宫腔镜检查致子宫内膜癌细胞脱落因素及脱落癌细胞活性分析

Factors impact endometrial cancer cells dissemination and functionally viability at hysteroscopy

目的探讨宫腔镜检查影响子宫内膜癌细胞脱落的因素,并进一步鉴定脱落的内膜癌细胞是否具有活性。方法对29例子宫内膜癌患者手术的离体子宫行宫腔镜检查,在100mmHg膨宫压力下收集宫腔灌流液,进行细胞学检查并对灌流液阳性的细胞进行培养,同时取宫腔原位癌灶行细胞培养作为对照。结果 29例宫腔灌流液中内膜癌细胞阳性11例(37.9%),灌流液细胞学阳性与病变期别(P=0.001)及癌灶直径(P=0.02)呈明显相关性,手术-病理分期晚及癌灶直径≥2 cm时癌细胞易脱落;脱落癌细胞培养存活4例(13.8%),主要为低分化腺癌和恶性程度高的特殊类型子宫内膜癌,宫腔原位病灶癌细胞培养全部存活。结论宫腔镜检查影响子宫内膜癌细胞脱落的主要因素为病变期别和癌灶直径;脱落癌细胞能否继续存活取决于肿瘤本身的生物学特点。

Objective To determine the factors influencing endometrial cancer cells retrograde and to evaluate the functional viability of disseminated tumor cells. Methods Totally 29 endometrial cancer patients underwent hysterectomy. In vitro fluid hysteroseopy was performed on the uteri and fluid was collected. Results Positive peritoneal cytology was seen in 11 of 29 （37.9%） uteri. The tumor cells were viable in 4 specimens （ 13.8% ）. Tumor cells were prone to disseminate when tumor diameter greater than or equal to 2cm. However, only low-grade adenocarcinoma cells and the special subtypes of endometrial cancer cells （ such as papillary serous adenocarcinoma and clear cell carcinomas, which had much poorer prognosis） could easily survive. Conclusion The endometrial cancer cells can be disseminated by hysteroscopy. Large size and late stage are the high risk factors. Cells of low grade tumors and the special subtypes of endome trial carcinoma are easier to survive.