The 3-year and 5-year overall survival rates were 91.7% （33/36） and 82. 4% （14/17） for Group A and 95.6% （87/91） and 86. 7% （39/45） for Group B. There were no statistically significant differences between the 2 groups＇survival rates （ P 〉 0. 05 ）. Conclusion Compared with fractional D＆C, hysteroscopy with directed biopsy or D＆C offered improved pathological diagnostic accuracy before sur- gery and discovered cervical involvement more precisely in endometria] carcinoma patients, but it did not increase the positive peritoneal cytology rate or affect the prognosis of these patients.

关 键 词：宫腔镜 分段诊刮 子宫内膜癌 

分 类 号：R71[医药卫生—妇产科学]