腹腔镜在性质可疑附件包块中应用价值的探讨

Application value of laparoscopy in management of suspected adnexal masses

目的验证恶性风险指数预测附件肿块良、恶性的准确性,探讨腹腔镜在可疑附件肿块治疗应用中的价值。方法回顾分析性质可疑附件肿块患者112例。术前计算恶性风险指数,然后进行腹腔镜检查,附件包块性质可疑者送检冰冻病理。计算并比较恶性风险指数≥200和腹腔镜诊断的敏感性及特异性。结果恶性风险指数<200为良性,共87例;恶性风险指数≥200为可疑恶性,共25例。石蜡病理提示卵巢恶性肿瘤15例,卵巢交界性肿瘤7例,卵巢良性肿瘤90例。恶性风险指数≥200的诊断敏感性、特异性分别为81.9%和92.2%;腹腔镜诊断的敏感性、特异性分别为100.0%和97.8%。经比较,腹腔镜诊断的敏感性和阳性预测值显著高于恶性风险指数≥200(2χ分别为16.2、17.8,均P<0.05)。结论恶性风险指数是术前预测附件包块性质简单而实用的方法,但在鉴别早期卵巢癌、交界性肿瘤等方面仍存在局限性。腹腔镜较恶性风险指数≥200进一步提高了附件包块诊断的准确性。

Objective To testify accuracy of the risk of malignancy index（RMI） to predict property of adnexal masses and to investigate application value of laparoscopy in treatment of suspected adnexal masses. Methods The clinical data of 112 women underwent laparoscopy for suspected adnexal masses were analyzed retrospectively. Before operation, the RMI of the woman was calculated according to her menopausal status, result of Doppler ultrasonography, and value of serum CA125. According to the RMI, all the women were divided into two groups ： group A （ 87 cases, the value of RMI was 〈 200 ） and group B （25 cases, the value of RMI was ≥200 ）. Then the women received laparoscopy. Laparoscopic findings served to categorize masses as benign, suspected malignant, or malignant. Pathological examination of frozen sections was conducted if the mass was suspected malignant. Histological diagnosis was as the reference standard, sensitivities and specificities of RMI≥200 and laparscopy were calculated and compared. Results The adnexal masses of 87 women with preoperative RMI 〈 200 were predicted as benign cysts and those of 25 women with preoperative RMI ≥ 200 were predicted as suspected malignant if preoperative RMI 〈 200 was considered cut-off of benign adnexal masses of the woman. Pathohistological analysis of wax-imbedded specimen proved 15 malignant ovarian tumors, 7 borderline ovarian tumors and 15 malignancies. Sensitivity and specificity of RMI 〉 200 were 81.9% and 92.2% respectively and those of laparoscopy were 100% and 97.8% for diagnosis of ovarian malignancies. The sensitivity and positive predictive value for malignant tumors of laparoscopy were significantly higher than those of the RMI ≥ 200 （χ^2 = 16, 2, 17.8, respectively, both P 〈 0.05 ）. Conclusion RMI is a simple and applicable method to discriminate malignant and benign adnexal masses before operation, However, it is limited in discrimination of borderline ovarian tumors and early ovarian carcinoma. Laparoscopy is more accurate in discriminating benign and malignant ovarian tumors than RMI.