宫腔镜检查对Ⅱ型子宫内膜癌患者腹腔细胞学结果及预后的影响

Effect of hysteroscopy on peritoneal cytology and prognosis in patients with type Ⅱ endometrial carcinoma

目的：研究宫腔镜检查对Ⅱ型子宫内膜癌患者腹腔细胞学结果及预后的影响,探讨其用于Ⅱ型子宫内膜癌术前诊断的安全性。方法：回顾分析2001年6月至2010年6月在我院接受手术治疗且术后确诊为Ⅱ型子宫内膜癌的84例患者的临床病理资料。根据其术前诊断方式,分为宫腔镜检查组（32例）和传统诊刮组（52例）。比较两组患者的临床病理特点和腹腔细胞学检查阳性率,评价宫腔镜检查对Ⅱ型子宫内膜癌癌细胞腹腔播散的影响;分析术前不同诊断方式对Ⅱ型子宫内膜癌患者预后的影响。结果：两组患者的年龄、病理类型、临床分期、肌层浸润、累及附件及淋巴转移及治疗方式等比较,差异均无统计学意义（P〉0.05）。宫腔镜诊刮组与传统诊刮组的腹水细胞学检查阳性率分别为37.5%（12/32）和17.3%（9/52）,差异有统计学意义（χ^2=4.308,P=0.036）。宫腔镜检查组与传统诊刮组患者的5年总生存率（OS）分别为56.8%和69.2%,5年无进展生存率（PFS）分别为50.7%和67.9%;两组患者的总生存率曲线和无进展生存曲线分别比较,差异均无统计学意义（P=0.329;P=0.424）。结论：宫腔镜检查用于Ⅱ型子宫内膜癌的诊断,可增加癌细胞腹腔播散的风险,但对其长期生存可能无影响。

Objective： To investigate the effect of hysteroscopy on peritoneal cytology and prognosis in patients with type Ⅱ endometrial carcinoma, and to investigate the safety of hysteroscopy in the diagnosis of endometrial carcinoma. Methods：The clinical and pathological datas of 8d patients with type Ⅱ endometrial carcinoma were retrospectively analyzed in our hospital from June. 2001 to June. 2010. According to the preoperative diagnosis methods, it was divided into the dilatation and curettage（DC） group with 52 cases and the hysteroscopy group with 32 cases. The clinical and pathological characteristics and the positive rate of peritoneal cytology were compared in two groups. The effect of hysteroscopy on the prognosis of patients with type Ⅱ endometrial carcinoma were analyzed. Results：There were no significant difference in age, pathological type, clinical stage, muscular invision, accessory and lymph node metastasis （ P 〉0.05 ）. The positive rate of peritoneal cytology were 37.5% （12/32） and 17.3% （9/52） in hysteroseopy group and DC group, respectively, which was statistically significant （χ^2 = 4. 308, P =0. 036 ）. The 5 year overall survival rate （OS） and progression free survival （PFS） were 56.8% vs 69.2% and 50.7% vs 67.9% ,respectively,and there were no significant difference between hysteroscopy group and DC group （ P = 0. 329 ; P = 0. 424 ）. Conclusions ： The use of hysteroscopy in diagnosis of type Ⅱ endometrial carcinoma increases the risk of peritoneal dissemination of cancer cells,but the long-term survival may not be affected.