磁共振成像与术中病灶探查诊断子宫内膜癌肌层浸润及盆腹腔淋巴结转移临床价值研究  

Value of MRI and intraoperative exploration in the diagnosis of myometrial infiltration and lymph node metastasis of endometrial carcinoma

作　　者：陈鸣[1] 刘建华[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院妇产科,上海200011

出　　处：《中国实用妇科与产科杂志》2016年第2期159-162,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨磁共振成像(MRI)和术中病灶探查在子宫内膜癌肌层浸润及盆腹腔淋巴结转移诊断中的临床应用价值。方法回顾性分析上海交通大学附属第九人民医院2010年1月至2014年3月收治的33例行全子宫+双侧附件切除术+盆腔及腹主动脉旁淋巴清扫术的子宫内膜癌患者临床资料,以手术病理诊断为标准,比较术前MRI检查、术中病灶探查在诊断肿瘤侵犯子宫肌层深度和淋巴结转移的符合率。结果 MRI检查发现有肌层浸润33例,其中浅肌层浸润8例,深肌层浸润25例;术中剖视子宫标本发现有肌层浸润33例,其中浅肌层浸润6例,深肌层浸润27例。术后病理结果浅肌层浸润6例,深肌层浸润27例。提示MRI诊断浅肌层浸润敏感度100.00%,特异度92.59%。诊断深肌层浸润敏感度92.59%,特异度100.00%;术中病灶剖视诊断深浅肌层浸润敏感度和特异度均为100.00%。33例患者中经病理组织学确诊,8例患者出现淋巴转移,其中仅有盆腔淋巴结转移4例,盆腔及腹主动脉旁淋巴结转移2例,仅有腹主动脉旁淋巴结转移2例;33例患者术前MRI检查提示2例淋巴结转移,漏诊6例,MRI诊断淋巴结转移的敏感度25%;病灶探查发现4例盆腔淋巴结肿大(病理证实2例阳性,2例阴性),2例腹主动脉旁淋巴结肿大(1例阳性,1例阴性)。3例患者因淋巴结转移分期升级,术后需要辅以化疗和(或)放疗。结论子宫内膜癌患者术前MRI检查对判断肌层浸润深度准确率较高,手术中子宫标本的剖视与病理组织学检查相同,具有重要价值;而MRI检查和术中淋巴结探查对判断子宫内膜癌患者淋巴结转移的意义不大。盆腔及腹主动脉旁(至肾静脉水平)淋巴清扫可以使手术病理分期更准确,为患者术后提供更合理的治疗指导。Objective To study the clinical value of MRI and intraoperative exploration in the diagnosis of myometrial infiltration and lymph node metastasis of endometrial carcinoma.Methods Thirty-three patients diagnosed histopathologically with endometrial carcinoma, who underwent preoperative MRI and eradicative operation with pelvic and para-aortic lymphadenectomy in Shanghai 9th People＇s Hospital from Jan 2010 to March 2014, were retrospectively studied. Preoperative MRI results and intraoperative explorational findings for assessment of myometria] infiltration and lymph node matestesis were rectified according to postoperative histopathology.Results Myometrial infiltration of 33 cases were all found by MRI （superficial infiltration in 8 cases, deep infiltration in 25 cases）. Intraoperative section of the uterus showed that myometrial infiltration was found in all 33 cases （superficial infiltration in 6 cases, deep infiltration in 27 cases）. The fact was that 6 cases were proved histopathologically to be superficial myometrial infiltration, and27 cases to be deep myometrial infiltration. This showed that the sensitivity and specificity of MRI in diagnosing superficial myometrial infiltration were respectively 100.00% and 92.59%, and in diagnosing deep myometrial infiltration they bwere respectively 92.59% and 100.00%. And the sensitivity and specificity of observation of uterine section in diagnosing either superficial or deep myometrial infiltration were both 100.00%. Among 33 cases,there were histopathologically 8 with lymph nodes metastasis （mere pelvic metastasis in 4 patients, both pelvic and para-aortic metastasis in 2, and only para-aortic metastasis in 2）.Two of 33 patients were found to have enlarged lymph nodes suspicious of lymphatical metastasis by preoperative MRI,and 6 cases were missed. Enlarged pelvic lymph nodes were found in 4 cases during the operation, and only 2 cases were proved to be metastatic lesion. Enlarged para-aortic lymph nodes were found in 2 cases, and only one case was pro

关 键 词：子宫内膜癌 磁共振成像 淋巴结转移 肿瘤浸润 

分 类 号：R737.3[医药卫生—肿瘤]