应用子宫内膜细胞采集器获取微量子宫内膜组织行组织病理学诊断的临床分析  

Clinical analysis of histopathology diagnosis of micro endometrial tissues obtained by endometrial cell collector

作　　者：任玲[1] 王海燕[2] 魏媛[1] 杨静[1] 周健[2] Ren Ling Wang Haiyan Wei Yuan Yang Jing Zhou Jian(Treatment ＆ Diagnosis Center of Cervical Diseases, Xuzhou Women ＆ Children＇s Healthcare Hospital, Jiangsu Xuzhou 221009, China)

机构地区：[1]江苏省徐州市妇幼保健院宫颈疾病诊治中心,221009 [2]9江苏省徐州市妇幼保健院妇科,22100

出　　处：《中国医师进修杂志》2016年第11期1016-1020,共5页Chinese Journal of Postgraduates of Medicine

基　　金：除州市科学技术局社会发展项目（KC14SH043）

摘　　要：目的：评价应用子宫内膜细胞采集器（净优）获取微量子宫内膜组织行组织病理学诊断的可行性及其应用范围。方法对193例需排除子宫内膜病变的患者均先以净优获取子宫内膜组织，后行宫腔镜下全面诊刮，分别行组织病理学诊断，分析比较两者的取材满意率及诊断符合率等。结果宫腔镜诊刮标本满意率为95.85%（185/193），8例不满意标本均为组织过少。净优取材标本满意率为82.38%（159/193），不满意标本34例，10例擦痕不能遍布整个宫腔，24例标本组织学质量为差。净优取材组织学质量为差的患者子宫内膜厚度明显小于取材满意患者[（0.64±0.18）cm比（0.97±0.43）cm]，差异有统计学意义（P＜0.05）。净优与宫腔镜诊刮病理诊断符合率为79.87%（127/159），净优诊断敏感度由高到低依次为正常月经期子宫内膜94.19%（81/86）、子宫内膜癌/不典型增生70.00%（7/10）、子宫内膜增殖症67.86%（38/56）、子宫内膜息肉14.29%（1/7）。净优漏诊2例子宫内膜癌，4例子宫内膜不典型增生，漏诊高级别子宫内膜病变的比率为6/16，所有漏诊病例均为采集组织过少，且其中4例内膜不典型增生患者均为保守治疗多次诊刮后。结论应用净优可取到微量子宫内膜组织，行组织病理学诊断的结果与宫腔镜诊刮结果一致性较好；当采集器全面采集到宫腔标本时，能较准确地筛查出子宫内膜癌/不典型增生；对子宫内膜不典型增生保守治疗多次诊刮后、内膜菲薄、超声高度怀疑子宫内膜息肉者不建议应用净优取材；当净优采集标本不满意时应行宫腔镜检查以免漏诊高级别子宫内膜病变。Objective To evaluate the feasibility and application of histopathology diagnosis of endometrial tissues obtained by endometrial cell collector （Jingyou, SAP-1）. Methods One hundred and ninety-three patients whose endometrial lesions should be excluded were selected. First, endometrial tissue were obtained from the patients by Jingyou, then they underwent comprehensive curettage under hysteroscopy. The histopathology diagnosis was performed respectively. The specimen satisfaction rate and diagnostic accuracy was analyzed and compared. Results The specimen satisfaction rate of curettage under hysteroscopy was 95.85%（185/193）. The specimens of 8 cases were not satisfied because the tissues were not enough. The specimen satisfaction rate of Jingyou was 82.38% （159/193）. The specimens of 34 cases were not satisfied, among whom in 10 cases scratches did not throughout the whole palace antrum, and in 24 cases tissues quality were poor. The endometrial thickness in unsatisfactory specimen by Jinyou was significantly thinner than that in satisfactory specimen：（0.64 ± 0.18） cm vs. （0.97 ± 0.43） cm, and there was statistical difference （P〈0.05）. The diagnostic accordance rate between Jingyou and curettage under hysteroscopy was 79.87%（127/159）. The sensitivity of Jingyou from high to low was 94.19% （81/86） in normal menstrual endometrial, 7/10 in endometrial carcinoma/ atypical hyperplasia, 67.86%（38/56） in endometrial hyperplasia and 1/7 in endometrial polyps. Missed diagnosis of jingyou inluded 2 cases of endometrial carcinoma and 4 cases of endometrial atypical hyperplasia. The misdiagnosed rate of high grade endometrial lesions was 6/16, and the patients were misdiagnosed because the tissues were not enough. Four cases of endometrial atypical hyperplasia had underwent conservative treatment of repeated curettage. Conclusions Application of Jingyou can obtain micro endometrial tissues, and the accordance rate of histopathology diagnosis is high with curettage under hysteroscopy.

关 键 词：活组织检查 病理学 子宫内膜细胞采集器 筛查 

分 类 号：R737.33[医药卫生—肿瘤]