本文選題：子宮內膜癌　切入點：SAP-I型子宮內膜細胞采集器　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景與目的:子宮內膜病變是一組以子宮內膜發(fā)生改變而導致的病變,在臨床上常見的有子宮內膜增生、子宮內膜息肉、子宮內膜不典型增生、子宮內膜癌。子宮內膜癌(Endometrial Carcinoma,EC)是一組源發(fā)于子宮內膜的上皮性惡性腫瘤。EC為女性常見的惡性腫瘤之一,占全身惡性腫瘤的7%,占生殖道惡性腫瘤20-30%。主要表現為不規(guī)則陰道流血及陰道排液,尤其是絕經后女性。近年來,隨著人們健康保健意識的提高、飲食及生活習慣的改變、老齡化人口的增加以及外源性激素濫用等因素,EC的發(fā)病率逐年呈上升趨勢,并且趨于年輕化。傳統的診斷“金標準”——分段診刮為盲目性取材,屬于有創(chuàng)性檢查,對患者的創(chuàng)傷較大,不適合進行重復操作,患者耐受性、依從性差,所以不適用于廣大人群的篩查。隨著EC發(fā)病率的升高,臨床醫(yī)生迫切需要一種簡單易行,患者耐受性、依從性較好,可以適用于大規(guī)模人群的篩查方法,這樣EC就可以得到早期發(fā)現、早期診斷、早期治療,從而改善患者的預后、提高生活質量。因此,本研究選取2015年9月至2016年11月因子宮內膜息肉、子宮肌瘤、子宮內膜不典型增生、子宮內膜癌等在吉林大學中日聯誼醫(yī)院行子宮內膜息肉切除術、子宮次全切除術及全子宮切除術患者共146例,在術前對所有患者進行子宮內膜細胞學檢查(Endometrial Cytological Test,ECT),分析對比細胞學檢查結果與術后組織病理學檢查結果,從而評價ECT篩查子宮內膜病變的臨床價值及應用前景。方法:選取2015年9月至2016年11月因子宮內膜息肉、子宮肌瘤、子宮內膜不典型增生、子宮內膜癌等在吉林大學中日聯誼醫(yī)院行宮腔鏡下子宮內膜息肉切除術、子宮次全切除術及全子宮切除術患者共146例。對患者從絕經狀態(tài)、子宮大小、子宮內膜厚度三個方面進行分組,其中未絕經患者101例、絕經患者45例;子宮孕3個月患者20例、子宮孕3個月患者126例;子宮內膜厚度1.2cm的患者48例、子宮內膜厚度1.2cm的患者98例。在術前對所有患者使用SAP-I型子宮內膜細胞采集器采集子宮內膜細胞,進行子宮內膜細胞學檢查。以趙健的子宮內膜細胞取材滿意標準作為評判標準,分析對比絕經狀態(tài)、子宮大小、子宮內膜厚度是否會影響SAP-I型子宮內膜細胞采集器的取材滿意度;以術后組織病理學結果為“金標準”,分析對比得出ECT篩查子宮內膜病變的靈敏度、特異度、陽性預測值及陰性預測值。本研究采用SPSS18.0統計軟件。計數資料采用χ2檢驗。以P0.05作為差別顯著性判斷標準。結果:1取材滿意度SAP-I型子宮內膜細胞采集器用于子宮內膜細胞采集的取材滿意度為94.52%(138/146)。1.1絕經狀態(tài)對取材滿意度的影響未絕經患者共101例,取材滿意者為96例;絕經患者共45例,取材滿意者為42例。絕經狀態(tài)對于SAP-I型子宮內膜細胞采集器取材滿意度的影響,差異無統計學意義(P0.05)。1.2子宮大小對取材滿意度的影響子宮孕3個月的患者共20例,取材滿意者為5例;子宮孕3個月的患者共126例,取材滿意者為123例。子宮大小對于SAP-I型子宮內膜細胞采集器取材滿意度的影響,差異有統計學意義(P0.05)。1.3子宮內膜厚度對取材滿意度的影響子宮內膜厚度1.2cm的患者共48例,取材滿意者為44例;子宮內膜厚度1.2cm的患者共98例,取材滿意者為94例。子宮內膜厚度對于SAP-I型子宮內膜細胞采集器取材滿意度的影響,差異無統計學意義(P0.05)。2 ECT診斷結果與術后病理組織學結果在146例患者中,去除取材不滿意的8例患者,對于取材滿意的138例患者進行子宮內膜細胞學檢查結果與術后組織病理學結果的對比分析,以術后組織病理學結果為診斷“金標準”。對比子宮內膜細胞學檢查結果與術后組織病理學檢查結果得出,ECT的診斷符合率為88.41%(122/138)。ECT篩查子宮內膜癌的靈敏度、特異度、假陰性率、假陽性率、陽性預測值、陰性預測值分別為97.22%、95.10%、2.78%、4.90%、87.50%、98.98%;ECT篩查子宮內膜良性病變的靈敏度、特異度、假陰性率、假陽性率、陽性預測值、陰性預測值分別為87.93%、96.25%、12.07%、3.75%、94.44%、91.67%。結論:1、SAP-I型子宮內膜細胞采集器采集子宮內膜細胞簡便易行,痛苦小,取材滿意度較高,證明該方法是可行的。2、SAP-I型子宮內膜細胞采集器采集子宮內膜細胞的取材滿意度不受絕經狀態(tài)、子宮內膜厚度的影響,但是受子宮大小的影響。3、子宮內膜細胞學檢查用于篩查子宮內膜病變有較高的診斷符合率、靈敏度及特異度,在篩查子宮內膜病變中具有一定的臨床價值。
[Abstract]:Background and objective: endometrial lesions are a group of endometrial changes caused by lesions in clinical common endometrial hyperplasia, endometrial polyps, endometrial atypical hyperplasia and endometrial cancer. Endometrial carcinoma (Endometrial Carcinoma EC) is a group of malignant epithelial tumors originated from.EC the endometrium is one of the most common malignant tumors in women, accounting for 7% of all malignant tumors, accounting for genital tract malignant tumor 20-30%. showed irregular vaginal bleeding and vaginal discharge, especially in postmenopausal women. In recent years, people with health care awareness, diet and lifestyle changes, the aging population and the increase of exogenous hormone abuse and other factors, the incidence of EC is rising year by year, and tend to be young. The traditional "gold standard" of diagnosis for blindness curettage specimens are invasive Check, large trauma to the patient, not suitable for repeated operation, patient tolerance, poor compliance, so the screening is not suitable in the crowd. With the increase of the incidence of EC, clinicians need a simple, patient tolerance, good compliance, screening method can be applied to large populations, such EC can be early detection, early diagnosis and early treatment, so as to improve the prognosis of patients, improve the quality of life. Therefore, this study from September 2015 to November 2016 due to endometrial polyps, uterine fibroids, endometrial atypical hyperplasia and endometrial carcinoma in China Japan Union Hospital of Jilin University for endometrial polyp resection of uterus total resection and total hysterectomy for patients with a total of 146 cases of endometrial cytology for all patients in the preoperative (Endometrial Cytological, Test, ECT), comparative analysis of cells Examination results and postoperative pathological examination results, and evaluation of ECT screening of endometrial lesions of the clinical value and application prospect. Methods: from September 2015 to November 2016 due to endometrial polyps, uterine fibroids, endometrial atypical hyperplasia and endometrial carcinoma in China Japan Union Hospital of Jilin University underwent hysteroscopic resection of endometrial polyps, subtotal hysterectomy and total hysterectomy in patients with a total of 146 cases of patients with menopausal status. From three aspects, the size of uterus, endometrial thickness were divided into two groups, including 101 cases of premenopausal patients, 45 patients with vast uterine pregnancy patients 3 months; 20 cases of uterine pregnancy, 3 months in 126 cases; 48 cases of patients with endometrial thickness 1.2cm, 98 cases of patients with endometrial thickness 1.2cm. Before surgery for all patients with type SAP-I endometrial cells acquisition endometrial cells, endometrial fine Cellular pathology. In endometrial cells of Zhao Jian were satisfactory standards as evaluation criteria, analysis of uterine size comparison, menopausal status, whether endometrial thickness would take satisfaction effect of type SAP-I endometrial cell collection; the postoperative histopathologic results as the "gold standard", the sensitivity analysis and comparison of ECT screening for endometrial in the specificity, positive predictive value and negative predictive value. This study uses SPSS18.0 statistical software. Enumeration data with 2 test. With P0.05 as the difference significant criteria. Results: 1 were satisfaction type SAP-I endometrial cell collector for endometrial cells collected from satisfaction was 94.52% (138/146).1.1 menopausal status influence based on the satisfaction of premenopausal patients with a total of 101 cases were satisfactory in 96 cases; menopause patients with a total of 45 cases were satisfactory in 42 cases. The menopausal status in SAP-I Effect of endometrial cell collector material satisfaction, there was no statistically significant difference (P0.05).1.2 uterine size effect on material satisfaction uterine pregnancy 3 months a total of 20 patients were satisfactory in 5 cases of uterine pregnancy; 3 months a total of 126 patients were satisfactory in 123 cases. The effect of the size of the uterus type SAP-I endometrial cell collector material satisfaction, the difference was statistically significant (P0.05).1.3 endometrial thickness effect on the material satisfaction of endometrial thickness in 1.2cm patients with a total of 48 cases were satisfactory in 44 cases; the thickness of endometrium of 1.2cm patients with a total of 98 cases were satisfactory in 94 cases of endometrial thickness. For type SAP-I endometrial cell collector material satisfaction, there was no statistically significant difference (P0.05).2 ECT diagnosis and postoperative pathological results in 146 patients, 8 cases were not satisfied with the removal of patients, Comparative analysis of 138 cases were satisfactory for patients with uterine endometrial biopsy results and postoperative pathological results, postoperative histopathologic results in the "gold standard" for diagnosis. The results of endometrial biopsy and postoperative pathological examination results, ECT diagnosis coincidence rate was 88.41% (122/138.ECT) the sensitivity of screening for endometrial cancer specificity, false negative rate, false positive rate, positive predictive value, negative predictive value were 97.22%, 95.10%, 2.78%, 4.90%, 87.50%, 98.98%; the sensitivity of ECT screening for endometrial benign lesions specificity, false negative rate, false positive rate, positive predictive value, negative predictive value were 87.93%, 96.25%, 12.07%, 3.75%, 94.44%, 1, 91.67%.. Conclusion: SAP-I type endometrial cell acquisition of endometrial cells is simple, less pain, the degree of satisfaction is high, prove that the method is feasible The.2 type SAP-I endometrial cells acquisition of endometrial cells were not affected by satisfaction of menopausal status, endometrial thickness, but influenced by the size of uterine.3, endometrial cytology for diagnosis coincidence rate of screening for endometrial lesions have high sensitivity and specificity, and has certain clinical value in screening of uterus endometrial lesions.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33;R711.74

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