丙泊酚静脉全麻下术中快速冰冻病理检查对诊断子宫内膜癌的价值研究

Value of intraoperative rapid frozen pathological examination in the diagnosis of endometrial carcinoma

目的探讨术中快速冰冻病理检查在子宫内膜癌诊断中的临床价值。方法选取2014年1月～2017年2月于陕西省核工业二一五医院进行子宫内膜癌手术患者279例，所有患者均于术中进行术中快速冰冻病理检查（快速法）和术后石蜡病理切片（石蜡法），以术后石蜡病理切片结果为诊断子宫内膜癌的金标准，观察术中快速冰冻病理检查在子宫内膜癌诊断中的灵敏度与特异性，分析术中快速冰冻病理检查在肿瘤分级与浸润深度诊断中的价值。结果279例子宫内膜癌患者中术后病理检查示，子宫内膜腺样癌150例，透明细胞癌41例，浆液性癌70例,子宫内膜增生18例。术中快速冰冻病理检查结果示：子宫内膜腺样癌146例，透明细胞癌31例，浆液性癌59例，子宫内膜增生43例，子宫内膜癌诊断符合率为89.61%，灵敏度为90.42%，特异性77.78%；术中快速冰冻病理检查在肿瘤分级诊断中Ⅰ级、Ⅱ级、Ⅲ级与石蜡法检查符合率分别为70.90%、90.48%和96.72%，经Ridit值计算与统计学分析，2种方法在肿瘤分级诊断中差异无统计学意义；术中快速冰冻病理检查在肿瘤浸润深度分级诊断中Ⅰ级、Ⅱ级、Ⅲ级与石蜡法检查符合率分别为60.94%、95.21%和100%，经Ridit值计算与统计学分析，2种方法在肿瘤浸润深度分级诊断中差异无统计学意义。结论术中快速冰冻病理检查在诊断子宫内膜癌中具有较高的灵敏度和特异性，是一种便捷、快速且可靠程度较高的术中诊断方法。

Objective To investigate the clinical value of fast frozen pathological examination in the diagnosis of endometrial carcinoma surgery.Methods279cases of endometrial cancer patients from January2014to February2017were performed with rapid intraoperative frozen pathological examination(rapid method)and postoperative pathological(Shi Lafa),the postoperative pathological results as the gold standard for the diagnosis of endometrial carcinoma,fast frozen pathological examination in the diagnosis of endometrial cancer,the sensitivity and specificity were observed,fast frozen pathological examination value in tumor grade and infiltration depth diagnosis was analyzed.Results279cases of endometrial carcinoma in patients with postoperative pathological examination showed150cases of adenoid carcinoma of the uterine endometrium,41cases of clear cell carcinoma,70cases of serous carcinoma,18cases of endometrial hyperplasia.Pathological examination showed rapid intraoperative frozen:146cases of endometrial carcinoma of uterus,31cases of clear cell carcinoma,59cases serous carcinoma,43cases of endometrial hyperplasia and endometrial cancer was89.61%,the sensitivity was90.42%,specificity was77.78%;rapid pathological examination in diagnosis and grading of tumor grade I,with grade II,III and paraffin test coincidence rate was70.90%,90.48%and96.72%,the Ridit value calculation and statistical analysis,there was no significant difference between two methods in grading diagnosis of tumors;pathological grade infiltration depth,diagnosis and grading of tumor in rapid intraoperative frozen grade II,III and paraffin test coincidence rate was60.94%,95.21%and100%the value of Ridit,analysis and statistics,two kinds of methods in the diagnosis and grading of tumor infiltration depth difference was not statistically significant.Conclusion The sensitivity and specificity of fast frozen pathological examination is higher in the diagnosis of endometrial cancer surgery,It is a convenient,fast and reliable method for intraoperative diagnosis,and has high clinical value.