宫腔镜辅助下分段诊刮术与单纯分段诊刮术诊断子宫内膜癌的比较

Comparative Analysis of Hysteroscopy and Dilatation and Curettage and Traditional D&C in Diagnosis of Endometrial Carcinoma

为比较宫腔镜辅助下分段诊刮术与单纯分段诊刮术在诊断子宫内膜癌中的临床意义 ,将经手术后病理证实的子宫内膜癌患者分为 2组 :宫腔镜辅助下分段诊刮组 (A组 ) 3 1例 ;单纯分段诊刮组 (B组 ) 3 9例。比较 2组术前诊断子宫内膜癌的准确性及开腹手术时腹水细胞学的检查结果。 2组患者的年龄、临床病理分期、病理分级及组织学类型差异无显著性。A组诊断宫颈受累的准确率为 96.77% (3 0 / 3 1 ) ,假阳性率为 3 .2 3 % (1 / 3 1 ) ;B组分别为 79.49%(3 1 / 3 9) ,1 5 .3 8% (6/ 3 9)。 2组准确率比较 ,差异有显著性 (P <0 .0 5 )。取腹水或腹腔冲洗液行细胞学检查。A组细胞学阳性率为 6.45 % (2 / 3 1 ) ,B组为 1 4.2 9% (3 / 2 1 ) ,2组间差异无显著性 (P >0 .0 5 )。提示 :宫腔镜辅助下分段诊刮术可提高术前诊断子宫内膜癌的准确性 ,从而避免不必要地扩大手术范围 ,而且不增加腹腔内播散的危险。

The objective of this study was to compare the value of hysteroscopy and dilatation and curettage and traditional D&C in diagnosis of endometrial carcinoma. Seventy patients with endometrial cancer were diagnosed and the operations were performed in our department. They were divided into two groups. Group A(31 patients) was examined by hysteroscopy, group B(39 patients) by D&C. There was no statistic difference in patients age, stage, grade and histological type of the disease between the two groups. Of group A, the accuracy rate for diagnosis of cervical canal involvement was 96.77%(30/31), the false positive rate was 3.23%(1/31). While in group B, the rate was 79.49%(31/39) and 15.38%(6/39) respectively. There was statistic difference (P<0.05) between two groups in estimating the involvement of cervical canal. There was no statistic difference (P>0.05) between two groups in positive peritoneal cytology. The hysteroscopy can discover the involvement of cervical mucosa more accurately in endometrial carcinoma patients, thus avoid unnecessary treatment, but the positive peritoneal cytology rate isn't improved.