宫腔镜联合彩阴超在子宫内膜癌临床分期中的价值

Value of hysteroscopy combined with transvaginal ultrasonography for clinical staging of early endometrial carcinoma

目的提高早期子宫内膜癌临床分期的准确性,适应子宫内膜癌患者保留生育功能的需要。方法回顾性分析159例实施全面手术病理分期的子宫内膜腺癌患者的临床资料,比较基于宫腔镜联合彩阴超的临床分期(简称新临床分期)与FIGO 2009手术病理分期的一致性;通过磁共振、彩阴超及宫腔镜下分段诊刮对肌层浸润、宫颈侵犯的诊断价值,以及对病理分级的术前评估价值,综合分析宫腔镜联合彩阴超在子宫内膜癌临床分期中的价值。结果宫腔镜联合彩阴超的新临床分期与新手术病理分期具有高度一致性(Kappa=0.773,P=0.046),且评估病理分级的准确性较高(Kappa=0.885,P=0.056)。结论宫腔镜联合彩阴超能较准确地预测早期子宫内膜癌的手术病理分期及高危因素,使保留生殖、内分泌功能的子宫内膜癌手术成为可能。

Objective To evaluate the application of hysteroscopy combined with transvaginal ultrasonography in clinical staging of endometrial carcinoma. Methods The clinical data of 159 patients with endometrial cancer who underwent comprehensive surgical staging were collected. The results of surgical staging and those based on hysteroscopy combined with transvaginal ultrasonography （new clinical staging ） were compared. Results The results of new clinical staging was highly consistent with those of surgical/pathological staging （ Kappa = 0.773, P = 0. 046 ）. Cervical invasion by D＆C under hysteroscopy had difference to that by surgical/pathological staging （Kappa =0. 885, P = 0. 056 ）. Conclusion The clinical staging based on hysteroscopy combined with transvaginal ultrasonography can accurately predict the surgical/pathological staging, which provides the possibility for preserving the fertility of patients.