宫腔镜对诊断子宫内膜癌的价值

目的 探讨宫腔镜检查对子宫内膜癌和子宫内膜增生的诊断价值。方法 对206例具有临床症状伴子宫内膜高危因素者行宫腔镜检查的结果进行回顾性分析。结果 宫腔镜下诊断为子宫内膜癌及可疑癌共37例(18.6％),经病理证实为子宫内膜癌22例,其中19例进行了手术,术后病理报告宫颈管未受侵15例,受侵4例,与术前宫腔镜诊断符合率94.7％。术中腹水细胞学检查阴性13例,阳性1例,可疑1例。206例中经病理证实Ⅰ～Ⅲ级非典型增生12例,宫腔镜诊断分别为:可疑癌4例,子宫内膜增生3例,正常或萎缩宫内膜4例,内膜结核1例。结论:宫腔镜检查直观病灶,准确定位活检,尤其适用于早期诊断。另外宫腔镜检查能够明确病灶部位和范围,提高宫颈管术前是否受侵的诊断率。

Evaluation of hysteroscopy for the diagnoas of endometrial carcinoma and atypical hyperplasia

Objective To evaluate hysteroscopic examinations for the diagnosis of endometrial carcinoma and atypical hy-perplasia. Methods 206 patients with clinical symptoms and high risk factors of endometrial carcinoma underwent hysteroscopic examinations. Results 37 cases were diagnosed endometrial carcinoma or suspicious cancer under hysteroscopy, but 19 out of 22 cases proved pathologically had operations. Endocervix was involved in 4 cases, the rest 15 were not involved. Cytology of peritoneal washing were negative in 13 cases,1 positive,1 suspicious. In addition there were 12 cases of atypical hyperplasia diagnosed by pathologist but under hysteroscopy 4 of them were suspicious cancer, 3 hyperplasia, 4 normal or atrophy and 1 tuber-coulosis. Conclusions The endometrium was observed directly so that biopsies could be taken more accurately under hysteroscopic examinations.This method is better used for diagnosis of the early cases. It can also demonstrate the site and range of the local lesions and increase the accuracy of preoperative diagnosis or endocervical invasion, however it is not very helpful for endometrial hyperplasia.