子宫内膜癌手术前分段诊断性刮宫价值的评价  

Value of Fractional Curettage of Prehysterectomy in Endometrial Neoplasms

作　　者：曲玉清[1] 王丽[1] 朱慧庭[1] 周先荣[1] 杜心谷[1] 

机构地区：[1]上海医科大学妇产科医院病理科,200011

出　　处：《中华妇产科杂志》2000年第5期267-269,共3页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　评价分段诊断性刮宫 (分段诊刮 )对判断子宫内膜癌的组织类型以及判断宫颈是否受累的价值。方法　对 6 91例子宫内膜癌术前均行分段诊刮 ,并对分段诊刮和手术切除标本的病理诊断结果进行比较分析。根据肿瘤与颈管的组织学关系不同 ,将颈管刮出物分为 4型 :Ⅰ型即肿瘤组织完全与颈管组织分离 ;Ⅱ型即肿瘤与颈管上皮相连 ;Ⅲ型即肿瘤浸润宫颈间质 ;Ⅳ型即标本中仅见肿瘤组织。结果　 (1)分段诊刮与手术切除标本病理诊断为子宫内膜癌的组织类型符合率为91.17% (6 30 / 6 91)。分段诊刮与手术切除标本病理诊断为分化差的子宫内膜癌中 ,其符合率为5 3.0 6 % (5 2 / 98)。 (2 ) 6 91例子宫内膜癌手术切除标本病理诊断宫颈受累者为 2 3.0 1% (15 9/ 6 91) ,宫颈未受累者为 76 .99% (5 32 / 6 91)。分段诊刮颈管刮出物各分型中 ,手术切除标本病理诊断宫颈受累者所占比例为 ,Ⅰ型 30 .30 % (10 / 33) ,Ⅱ型 9例中有 9例 (9/ 9) ,Ⅲ型 10 0 .0 0 % (40 / 40 ) ,Ⅳ型 46 .88% (2 9/6 3) ;分段诊刮颈管刮出物无肿瘤组织者 5 6 0例中 ,手术切除标本病理诊断为宫颈受累者 71例 ,占12 .6 8% (71/ 5 6 0 )。结论　 (1)分段诊刮诊断子宫内膜癌组织类型可靠性与肿瘤组织类型有关 ,对诊断分化差的子宫内膜癌有较大局?Objective To evaluate the value of fractional curettage in the histologic type, histologic grade and cervical involvement of the endometrial carcinoma. Methods A total of 691 cases of endometrial carcinoma in fractional curettage specimen were analyzed retrospectively, patients with no carcinoma postoperatively in the removed uterus were excluded from the study. Those endocervical curettages with adenocarcinoma according the histologic relationship between tumor tissue and endocervial tissue were divided into 4 main groups. Results (1) The inaccurate rate of histologic type in prehysterectomy curettage was 8.83% (61/691). About a half poorly differentiated adenocarcinomas were undergraded in the prehysterectomy curettage. (2) In 691 cases of endometrial carcinomas,159 (23.01 %) cases were determinated cervical involvement by tumor in the hysterectomy specimen, of which 88 cases had tumor tissue in the prehysterectomic curettage. In a variety of histologic appearances of endocervical curettage, the ratio of cervical involvement by tumor in hysterectomy was respectively group Ⅰ 30.30% (10/33), group Ⅱ 9 cases (9/9), group Ⅲ 100.00% (40/40),group Ⅳ 46.88% (29/63), those without tumor tissue in the endocervical curettage 12.68 %(71/560). Conclusions (1) The reliability of histologic type of endometrial carcinoma based on the findings of the fractional curettage specimen is related to the tumor type. The diagnosis of poorly differentiated adenocarcinomas in the prehysterectomy specimen is limited. (2) Determinating the presence or absence of cervical involvement can't only depend upon the endocervical curettage with or without tumor tissue. It is suggested that those endocervical curettage with tumor tissue be divided into 4 main groups according the histologic relationship between tumor tissue and endocervial tissue, groupⅡand group Ⅲ are good predictors of cervical involvement by tumor.

关 键 词：子宫内膜肿瘤 子宫颈 腺癌 诊断 

分 类 号：R737.33[医药卫生—肿瘤]