宫腔镜检查诊断子宫内膜癌的价值及其与腹腔冲洗液细胞学、预后关系的meta分析  

The risk of hysteroscopy in patients with endometrial cancer: a meta analysis

作　　者：沈艳[1] 罗攀 肖诚瑀 廉然芳 武静[1] 汪宏波[1] Shen Yan;Luo Pan;Xiao Chengyu(Wuhan Union Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 43002)

机构地区：[1]华中科技大学同济医学院附属协和医院体检中心,武汉430022

出　　处：《现代妇产科进展》2018年第7期526-530,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨宫腔镜检查在子宫内膜癌患者中的诊断价值,分析其是否增加子宫内膜癌细胞的腹腔内播散及对患者临床结局的影响。方法:计算机检索Pubmed、Web of science、Elsevier、CNKI等数据库,搜集子宫内膜癌患者术前进行和未进行宫腔镜检查的随机对照或病例对照实验。采用Rev Man 5.3及Stata12.0软件进行Meta分析。结果:共纳入22篇文献,共7127例子宫内膜癌患者。Meta分析结果显示,子宫内膜癌患者术前行宫腔镜检查组与未行宫腔镜检查组比较,不增加患者癌细胞腹腔内播散的风险(OR=1.61,95%CI为0.94~1.43,P=0.18)。宫腔镜检查组中,腹腔冲洗液细胞学阳性率与采用的膨宫介质相关,液体膨宫介质增加腹腔冲洗液肿瘤细胞阳性率,且使用盐水时最显著(OR=1.54,95%CI为1.08~2.19,P=0.02)。对3篇文献合并分析两组的5年总存活率及无病生存率,HR分别为1.28(0.75~2.17)和1.17(0.63~2.15)。结论:子宫内膜癌患者术前行宫腔镜检查能提高诊断准确性,且不增加癌细胞的腹腔内播散,亦无证据表明宫腔镜检查可导致不良临床结局,是较理想的检测手段;盐水等液体介质是腹腔冲洗液细胞学阳性的高危因素之一,应慎用。Objective： To investigate the diagnosis value of hysteroscopy on patients with endometrial cancer,to analyze whether hysteroscopy increase the risk for peritoneal dissemination of cancer cells and the effect of hysteroscopy on disease prognosis. Methods： Literature search through Pubmed,Web of science,Elsevier and CNKI databases for controlled clinical trials（ random control,case control） in patients with endometrial cancer who diagnosed by hysteroscopy or nonhysteroscopy before surgery.Rev Man 5.3 and Stata 12.0 were used for meta-analysis. Results： 22 trials about 7127 patients were included in the meta-analysis. The results showed that hysteroscopy before surgery compared with no hysteroscopy,it didn ＇t increase the risk for peritoneal dissemination of cancer cells（ OR = 1. 61,95% CI 0. 94 ~ 1. 43,P = 0. 18）. In hysteroscopy group,peritoneal washings cytology positive rates related to expanding medium,it could increase the positive rate of ascites cytology when a liquid medium was used as distention medium,especially saline was used（ OR = 1.54,95% CI 1.08 ~ 2.19,P = 0.02）. Three trials calculated for 5 yeras overall survival（ OS） and disease free survival（ DFS） separately,the HR were 1. 28（ 0. 75,2. 17） and 1. 17（ 0. 63,2. 15）. Conclusions： Hysteroscopy before surgery in women with endometrial cancer can improved the diagnostic accuracy,and do not appear to increase peritoneal tumor cell dissemination. For now,there is no evidence to state clearly that hysteroscopy before surgery can cause a worse clinical outcome,it can be an effective detection means; since saline can be a high risk factors for peritoneal dissemination of cancer cells,it should be reconsidered when use it.

关 键 词：宫腔镜 子宫内膜癌 诊断 腹腔冲洗液 肿瘤细胞学 临床结局 

分 类 号：R737.33[医药卫生—肿瘤]