术中肉眼估计Ⅰ期子宫内膜癌肌层浸润深度的临床价值

Clinical value of intraoperative evaluation of depth of myometrial invasion in stage I endometrial cancer

目的：探讨子宫内膜癌术中肉眼估计肌层浸润深度的准确度，指导术中淋巴结处理方式，有利于准确的手术分期及术后轴助治疗方式的选择。方法：比较Ⅰ期子宫内膜癌术中肉眼观察的肌层浸润深度及术后显微镜下组织学肌层浸润深度。结果：１１９例可评价Ｉ期子宫内膜癌病例中，术中准确估计肌层浸润深度１０６例。术中肉眼观察肌层浸润深度的准确度为８９．１％。子宫肌层浸润深度＞１／２的敏感度、特异度、阳性预测值和阴性预测值分别为：８４．６％、９０．３％、７０． ９％和９５．５％。结论：术中肉眼估计子宫内膜癌肌层浸润深度是可靠的、经济、快速的估计子宫肌层浸润深度的方法，可以用于帮助手术医生筛选盆腔和腹主动脉旁淋巴结转移的高危病人。

Objective: To determine if depth of myometrial invasion in patients with endometrial cancer esti- mated by gross visual examination accurately identified the microscopic myometrial invasion. Methods : Compar- ing depth of myometrial invasion by intraoperative gross estimation with final histologic depth of invasion. Re- sults : Of the 119 evaluable patients with stage I endometrial cancer, the depth of invasion was accurately deter- mined by gross estimation in 89. 1% (106/119)of cases. The sensitivity, specificity, and positive and negative predictive values of depth of myometrial invasion more than 1 /2 intraoperative gross estimation were 84.6 % , 90.3% ,70.9% ,and 95. 5% .respectively. Conclusion : Intraoperative gross estimation of myometrial invasion is a reliable,inexpensive and fast method for evaluating the invasiveness of endometrial cancer, and can be used to assist the surgeon in selecting patients at increased risk for pelvic and para - aortic metastases.