子宫内膜癌术中大体检查子宫肌层浸润的意义

The Significance of Intraoperative Gross Examination of Myometrial Invasion in Endometrial Cancer

目的 :探讨子宫内膜癌术中大体检查子宫肌层浸润的价值。方法 :选取 116例 1998年 1月～ 2 0 0 4年 2月上海市第一妇婴保健院妇科收治的子宫内膜癌病例 ,术前经分段诊断性刮宫术证实为子宫内膜癌 ,且术前未予放疗、化疗或激素治疗。术中行子宫切除后 ,切开子宫标本 ,再沿病灶切下肌层 ,观察并记录癌灶浸润肌层小于 1/ 2 (浅肌层 )还是大于 1/ 2 (深肌层 ) ,术后与病理检查比较 ,计算出敏感度 ,假阴性 (漏诊 )率 ,特异度 ,假阳性 (误诊 )率 ,准确率 ,阳性预测值 ,阴性预测值。结果 :术中大体检查子宫肌层浸润的准确率 (AC) 91.4 % ,敏感度 (SN) 78.9% ,假阴性 (漏诊 )率 2 1.1% ,特异度 (SP) 93.8% ,假阳性 (误诊 )率 6 .2 % ,阳性预测值 (PPV) 71.4 % ,阴性预测值 (NPV) 95 .8%。结论 :子宫内膜癌术中大体检查子宫肌层浸润是一种方便、经济、有效的方法 。

Objective: To determine the value of intraoperative gross inspection of myometrial invasion in endometrial cancer. Methods: All 116 patients with endometrial cancer were admitted between January 1998 and February 2004, who were preoperatively diagnosed by fractional curettage. None had received preoperative radiotherapy, chemotherapy or hormonal therapy. After hysterectomy done, uterine anterior wall was incised along the uterine fundus to cervix. Then an incision was made through the tumor focus. The depth of myometrial invasion was noted as less or greater than 1/2 and compared to pathologic examination. Statistical calculations were used to evaluate accuracy, sensitivity, specificity, positive and negative predictive values, and false-positive and false-negative rates of the method. Results: Gross visual estimation accurately identified the microscopic myometrial invasion in 91.4% of cases. Sensitivity, specificity and positive and negative predictive values of gross estimation in determining a microscopic myometrial invasion greater than 1/2 were 78.9%, 93.8%, 71.4% and 95.8%. False positive rate and false negative rate were 6.2% and 21.1%. Conclusion:Intraoperative gross estimation of myometrial invasion in endometrial cancer is a convenient, economic and effective method, which is helpful for surgeon to decide the need of extended surgery.