摘要
目的探讨诊断性宫腔镜在子宫内膜癌诊断中的价值及腹腔手术治疗子宫内膜癌的临床效果。方法回顾性分析36例子宫内膜癌患者的临床资料。结果 17例行分段诊断性刮宫(诊刮),19例行诊断性宫腔镜,两组子宫切除术前与术后病理诊断符合率分别为64.7%(11/17)及94.7%(18/19),差异有显著性(P<0.05);其腹腔积液细胞学阳性率分别为5.9%(1/17)及10.5%(2/19),差异均无显著性(P>0.05);在Ⅰ期子宫内膜癌诊断中,宫腔镜组与诊刮组的准确性分别为92.9%(13/14)和57.1%(8/14),差异无统计学意义(P=0.074)。腹腔镜组(29例)和开腹组(7例)在术中出血量(121.7ml vs 271.4ml,P=0.0060)和术后肛门排气时间(38.6±8.5 h vs 51.6±8.6 h,P=0.0057)比较,差异均有显著性;平均手术时间(245.0±71.3min vs 260.0±73.9 min,P=0.6228)、清除盆腔淋巴结数量(22.3±7.2 vs 21.3±9.0,P=0.8205)、术后住院天数(10.2±2.6 vs 12.1±2.1,P=0.0669)等比较,差异均无显著性。随访期间,开腹组1例复发死亡。结论宫腔镜检查并定位活检诊断子宫内膜癌的准确性高,是否造成子宫内膜癌细胞腹膜腔播散尚存在争议;腹腔镜手术能达到与开腹手术一样的效果。
Objective To explore the effect of hysteroscopy as a diagnosis for endometrial carcinoma and to determine the elinieal outcome of laparoseopic surgery in endometrial carcinoma. Methods 36 patients with endometrial carcinoma had enrolled in the retrospective analysis. Results The peritoneal cytology was positive in 1 （5.9%） of the 17 cases diagnosed by D＆C and 2 （ 10. 5% ） of the 19 eases diagnosed by hysteroscopy （P = 1. 000）. Based on the pathological examination, the accuracy of D＆C was 64. 7% （ 11/17）, which was significantly lower than that of hysteroseopy [94. 7% （18/19）, P =0. 028]. In the cases with stage Ⅰ endometrial carcinoma, the diagnostic accordance rate of hysteroscopy was 92.9% （13/14）, while that of the D＆C was 57. 1% （8/14, P =0.074）. As compared with the open group （7 cases）, the laparoscopic group （29 cases） presented a significant difference in blood loss （121.7±79.6 vs 271.4±99.4ml, P =0. 0060）, earlier time to first passing flatus （38.6±8.5h vs 51.6±8.6h, P =0. 0057）, similar operatingtime （245.0±71.3 min vs 260. 0±73.9 min, P =0. 6228）, similar number of lymph nodes yielded （22. 3±7.2 vs 21.3±9.0, P = 0. 8205）, and similar days of average post-operative hospital stay （ 10. 2±2. 6 vs 12. 1±2. 1, P = 0. 0669）. During follow-up period, only one case in laparotomic group had a relapse and died finally. Conclusion Theaccuracy of hysteroscopy used in the diagnosis of endometrial carcinoma is good, but the dispute still exits that it may facilitate the tumor cell dissemination at present. Laparoscopic radical hysterectomy and pelvic lymphadenectomy may be an alternative treatment for endometrial carcinoma.
出处
《癌症进展》
2012年第2期174-178,共5页
Oncology Progress
关键词
子宫内膜癌
腹腔镜
宫腔镜
诊断性刮宫
endometrial carcinoma laparoscopy hysteroscopy dilatations and curettages （D＆C）
