本文關(guān)鍵詞： 子宮內(nèi)膜不典型增生 病理升級 高危因素　出處：《大連醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：回顧性分析98例子宮內(nèi)膜不典型增生患者的臨床病例資料，評價診斷性刮宮、宮腔鏡下定點活檢及術(shù)中冰凍病理的診斷價值；分析漏診原因；探尋可以預測子宮內(nèi)膜不典型增生升級的高危因素。 材料和方法：選取2003年01月01日-2013年12月31日因子宮內(nèi)膜不典型增生在大連醫(yī)科大學附屬第一醫(yī)院婦科接受子宮切除術(shù)的98例患者的臨床資料進行回顧性分析。比較入組病例術(shù)前病理、術(shù)中冰凍以及術(shù)后石蠟病理結(jié)果，總體評估診斷性刮宮與宮腔鏡下定點活檢及術(shù)中冰凍病理在子宮內(nèi)膜不典型增生診斷中的價值；根據(jù)術(shù)后石蠟切片病理結(jié)果將病例分為非子宮內(nèi)膜癌組和子宮內(nèi)膜癌組，比較兩組病例的年齡、絕經(jīng)狀態(tài)、體重指數(shù)（BMI）、生育情況、合并癥（高血壓、糖尿病、其他惡性腫瘤史）、臨床表現(xiàn)、腫瘤標記物（血清CA125）、超聲提示子宮內(nèi)膜厚度及血流情況等相關(guān)因素，探尋可以預測EAH患者中升級為子宮內(nèi)膜癌的高危因素。 統(tǒng)計方法：采用SPSSl7．0統(tǒng)計學軟件進行數(shù)據(jù)分析，PO.05有統(tǒng)計學意義。 結(jié)果： 1.入組的98例病例中，術(shù)后石蠟切片病理證實仍為子宮內(nèi)膜不典型增生的有61例（62.24%）；升級為子宮內(nèi)膜癌的有37例（37.76%），其中36例為子宮內(nèi)膜樣腺癌，1例合并鱗癌成分。Ia期病例約占81.08%（30/37）；Ib期病例約占5.41%（2/37）；II期病例約占5.41%（2/37）；III期病例約占8.11%（3/37）。高分化癌約占72.97%（27/37），中分化癌約占21.62%（8/37），低分化癌約占5.41%（2/37）。 2.術(shù)后石蠟切片病理診斷與術(shù)前不典型增生分度有關(guān)，隨著EAH分度的增加，升級為子宮內(nèi)膜癌也有增加趨勢。輕、中、重度不典型增生中升級為子宮內(nèi)膜癌的概率分別為：11.76%（2/17）、10.53%（4/38）、80%（28/35）。 3.診斷性刮宮與宮腔鏡下定點活檢對子宮內(nèi)膜不典型增生病例手術(shù)前后病理的診斷符合率分別為61.84%（47/76），63.64%（14/22）；兩組子宮內(nèi)膜癌的漏診率分別為38.16%（29/76），36.36%（8/22）。 4.術(shù)中冰凍病理對子宮內(nèi)膜癌診斷的敏感性為63.64％，特異性65％，陽性預測值66.67％，陰性預測值61.9％，總準確率為64.29%。術(shù)中冰凍病理對子宮內(nèi)膜癌的漏診率為36.36%。 5.單因素分析：絕經(jīng)、肥胖、超聲提示子宮內(nèi)膜增厚及血流情況等參數(shù)對預測子宮內(nèi)膜不典型增生病例升級為子宮內(nèi)膜癌有統(tǒng)計學意義；多因素Logistic回歸分析后僅肥胖、超聲提示內(nèi)膜血流豐富有統(tǒng)計學意義。 結(jié)論： 1.術(shù)前診斷為EAH，而術(shù)后石蠟切片病理證實為子宮內(nèi)膜癌的患者，絕大多數(shù)為早期、分化程度較好的子宮內(nèi)摸樣腺癌； 2.隨著術(shù)前EAH分度的增加，術(shù)后石蠟病理診斷升級為子宮內(nèi)膜癌有增加趨勢； 3.術(shù)前用診斷性刮宮、宮腔鏡下定點活檢病理以及術(shù)中冰凍病理對子宮內(nèi)膜癌的診斷，均存在一定的假陰性，需謹慎對待； 4.伴有肥胖的EAH患者，如果超聲提示內(nèi)膜血流較豐富，，應高度警惕有升級為子宮內(nèi)膜癌的可能。
[Abstract]:Objective: to retrospectively analyze the clinical data of 98 cases of endometrial atypical hyperplasia and evaluate the diagnostic value of uterine curettage, hysteroscopic fixed point biopsy and intraoperative frozen pathology. Analyze the causes of missed diagnosis; To explore the risk factors for predicting the progression of endometrial atypical hyperplasia. Materials and methods:. Clinical data of 98 patients undergoing hysterectomy in the first affiliated Hospital of Dalian Medical University from January 1st 2003 to December 31st 2013 due to atypical hyperplasia of endometrium were selected. Retrospective analysis. The preoperative pathology of the patients was compared. The clinical value of intraoperative frozen and paraffin paraffin pathological findings, diagnostic curettage and hysteroscopic biopsy, and intraoperative frozen pathology in the diagnosis of endometrial atypical hyperplasia were evaluated. According to the pathological results of paraffin section, the patients were divided into two groups: non-endometrial carcinoma group and endometrial carcinoma group. The age, menopausal status, body mass index (BMI), fertility status, complications (hypertension) were compared between the two groups. Diabetes, other malignant tumor history, clinical manifestations, tumor markers (serum CA125), ultrasound to indicate endometrial thickness and blood flow and other related factors. To explore the risk factors for progression to endometrial carcinoma in EAH patients. Statistical methods: SPSSl7.0 statistical software was used to analyze the data of PO.05 with statistical significance. Results: 1. Among the 98 cases in the group, 61 cases were confirmed as atypical hyperplasia of endometrium by paraffin section after operation. 37 cases of endometrial carcinoma were upgraded to endometrial carcinoma, of which 36 cases were endometrial adenocarcinoma and 1 case was complicated with squamous cell carcinoma. The proportion of Ib cases was about 5.41 / 37; The proportion of stage II cases was about 5.41 / 37; Cases of III accounted for about 8.11 / 37, well-differentiated carcinoma accounted for about 72.97 / 37 and moderately differentiated cancer accounted for 21.62 / 837). Poorly differentiated cancer accounts for about 5.41 / 37. 2.The pathological diagnosis of paraffin section after operation is related to the degree of atypical hyperplasia before operation. With the increase of EAH grade, there is an increasing tendency to upgrade to endometrial carcinoma. The odds of progression to endometrial cancer in severe dysplasia are as follows: 11. 76 / 17 / 10. 53, 10 / 4 / 38 / 80 / 35. 3. Diagnostic curettage and hysteroscopic biopsy for atypical hyperplasia of endometrium before and after operation, the diagnostic coincidence rate was 61.84 / 47 / 76, respectively. 63.64 / 22; The rate of missed diagnosis for endometrial carcinoma in the two groups was 38.16 / 29 / 76 / 36.36 / 32. 36%, respectively. 4. The sensitivity of intraoperative frozen pathology to the diagnosis of endometrial carcinoma was 63.64, the specificity was 65, the positive predictive value was 66.67, and the negative predictive value was 61.9%. The total accuracy was 64.29.The rate of missed diagnosis of endometrial carcinoma by intraoperative frozen pathology was 36.36. 5. Univariate analysis: the parameters of menopause, obesity, ultrasound indicating endometrial thickening and blood flow were statistically significant in predicting endometrial atypical hyperplasia to endometrial carcinoma. Multiple factor Logistic regression analysis was only obesity, ultrasound showed that the intimal blood flow was significant. Conclusion: 1. EAH was diagnosed preoperatively, and the majority of patients with endometrial carcinoma confirmed by paraffin section after operation were early and well-differentiated intrauterine stromal adenocarcinoma. 2. With the increase of preoperative EAH, postoperative paraffin wax pathological diagnosis of endometrial carcinoma has an increasing trend; 3. The diagnosis of endometrial carcinoma with diagnostic curettage, hysteroscopy and intraoperative frozen pathology were all false negative and should be treated with caution. 4. Patients with EAH with obesity should be highly alert to the possibility of progression to endometrial carcinoma if ultrasound indicates that endometrial blood flow is abundant.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R713.4

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