子宫内膜增生患者术后诊断为子宫内膜癌的危险因素探讨  

An analysis of the risk factor of endometrial carcinoma in postoperative patients with endometrial hyperplasia

作　　者：任王静 刘娟[2] 闵爱萍[1] 万晓丽[1] 吴羽[1] 夏秀英[1] 罗晓[1] 

机构地区：[1]乐山市人民医院妇产科,614000 [2]乐山市人民医院肿瘤科,614000

出　　处：《妇产与遗传（电子版）》2017年第3期20-24,共5页Obstetrics-Gynecology and Genetics (Electronic Edition)

摘　　要：目的探讨子宫内膜增生患者术后诊断为子宫内膜癌的临床危险因素。方法选择2014年4月至2017年5月在乐山市人民医院妇产科住院、术前诊断为EH且接受子宫切除术或子宫内膜电切术的76例患者作为研究对象,统计分析年龄、BMI、诊刮病理类型、术中冰冻切片病检结果、术后病检结果等临床资料,对比子宫内膜癌组与非内膜癌组的上述临床指标差异。结果 76例EH患者有28例术后诊断为子宫内膜癌,其中38例增生不伴非典型性患者有10例术后诊断为子宫内膜癌(26.3%),38例非典型增生患者有18例术后诊断为子宫内膜癌(47.4%),差异无统计学意义(P>0.05);52例EH患者行术中冰冻切片病检,有25例最终诊断为子宫内膜癌,其中11例子宫内膜癌术中冰冻切片病检未检测出(44.0%);子宫内膜癌组与非子宫内膜癌组的年龄、BMI、诊刮病理类型等临床指标差异均无统计学意义(P>0.05)。结论年龄、BMI、初潮年龄、绝经状态等临床指标不能作为EH患者漏诊子宫内膜癌的危险因素;子宫内膜复杂性增生患者亦有可能存在较高的子宫内膜癌漏诊率;术中冰冻切片病检在鉴别EH与子宫内膜癌中的价值有限。Objective To investigate clinic-pathologic risk factors of endometrial carcinoma( EC) in postoperative patients with endometrial hyperplasia( EH). Methods Our study included 76 patients who were diagnosed preoperatively with EH,and received hysterectomy or transcervical resection of endometrium( TCRE) from April 2014 to May 2017 in the Department of Obstetrics and Gynecology of People's Hospital of Leshan City. The clinical data, including age, body mass index( BMI),pathological categories of diagnostic curettage,pathological findings of intraoperative frozen section,and postoperative pathological findings were retrospective analyzed and the differences in the above clinical indexes between EC group and non-EC group were compared. Results Of 76 EH patients,28 were diagnosed with EC after operation: 10 of 38( 26. 3%) hyperplasia without atypia patients were diagnosed with EC, while 18 of 38( 47. 4%) atypical hyperplasia patients were diagnosed with EC, with no significant difference( P > 0. 05). Intraoperative pathological examination of frozen section was performed in 52 EH patients,and 25 were eventually diagnosed with EC,of whom 11( 44. 0%) were not diagnosed with EC by intraoperative pathological examination of frozen section. There is no significant differences exist in the following clinical indexes,including age,BMI,pathological categories of diagnostic curettage etc, between EC group and non-EC group. Conclusions The clinical indexes,including age,BMI,age of menarche, and menopausal status etc. are not the risk factors of the missed diagnosis of EC in EH patients. High rate of missed diagnosis can also exist in the patients with complex hyperplasia. The intraoperative pathological examination of frozen section has limited value in differential diagnosis of EH and EC.

关 键 词：子宫内膜增生 子宫内膜癌 危险因素 

分 类 号：R737.33[医药卫生—肿瘤] R711.74[医药卫生—临床医学]