宫腔镜在诊断子宫内膜癌及癌前病变中的价值

Value of hysteroscopy in the diagnosis of endometrium cancer and atypical hyperplasia

目的 探讨宫腔镜检查对子宫内膜癌和子宫内膜癌前病变的诊断价值。方法 回顾分析 1994年 4月至 1999年 2月 2 0 6例具有临床症状伴子宫内膜癌高危因素行宫腔镜检查病例。结果 宫腔镜诊断子宫内膜癌及可疑癌 37例 (18 0 % ) ,经病理证实为癌者 2 2例 (10 7% ) ,19例进行了手术 ,术后病理证实宫颈管受侵 4例 ,未受侵 15例 ,与之相比 ,手术前宫腔镜诊断符合率为 94 7%。术中腹水细胞学检查 15例 ,阴性 13例 ,阳性 1例 ,可疑 1例。 2 0 6例中经病理证实Ⅰ～Ⅲ级非典型增生 12例 ,而宫腔镜下诊断为可疑癌 4例 ,增生 4例 ,正常或萎缩子宫内膜 3例 ,内膜结核 1例。结论 宫腔镜检查直观病灶 ,准确活检 ,适用于早期诊断 ,同时明确病灶部位和范围 ,提高宫颈管受侵与否的诊断率 。

Objective To evaluate hysteroscopy examination in the diagnosis of endometrium cancer and atypical hyperplasia.Methods 206 patients with clinical symptoms and high-risk factors of endometrium cancer underwent hysteroscopy examination.Results 37 cases were diagnosed as endometrium cancer or suspicious cancer under hysteroscopy,but 22 cases were demonstrated(10 7%).19 of 22 patients were performed operation.Endocervix was involved in 4 cases,the rest 15 were not involved. 94 7% of them coincided with the diagnosis by hysteroscopy before operation.Peritoneal washing cytology was performed in 15 cases,13 negative,1 positive,1 suspicious.In addition, there were 12 cases with atypical hyperplasia in all these 206 patients diagnosed by pathology,while,by hysteroscopy,they were suspicious cancer(4 cases),hyperplasia(4 cases),normal or atrophy(3 cases) and tuberculosis(1 case) respectively.Conclusion The endometrial focus is observed directly and biopsied more exactly under hysteroscopy.This method fits the diagnosis of the early disease.Meanwhile, we can find the focus site and spread area,improve the diagnosis rate of endocervical invasion,but it is difficult to distinguish the type of hyperplasia.