宫腔镜检查术对子宫内膜癌癌细胞扩散影响的研究

Study on spreading influence of endometrial carcinoma cells in hysteroscopy

目的:探讨宫腔镜术时灌流介质经输卵管溢出的影响因素,及其是否引起子宫内膜癌细胞的扩散。方法:收集27例非子宫内膜癌患者全子宫+双附件切除术后的离体标本,在不同膨宫压力值下行宫腔镜灌注,观察输卵管溢液情况。另外收集12例子宫内膜癌患者全子宫+双附件切除术后的离体标本,在100 mmHg的膨宫压力值下行宫腔镜灌注,收集输卵管溢液,分离、离心后找癌细胞。结果:术中钳夹输卵管组溢液率明显低于未钳夹组(P<0.01);膨宫压力40 mmHg时输卵管即有溢液,且随着膨宫压力的增大,溢液速度加快;正常大小子宫与大于正常子宫的输卵管溢液率差异无统计学意义。子宫内膜癌患者离体标本的输卵管溢液经分离、离心后未找到癌细胞。结论:输卵管溢液与膨宫压力及输卵管是否通畅有关,与子宫大小无关。宫腔镜膨宫介质灌注子宫内膜癌离体子宫标本,未能将癌细胞经输卵管带出。

Objective： To determine the factors affecting the overflow of perfusion medium in hysteroscopy through the Fallopian tube and to confirm the factors causing the spread of endometrial carcinomatous cells.Methods： 27 samples of isolated total uterus and two-sided annex from patients with non-endometrial carcinoma after operation were obtained.Then hysteroscopy perfusion was carried out under different uterine distention pressures and the perfusion medium overflowing through the Fallopian tube was observed.In addition,12 samples from patients with endometrial carcinoma were collected,and they were perfused via the Fallopian tube at 100 mmHg.Carcinomatous cells were found after separation and centrifugation.Results： The overflow rates in the group with jaw in Fallopian tube were significantly lower than those in the group without the jaw in Fallopian tube（P0.01）.On the basis of ensuring uterine distension,perfusion medium overflowed through the Fallopian tube at the uterine distension pressure of 40 mmHg,as well as the overflow rates accelerated by increasing of perfusion pressure.There were not significant differences between the overflow rates of normal-sized uteri and those of the bigger ones.In patients with endometrial carinoma,carcinomatous cells could not be found after the hydrorrhea from the Fallopian tube was separated and centrifugated.Conclusion： A significant correlation is observed between the overflow of the Fallopian tube and uterine distention pressure.The hydrorrhea from the Fallopian tube is not related to the size of the uterus,but to the perfusion pressure and smoothness of the Fallopian tube.The carcinomatous cells cannot be found when perfusion medium overflows through the fallopian tube in isolated preparations from endometrial carcinoma patients during the hysteroscopic operation.