合并子宫腺肌病对子宫内膜癌诊断及预后的影响  

Influences of adenomyosis on diagnosis and prognosis of endometrial cancer

作　　者：薛艳[1] 杨雷[1] 曾宪玲[1] 王俊侠[1] 孟龄婷 朱克修[1] 

机构地区：[1]西安交通大学第一附属医院妇产科,陕西西安710061

出　　处：《中国妇幼健康研究》2016年第12期1509-1512,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的分析合并和未合并子宫腺肌病的子宫内膜癌患者的临床及病理特点,探讨合并子宫腺肌病对子宫内膜癌诊断及预后的影响。方法收集2009年1月至2015年12月于西安交通大学第一附属医院妇产科确诊的子宫内膜癌病例541例,将病理诊断中合并有子宫腺肌病的59例作为实验组,随机抽取未合并子宫腺肌病的220例作为对照组,回顾性比较两组的临床病理特征及检查结果。结果与对照组相比,实验组中子宫内膜癌患者分期早（Z=3.213,P=0.001）,分化好（Z=2.642,P=0.008）,差异具有统计学意义。实验组单纯诊刮的符合率较对照组低,但无统计学差异。实验组中B超诊断子宫内膜癌的比例较对照组显著降低（χ2=4.132,P=0.042）。两组病例中ER、PR、P53、Ki-67的表达无统计学差异（χ2值分别为0.257、1.573、1.601、0.641,均P〉0.05）。但在不同分型、分化程度、分期的子宫内膜癌患者中ER、PR、P53、Ki-67的表达均有统计学差异（χ2值2.203~30.630,均P〈0.05）,前两者与临床病理特征呈负相关,后两者呈正相关。结论合并子宫腺肌病的子宫内膜癌患者肿瘤的分期早、分化好,预后更好。但因其子宫增大、病灶局限,使得单纯诊刮的病理符合率降低,使诊断更为困难。因此对于多孕、多次流产的高危子宫内膜癌患者诊断时建议行宫腔镜下诊刮。此外,对子宫内膜癌患者的手术病理标本行免疫组化染色有助于判断其临床预后。Objective To investigate the impact of combined adenomyosis on the diagnosis and prognosis of endometrial cancer through retrospective analysis of clinic-pathologic features of endometrial cancer patients with or without adenomyosis. Methods Totally 541 cases of endometrial cancer diagnosed in the First Affiliated Hospital of Xi ＇an Jiaotong University from January 2009 to December 2015 were collected. Fifty-nine patients with adenomyosis confirmed in pathological examination were recruited in experimental group,and 220 patients without adenomyosis were randomly chosen in control group. Retrospective analysis was conducted in clinical and pathological features as well as examination results in two groups. Results Comprared to the control group,the pathological stage was early and differentiation was good in the experimental group with statistical significance（ Z value was 3. 213 and 2. 642,respectively,P value was0. 001 and 0. 008,respectively）. The accordance rate of simple curettage in the experimental group was lower than that in the control group,but no statistical difference was found. Furthermore,the proportion of B-ultrasound was significantly lower in the experimental group than in the control group（ χ2= 4. 132,P = 0. 042）. The expressions of ER,PR,P53 and Ki67 were not significantly different between two groups（ χ2value was 0. 257,1. 573,1. 601 and 0. 641,respectively,all P 〉0. 05）,but they were statistically different among patients with different types,differentiation and stage（ χ2value ranged 2. 203 to 30. 630,respectively,all P 〈0. 05）. ER and PR were negatively correlated with clinical and pathological features,but P53 and Ki67 were positively correlated. Conclusion Endometrial cancer patients with adenomyosis have the characteristics of early stage,low grade and favorable prognosis,but the positive rate of curettage is lower and thus diagnosis becomes more difficult because of enlargement of uterine cavity and localized foci. Therefore,hysteroscope curettage is recommended

关 键 词：子宫内膜癌 子宫腺肌病 诊断 预后 

分 类 号：R737.33[医药卫生—肿瘤]