上、下级医生术中肉眼观察对判断子宫内膜癌肌层浸润深度的区别

目的探讨上、下级医生术中肉眼观察对判断子宫内膜癌肌层浸润深度的区别,以提高术中肉眼判断子宫内膜癌肌层浸润深度的准确性。方法收集2000年1月至2009年10月在阜阳市肿瘤医院经手术治疗、术后病理检查分期为Ⅰ期子宫内膜癌的患者41例,以术后病理诊断为金标准,比较上、下级医生术中肉眼观察对判断子宫内膜癌肌层浸润深度的区别。结果下级医生对肌层浸润总的诊断准确率为58.54%（24/41）,对深肌层浸润判断的准确率为69.23%（9/13）,而对浅肌层浸润判断的准确率为56.00%（14/25）。上级医生对肌层浸润总的诊断准确率为90.24%（37/41）,对深肌层浸润判断的准确率为92.31%（12/13）,而对浅肌层浸润判断的准确率为88.00%（22/25）。比较两级医生在判断子宫内膜癌肌层浸润方面的不同,上级医生肉眼观察判断的阳性和阴性预测值更好,可作为术中指导。结论通过反复比较,掌握正确的切开和观察方法及形态学诊断标准,积累病理学经验,可以不断提高下级医生术中肉眼观察对判断子宫内膜癌肌层浸润深度的准确率。

The difference of the depth of myometrial invasion in endometrial carcinoma with intraoperative visual observation between the superior and junior doctors

Objective To improve the accuracy of the depth of myometrial invasion of endometrial cancer observed by naked eyes during operation through investigating the difference of the depth of myometrial invasion in endometrial carcinoma with intraoperative visual observation between superior and junior doctors.Methods The data from endometrial cancer in-patients with stageⅠ of surgical-pathological staging was collected and compared in Fuyang tumor hospital from Jan.2000 to Oct.2009.The results of the depth of myometrial invasion in endometrial carcinoma with intraoperative visual observation between the superior and junior doctors were compared and in according to the gold standard as postoperative pathological diagnosis.Results The diagnostic accuracy rate of myometrial invasion overall was 58.54% （24/41） and the diagnostic accuracy rate of deep myometrial invasion,shallow muscularis invasion was 69.23% （9/13） and 56% （14/25） respectively by the junior doctors.While The diagnostic accuracy rate of myometrial invasion overall was 90.24% （37/41）and the diagnostic accuracy rate of deep myometrial invasion,shallow muscularis invasion was 92.3% （12/13）,and 88% （22/25）respectively by the junior doctors.The positive and negative predictive value of superior doctors used as intraoperative guidance was better than that of junior doctors through comparing the results of myometrial invasion in endometrial cancer determined by superior doctors and junior doctors.Conclusion Junior doctors could continue to improve the accuracy of the depth of myometrial invasion in endometrial carcinoma by visual observation through repeated comparisons to master the correct incision methods,observation methods and morphological diagnostic criteria,to accumulate pathological of experience.