發(fā)布時間：2018-02-05 02:46

  本文關(guān)鍵詞： 子宮內(nèi)膜癌 MRI 手術(shù)-病理分期 肌層浸潤 宮頸間質(zhì)浸潤　出處：《河北醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：子宮內(nèi)膜癌是女性高發(fā)的惡性腫瘤之一，是生殖系統(tǒng)中常見的惡性腫瘤,它的發(fā)病率位于宮頸癌以后。2010年美國將近43470例子宮內(nèi)膜癌新發(fā)，約7950例因此而死亡。伴著現(xiàn)代生活水平的增高及婦女肥胖人數(shù)的增多，子宮內(nèi)膜癌的發(fā)生率也越來越高。已絕經(jīng)婦女所占比例最高（70%），然后是更年期婦女，5%婦女發(fā)病＜40歲。子宮內(nèi)膜癌的診斷的金標(biāo)準(zhǔn)為診刮術(shù)或?qū)m腔鏡內(nèi)膜活檢。治療前，如果能確定肌層浸潤深度、宮頸間質(zhì)是否浸潤、淋巴結(jié)是否轉(zhuǎn)移，對治療方案的選擇和評價預(yù)后起重要作用。磁共振成像（MRI）軟組織分辨率高，可多方位成像，是子宮內(nèi)膜癌術(shù)前分期診斷常用的影像學(xué)檢查手段，但對于其準(zhǔn)確性、特異性、靈敏性的研究結(jié)果各不相同。本研究使用FIGO2009年分期標(biāo)準(zhǔn)，通過比較我院94例子宮內(nèi)膜癌患者MRI分期和手術(shù)-病理分期的一致性，，分析MRI分期的準(zhǔn)確性，評價MRI分期對子宮內(nèi)膜癌的應(yīng)用價值。 方法：選取2010年1月至2013年1月河北醫(yī)科大學(xué)第四醫(yī)院婦科住院手術(shù)治療的子宮內(nèi)膜癌患者94例�；仡櫺苑治鏊x取的94例患者的病歷資料。94例病人均采用1.5TMRI進行檢查。94例病人分別做了T2WI和TlWI增強圖像和DWI圖像。由兩位資深醫(yī)師采用盲法進行閱片，依據(jù)FIGO2009年子宮內(nèi)膜癌分期標(biāo)準(zhǔn)得出MRI分期。若得出的兩個MRI分期結(jié)果不一致，則兩位醫(yī)師經(jīng)過討論后，從而最終得出MRI分期。得出的MRI分期與手術(shù)-病理分期比較，所有數(shù)據(jù)均采用SPSS13.0軟件進行統(tǒng)計學(xué)分析，判斷其一致性。同時得出MRI判斷深淺肌層浸潤、宮頸間質(zhì)浸潤、淋巴結(jié)轉(zhuǎn)移與否的準(zhǔn)確率、特異度、靈敏度。 結(jié)果：根據(jù)FIGO2009年分期標(biāo)準(zhǔn)，MRI分期與手術(shù)-病理分期進行一致性檢驗。結(jié)果為K=0.2947,z=3.7546,P＜0.05，有統(tǒng)計學(xué)意義。可以認(rèn)為子宮內(nèi)膜癌患者術(shù)前MRI分期與手術(shù)-病理分期結(jié)果具有一致性。一致性強度為中度(K=O．2947)。本研究結(jié)果顯示，MRI診斷子宮內(nèi)膜癌分期整體準(zhǔn)確率為88.3%（83/94）。MRI鑒別深淺肌層浸潤的準(zhǔn)確率、特異度、靈敏度分別為96.8%（91/94）、98.4%（62/63）、93.5%（29/31）。MRI鑒別宮頸間質(zhì)受累與否的準(zhǔn)確率、特異度、靈敏度分別為95.7%（90/94）、96%（48/50）、95.5%（42/44）。MRI診斷淋巴結(jié)轉(zhuǎn)移的準(zhǔn)確率、特異度、靈敏度分別為96.8%（91/94）、100%（87/87）、57.1%（4/7）。94例中僅1例病理報告顯示腸道粘膜受累（IV期），而術(shù)前MRI沒有檢測出來。 結(jié)論：MRI在鑒別子宮深淺肌層浸潤、宮頸間質(zhì)受累情況、淋巴結(jié)轉(zhuǎn)移與否的準(zhǔn)確率高、特異性強、靈敏度高，特別是在判斷前兩者時則更加明顯。臨床上，子宮內(nèi)膜癌患者入院后的檢查應(yīng)包括MRI檢查，它能夠為治療方案的選擇提供值得信賴的理論依據(jù)，值得臨床推廣使用。
[Abstract]:Objective: endometrial carcinoma is one of the most common malignant tumors in women and is a common malignant tumor in the reproductive system. In 2010, nearly 43470 new cases of endometrial cancer in the United States, about 7, 950 cases died as a result of the rise in modern living standards and increased obesity among women. The incidence of endometrial cancer is also increasing. Menopausal women have the highest percentage of women, followed by menopausal women. 5% Women are less than 40 years old. The gold standard for diagnosis of endometrial carcinoma is curettage or hysteroscopic endometrial biopsy. Before treatment, if the depth of myometrial invasion, cervical stroma infiltration and lymph node metastasis can be determined. MRI plays an important role in the selection of treatment regimen and the evaluation of prognosis. MRI has high soft tissue resolution and can be used in multi-directional imaging. MRI is a commonly used imaging method for preoperative staging diagnosis of endometrial carcinoma. However, the accuracy, specificity and sensitivity of the study results are different. This study uses the FIGO2009 annual staging standard. By comparing the consistency between MRI staging and operation-pathological staging in 94 patients with endometrial carcinoma in our hospital, the accuracy of MRI staging was analyzed and the application value of MRI staging in endometrial carcinoma was evaluated. Methods:. From January 2010 to January 2013, 94 cases of endometrial carcinoma treated by gynecological surgery in 4th Hospital of Hebei Medical University were selected. The medical records of 94 cases were retrospectively analyzed. All patients were examined with 1.5T MRI. 94 patients were performed T2WI and TlWI enhanced images and DWI images respectively. According to the FIGO2009 year endometrial carcinoma staging criteria, MRI staging. If the two MRI staging results are not consistent, then the two physicians after discussion. Finally, the MRI staging was obtained. The MRI staging was compared with the operation-pathological staging. All the data were statistically analyzed by SPSS13.0 software. At the same time, the accuracy, specificity and sensitivity of MRI in judging the invasion of myometrium, the interstitial invasion of cervix and lymph node metastasis were obtained. Results: according to the annual FIGO2009 staging standard, the consistency between MRI staging and operation-pathological staging was tested. The results were 0.2947 and 3.7546 (P < 0. 05). There is statistical significance. It can be considered that preoperative MRI staging is consistent with surgical and pathological staging in patients with endometrial carcinoma. The consistency intensity is moderate K0. 2947. The results of this study show that there is no significant difference between preoperative MRI staging and surgical and pathological staging in patients with endometrial carcinoma. The overall accuracy of MRI in the diagnosis of endometrial carcinoma staging was 88. 3 / 94. The accuracy, specificity and sensitivity of MRI in differentiating the invasion of deep and superficial myometrium were 96.881 / 94 respectively. The accuracy, specificity and sensitivity of MRI in differentiating cervical stroma from cervical stroma were 95.790 / 94. The accuracy, specificity and sensitivity of MRI in the diagnosis of lymph node metastasis were 96.881 / 94. Only one of the 94 patients with 87 / 87 / 57.1and 57.1% had a pathological report of intestinal mucosal involvement in stage IV, but MRI was not detected before operation. Conclusion the differential diagnosis of myometrium invasion, cervical stroma involvement, lymph node metastasis and lymph node metastasis is highly accurate, specific and sensitive. Clinical examination of endometrial carcinoma patients should include MRI examination, which can provide reliable theoretical basis for the choice of treatment options. It is worth popularizing in clinic.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33

【引證文獻】

相關(guān)期刊論文 前1條

1 王青月;賈振偉;朱艷霞;劉勝輝;許軍成;;彩色多普勒超聲、動態(tài)增強MRI在子宮內(nèi)膜癌術(shù)前分期診斷中的應(yīng)用[J];臨床合理用藥雜志;2015年31期

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