【摘要】：目的： 評(píng)價(jià)宮腔鏡檢下診刮術(shù)在術(shù)前診斷子宮內(nèi)膜癌應(yīng)用價(jià)值，以及能否將腹腔沖洗液的陽(yáng)性率增加。 方法： 收集大連醫(yī)科大學(xué)附屬第一、二醫(yī)院中2010年1月-2013年12月的4年間收治的經(jīng)手術(shù)治療、術(shù)后病理證實(shí)為子宮內(nèi)膜癌并且資料完整的患者190例。對(duì)其進(jìn)行回顧性分析，并將患者根據(jù)術(shù)前確診方法的不同分為宮腔鏡下的診刮術(shù)組（A組）92例、單純?cè)\刮術(shù)組（B組）98例；宮腔鏡下診刮術(shù)組年齡32-72歲，平均(50.9±8.7)歲，單純?cè)\刮術(shù)組年齡35-73歲，平均(52.6±10.2)歲，比較兩組手術(shù)前后的臨床分期、病理組織學(xué)類型、組織學(xué)分級(jí)、宮頸受累情況、腹腔沖洗液細(xì)胞學(xué)檢查并對(duì)腹腔沖洗液陽(yáng)性的影響因素進(jìn)行了分析。 結(jié)果： 1.A組92例患者中只有2例手術(shù)前后病理類型診斷有所不同，，符合率為97.8%（90/92）；B組98例中，15例患者手術(shù)前后的病理類型診斷不同，符合率為84.7%（83/98），兩組進(jìn)行比較，統(tǒng)計(jì)學(xué)存在顯著性差異（P0.01）。 2.A組（90例術(shù)前進(jìn)行臨床分期）手術(shù)前后診斷臨床分期的總符合率為95.6%（86/90）,B組（92例術(shù)前進(jìn)行臨床分期）臨床分期的總符合率為77.2%(71/92)，兩組相比較，差異存在顯著性（P0.01）。 3.A組28例患者術(shù)前進(jìn)行組織學(xué)分級(jí)，B組42例患者術(shù)前進(jìn)行組織學(xué)分級(jí)，兩者在手術(shù)前后組織學(xué)分級(jí)的總符合率為78.6%和73.8%，差異沒(méi)有統(tǒng)計(jì)學(xué)意義（P0.05）。 4.A組于手術(shù)前后病理診斷宮頸受累的靈敏度、陽(yáng)性及陰性預(yù)測(cè)值、符合率分別為79.3%、100%及91.3%、93.5%,，B組分別為55.6%、45.5%及89.5%、79.6%。兩組進(jìn)行比較分析，A組陽(yáng)性預(yù)測(cè)值和符合率均明顯高于B組，且兩者之間存在顯著性差異(P0.05)。 5.A組患者的腹腔沖洗液中找到癌細(xì)胞的陽(yáng)性率為23.9%(22/92），比B組陽(yáng)性率20.4%（20/98）略高,但兩者之間差異不存在統(tǒng)計(jì)學(xué)意義（P0.05）。 6.子宮內(nèi)膜癌腹腔沖洗液陽(yáng)性與手術(shù)-病理分期之間的關(guān)系，分期晚（Ⅱ-Ⅲ期）的陽(yáng)性率為34%（17/50），比分期早（Ⅰ期）的陽(yáng)性率17.9%（25/140）明顯升高，且統(tǒng)計(jì)學(xué)存在顯著性差異（P0.05）；但其與病理學(xué)類型、分級(jí)以及對(duì)肌層侵襲的深度等均沒(méi)有差異存在（P0.05）。 結(jié)論： 1.宮腔鏡檢下診刮術(shù)在術(shù)前對(duì)子宮內(nèi)膜癌的病理類型、臨床分期的診斷具有較高準(zhǔn)確率，且能對(duì)宮頸侵及情況做出準(zhǔn)確的判斷。 2.宮腔鏡檢下診刮術(shù)在術(shù)前診斷子宮內(nèi)膜癌組織學(xué)分級(jí)的精確性與單純?cè)\刮術(shù)相比無(wú)明顯差異。 3.宮腔鏡手術(shù)并沒(méi)有增加腹腔沖洗液的陽(yáng)性率。 4.腹腔沖洗液陽(yáng)性率的增加與手術(shù)-病理分期有關(guān)系，而與癌組織對(duì)肌層的浸潤(rùn)深度、癌組織的分類及癌細(xì)胞分化級(jí)別等之間沒(méi)有相關(guān)性。
[Abstract]:Objective: to evaluate the value of hysteroscopic curettage in the preoperative diagnosis of endometrial carcinoma and whether the positive rate of peritoneal lavage can be increased. Methods: 190 patients with endometrial carcinoma proved pathologically by operation from January 2010 to December 2013 in the first and second affiliated hospitals of Dalian Medical University were collected. The patients were divided into hysteroscopic curettage group (group A, n = 92) and simple curettage group (group B, n = 98). The age of hysteroscopic curettage group was 32-72 years old (mean 50.9 鹵8.7) years, and that of simple curettage group was 35-73 years old (mean 52.6 鹵10.2 years). The clinical stages and histopathological types of the two groups before and after operation were compared. Histological grade, cervical involvement and cytological examination of celiac lavage fluid were analyzed. Results: 1. In group A, only 2 of 92 patients were diagnosed differently before and after operation, the coincidence rate was 97.8% (90 / 92). In group B, the pathological types of 15 patients were different before and after operation, the coincidence rate was 84.7% (83 / 98). There was significant difference between the two groups (P0.01). 2.The total coincidence rate of clinical staging before and after operation in group A (90 cases with preoperative clinical staging) was 95.6% (86 / 90), B) (92 cases with preoperative clinical staging) was 77.2% (71 / 92). There was significant difference between the two groups (P 0.01). 3. Histological grading was performed in 28 cases of group A and 42 cases of group B before operation. The total coincidence rates of histological grading before and after operation were 78.6% and 73.8%, respectively. The difference was not statistically significant (P0.05). 4. The sensitivity, positive and negative predictive values of pathological diagnosis of cervical involvement in group A before and after operation were 79.30.100% and 91.3393.5%, respectively. In group B, they were 55.655% and 89.5%, respectively. 79.6am. The positive predictive value and coincidence rate of group A were significantly higher than that of group B, and there was significant difference between the two groups (P0.05). 5.The positive rate of cancer cells found in peritoneal lavage fluid of group A was 23.9% (22 / 92), which was slightly higher than that of group B (20.4%) (20 / 98), but there was no significant difference between the two groups (P0.05). 6. The positive rate of abdominal lavage fluid in endometrial carcinoma was 34% (17 / 50) late in stage 鈪

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