摘要
目的探讨子宫内膜癌病理组织学差异原因及防范措施,以提高子宫内膜癌首诊准确率,正确选择治疗方式。方法回顾性分析2003年1月至2009年6月新疆医科大学附属肿瘤医院收治住院的361例子宫内膜癌患者的主要临床症状、诊断方式与方法、术前病理组织学诊断、病理分级等,分析手术前后病理组织诊断的复杂性、差异性。结果 (1)术前子宫内膜癌诊断符合率为80.3%,手术前后病理组织学诊断完全符合的诊断符合率为74.5%,203例子宫内膜癌患者手术前后病理组织学分级改变占43.3%,其中19.2%病理组织学分级升级;(2)同一个患者,只有一种病理组织学类型272例,有2种病理组织学类型77例,有3种病理组织学类型12例。(3)肿瘤专科医院病理切片会诊诊断符合率为92.5%,高于综合医院。(4)宫腔镜辅助下诊断性刮宫病理组织学诊断符合率为93.1%,但不增加腹水阳性率。(5)23例(6.4%)子宫内膜癌患者术前、术中误诊,手术方式选择不合适。结论规范正确的首诊过程是避免子宫内膜癌误诊的关键,宫腔镜下诊刮术可提高术前诊断符合率。
Objective To analyze the disagreement of pathology results and safeguard of endometrial carcinoma and improve the firstly accurate diagnosis so as to give the proper treatment and surgery.Methods 361 cases with endometrial carcinoma admitted from January 2003 to June 2009 were reviewed,and clinical symptoms,diagnostic schedule,pathologic diagnosis before operation,category of histology were summarized to analyze pathological disagreement before and after surgery.Results The concordance rate of pathologic diagnosis was 80.3% before operation,the preoperative and postoperative coincidence rate of pathologic diagnosis was 74.5%,43.3% tumor grade in 203 cases with endometrial carcinoma was changed and 19.2% tumor grade was downgraded..Among 361 endometrial carcinoma cases,272 cases had one kind of pathologic diagnosis,77 cases had two kinds of pathologic diagnosis,12 cases had three kinds of pathologic diagnosis.The coincidence rate of pathologic consultant in oncology hospital was 92.5%,and was significantly higher than that in other hospitals.The coincidence rate of hysteroscopy assisted curettage was 93.1% and hysteroscopy did not increase the rate of positive peritoneal cytology in the patients.23 cases were misdiagnosed as endometrial hyperplasia in operation and received unsuitablel operation.Conclusion The procedure of standard treatment and accurate first diagnosis is key to avoid misdiagnosis and mistreatment of endometrial carcinoma,giving the curettage under hysteroscopy can improve the agreement rate of endometrial carcinoma.
出处
《海南医学》
CAS
2011年第12期33-37,共5页
Hainan Medical Journal
