發(fā)布時間：2018-04-01 03:23

  本文選題：子宮內(nèi)膜不典型增生　切入點：子宮內(nèi)膜癌　出處：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:回顧性分析91例術(shù)前診斷為子宮內(nèi)膜不典型增生患者的臨床病理資料,預測術(shù)前子宮內(nèi)膜不典型增生患者發(fā)生術(shù)后隱匿癌的高危因素。方法:選取2007年1月1日至2016年12月31日期間因子宮內(nèi)膜不典型增生于大連醫(yī)科大學附屬第二醫(yī)院行子宮切除手術(shù)的91例患者的臨床病理資料。術(shù)前診斷為子宮內(nèi)膜不典型增生的方式分為診斷性刮宮術(shù)或?qū)m腔鏡直視下定點活檢術(shù)。根據(jù)術(shù)后石蠟切片病理結(jié)果將入組病例分為子宮內(nèi)膜不典型增生組(65例)和子宮內(nèi)膜癌組(26例),比較非癌組和癌組患者的年齡、絕經(jīng)狀態(tài)、身高體重、生育情況、合并高血壓或者糖尿病、惡性腫瘤病史、腫瘤家族史、臨床表現(xiàn)、病程、術(shù)前EAH分度、血清CA125值、子宮內(nèi)膜取材前盆腔超聲提示子宮內(nèi)膜厚度及血流情況等相關(guān)因素,探尋子宮內(nèi)膜不典型增生患者術(shù)后發(fā)生隱匿癌的高危因素。結(jié)果:1.以術(shù)后病理結(jié)果為依據(jù)將入組的91例患者分為子宮內(nèi)膜不典型增生組(非癌組)和子宮內(nèi)膜癌組(癌組),其中非癌組有65例,占71.43%;癌組有26例,占28.57%。發(fā)生的隱匿癌全為子宮內(nèi)膜樣腺癌。癌細胞高分化者(G1)有19例,占73.08%,中分化者(G2)有6例,占23.08%,低分化者(G3)有1例,占3.85%。隱匿癌中有20例是I a期,占76.92%,其中癌組織局限在子宮內(nèi)膜的有9例(34.62%)、淺肌層浸潤(1/2肌層)有11例(42.31%);4例是I b期,占15.38%;2例是II期,占7.69%。2.診斷性刮宮術(shù)診斷子宮內(nèi)膜不典型增生的準確率為70.00%、隱匿癌發(fā)生率為30.00%;宮腔鏡直視下定點活檢術(shù)診斷子宮內(nèi)膜不典型增生的準確率為76.19%、隱匿癌發(fā)生率為23.81%。診刮組和宮腔鏡組診斷子宮內(nèi)膜不典型增生的符合率和術(shù)后隱匿癌的發(fā)生率差異無明顯統(tǒng)計學意義。3.EAH患者術(shù)中行快速冰凍切片病理檢查,其診斷子宮內(nèi)膜癌的敏感性、特異性、陽性預測值、陰性預測值和總的診斷符合率分別為62.50%、70.59%、66.67%、66.67%和66.67%。4.絕經(jīng)狀態(tài)、BMI≥28kg/m~2、病程、術(shù)前EAH分度、子宮內(nèi)膜厚度、子宮內(nèi)膜血流情況進行單因素分析有統(tǒng)計學意義,將其行多因素Logistic回歸分析得出結(jié)論:BMI≥28kg/m~2、EAH分度及子宮內(nèi)膜血流豐富為子宮內(nèi)膜不典型增生發(fā)生術(shù)后隱匿癌的高危因素。結(jié)論:1.EAH患者切除子宮術(shù)后隱匿癌的發(fā)生率為28.57%,隱匿癌大多數(shù)為分化程度好的早期子宮內(nèi)膜腺癌;2.術(shù)前診斷性刮宮術(shù)和宮腔鏡直視下定點活檢術(shù)診斷Ec的漏診率分別為30.00%和23.81%,術(shù)中行快速冰凍切片病理檢查診斷Ec的符合率為66.67%,必要時需行其他輔助檢查提高診斷的準確率;3.肥胖(BMI≥28kg/m~2)、重度子宮內(nèi)膜不典型增生及子宮內(nèi)膜血流豐富為子宮內(nèi)膜不典型增生發(fā)生術(shù)后隱匿癌的高危因素。
[Abstract]:Objective: to retrospectively analyze the clinical and pathological data of 91 cases of endometrial atypical hyperplasia diagnosed before operation, and predict the high risk factors of occult carcinoma after operation in patients with atypical hyperplasia of endometrium.Methods: from January 1, 2007 to December 31, 2016, 91 patients with endometrial atypical hyperplasia underwent hysterectomy in the second affiliated Hospital of Dalian Medical University.Preoperative diagnosis of endometrial atypical hyperplasia can be divided into diagnostic curettage or hysteroscopy.According to the pathological results of paraffin section after operation, the patients were divided into two groups: 65 cases of atypical hyperplasia of endometrium and 26 cases of endometrial carcinoma. The age, menopausal status, height, weight, fertility of the patients in non-cancer group and cancer group were compared.Associated factors such as hypertension or diabetes, history of malignant tumor, family history of tumor, clinical manifestation, course of disease, preoperative EAH score, serum CA125 value, endometrial thickness and blood flow were revealed by pelvic ultrasound before endometrial sampling.To explore the risk factors of occult carcinoma in patients with atypical hyperplasia of endometrium after operation.The result is 1: 1.According to the postoperative pathological results, 91 patients were divided into two groups: atypical hyperplasia of endometrium (non-carcinoma group) and endometrial carcinoma group (cancer group), including 65 cases (71.43%) in non-cancer group and 26 cases (28.57%) in cancer group.All occult carcinomas are endometrial adenocarcinoma.There were 19 cases (73.08%) of cancer cells with high differentiation, 6 cases (23.08%) with moderate differentiation, and 1 case (3.85%) with low differentiation.Of them, 20 cases were stage I a (76.92%), of which 9 cases were located in endometrial tissue (34.62%), 11 cases had superficial muscle layer infiltrating 1 / 2 muscle layer (42.31 1%), 4 cases were stage I b, and 2 cases were stage II, accounting for 7.69.2%.The diagnostic accuracy of uterine curettage in the diagnosis of endometrial atypical hyperplasia was 70.00.The occult carcinoma rate was 30.00.The accuracy of hysteroscopy in diagnosing endometrial atypical hyperplasia was 76.19 and the occult cancer rate was 23.81.The accuracy of diagnosis of endometrial atypical hyperplasia by hysteroscopy was 76.19 and that of occult carcinoma was 23.81.There was no significant difference between the coincidence rate of diagnosis of atypical hyperplasia of endometrium and the incidence of occult carcinoma after operation. 3. The sensitivity and specificity of the diagnosis of endometrial carcinoma were detected by rapid frozen section pathological examination.The positive predictive value, the negative predictive value and the total diagnostic coincidence rate were 62.50% and 66.67%, 66.67% and 66.67%, respectively.In menopausal women, EAH 鈮，

本文編號：1693750