40例子宫内膜癌手术前后诊断差异临床意义的比较分析

Comparison of the diagnosis for 40 cases of endometrial cardnoma before and after operations

目的 分析子宫内膜癌手术前后临床与手术病理分期、病理类型及组织学分级,B超、CT及血CA125水平差异的临床意义。方法 回顾性分析1998年10月-2000年3月间经手术治疗的子宫内膜癌患者40例,术前行诊断性刮宫,确定病理诊断、临床分期,同时行阴道B超、CT检查及测定血清CA125,其中29例行盆腔、腹主动脉旁淋巴结切除术,行手术病理分期,并对手术前后诊断存在差异进行比较分析。结果 临床分期误差率,Ⅰ期11.8％,Ⅱ期62.5％;以血CA125监测是否宫外扩散符合率87.5％;临床Ⅰ期淋巴结转移率5.3％,腹水细胞学检查阳性3.3％,肌层浸润者83.3％;Ⅱ期淋巴结转移率62.5％,腹水细胞学检查阳性50％,均有肌层浸润。结论 子宫内膜癌临床Ⅰ期、高分化、B超检查病变局限内膜及浅肌层,CT无淋巴结异常显示,患者术前与术后分期有很好的相关性,可缩小手术范围;术前CA125测定对监测宫外扩散有一定价值。

Objective To analyse the differences of clinical and surgical-pathological staging, pathologic type, histology degree, results of B-ultrasonography and CT scan, serum CA125 in cases of endometrial carcinoma before and after operations. Methods Forty patients with endometrial carcinoma underwent surgery from Oct. 1998 to Mar.2000 were studied prospectively. Before operations, all patients had diagnostic uterine curettage, as well as B - ultrasonography, CT scan, and vaginal examination, to make certain of the pathological diagnosis and clinical staging. Serum CA125 was measured pie- and post-operation. 29 cases underwent pelvic and para - aortic lymphadenectomy so the surgical pathological stagings were clear. Results The differences between clinical and surgical-pathological staging in stage I was 11.8%, while 62.5% in stage Ⅱ. The coincident rate between increase of serum CA125 and extrauterine metastasis was 87.5% . In clinical stage I, 5.3% cases were found with lymph node me-tastases, 3.3% with positive peritoneal cytology and 96.6% with myometrial invasion. In clinical stage Ⅲ, 62.5% cases had lymph node metastases, 50% with positive peritoneal cytology and 100% with myometrial invasion. Conclusions Cases of endometrial carcinoma of clinical stage I , well-differentiated, lesions within mucosa or superficial myometrium by B-ultrasonography, and no lymph nodes metastasis by CT scan show good correlation in staging before and after operation. So we can reduce the field of operation. Cases besides the above mentioned should underwent staging operation to make sure whether adjuvant treatment are needed or not. Serum CA125 is valuable for monitoring the extrauterine metastasis.