不同方法获取子宫内膜进行组织学诊断的对照研究  

Different methods for the diagnosis of endometrial histological comparative study

作　　者：冷旭[1] 王敏[1] 张淑兰[1] 王丹[1] 曹薇[1] 杨向红[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004

出　　处：《中华妇产科杂志》2013年第12期891-895,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的评价Pipelle子宫内膜取样器获取子宫内膜进行组织学诊断的可行性。方法采用前瞻性、自身对照研究方法，于2012年3—12月期间在中国医科大学附属盛京医院对200例进行子宫内膜活检的患者，先以Pipelle子宫内膜取样器获取子宫内膜组织，随后进行常规诊刮，两种方法获取的内膜组织分别送检，同一位病理医师对标本质量进行评估并做出组织学诊断。结果200例患者完成观察，两种取材方法都得到子宫内膜标本并进行了组织学诊断。Pipelle取样器的取材满意度为93．0％（186／200；14例只取到了少量的子宫内膜），其病理诊断结果准确率为85．0％（170／200；170例做出了与诊刮完全一致的病理诊断），两种取材方法在病理诊断一致性上无显著差异（P〉0．05）；Pipelle取样过程中患者无疼痛感。诊刮、Pipelle取样器两种取材方法诊断的敏感度分别为100．0％和85．O％，两者比较，差异无统计学意义（P〉0．05）。Pipelle取样器对子宫内膜癌诊断敏感度仅为54．5％，但11例子宫内膜癌其成功检出6例，另有3例诊断为重度不典型增生，1例为复杂性增生，1例取样时人为因素而仅诊断为破碎内膜；去除人为因素的1例，Pipelle取样器作为对可疑子宫内膜癌的筛查率达90％。结论子宫内膜取样器可获取满意的内膜标本用于组织学诊断，其对正常内膜、单纯性增生、复杂性增生、不典型增生、子宫内膜癌等的诊断准确率与诊刮基本一致，可以作为子宫内膜病变的常规筛查工具。Objective To evaluate the feasibility of endometrial sampler Pipelle for endometrial histologic diagnosis. Methods Using prospective and self-control methods, 200 patients with endometrial biopsy firstly used Pipelle endometrial sampler for endometrial tissue, then followed by diagnostic curettage, the same pathologist evaluated the specimen quality and made the histologic diagnosis. Results Totally 200 patients completed the observation, the specimen satisfaction of Pipelle was 93.0% （ in this 200 cases, 186 cases were satisfactory） , its pathological accuracy was 85.0% （in this 200 cases, 170 cases＇ pathological results are highly consistent with diagnostic curettage）. There was no significant difference between two kinds of endometrial sampling （P〉0.05）. There was no pain for patients during the Pipelle using process. Conclusion Pipelle could obtain satisfactory samples used for histological diagnosis in normal endometrium, simple hyperplasia, complex hyperplasia, atypical hyperplasia and endometrial cancer disease, because its pathological accuracy is so close to the diagnostic curettage, which may be used as a routine screening tool of endometrial diseases.

关 键 词：子宫内膜 活组织检查 刮除术 诊断设备 子宫内膜肿瘤 子宫内膜增生 对比研究 

分 类 号：R446.8[医药卫生—诊断学]