宫腔镜检查对子宫内膜癌的诊断价值

探讨宫腔镜检查在子宫内膜癌诊断中的价值。方法 :经手术治疗的子宫内膜癌共 10 2例分为两组 :(1)宫腔镜检查组 (39例 ) ,在宫腔镜下行分段诊刮术 ;(2 )单纯分段诊刮组 (6 3例 )。比较两组术前后宫颈受累情况的诊断符合率及开腹手术时腹水细胞学检查的结果。结果 :两组患者的年龄、临床分期、病理分级及组织学类型差异无显著性 ,宫腔镜检查组诊断宫颈受累的准确率为 97.4% (38/ 39) ,明显高于单纯分段诊刮组 (76 .2 % ,48/ 6 3) ,其假阳性率 (0 / 35 )明显低于单纯分段诊刮组 (2 1.6 % ,11/ 5 5 ) (P值均 <0 .0 1) ,两组患者均无腹水 ,有 84.3 %(86 / 10 2 )在开腹手术时行腹腔洗液细胞学检查。宫腔镜检查组腹腔洗液细胞学阳性率为 8.8% (3/ 34) ,单纯分段诊刮组为 13.5 % (7/ 5 2 ) ,两组差异无显著性 (P >0 .0 5 )。结论 :宫腔镜检查可提高子宫内膜癌诊断的准确性 ,能较确切地了解宫颈是否受累 ,同时可能并不增加肿瘤细胞扩散的机会 ,对可疑宫内病变者应在宫腔镜检查下分段诊刮。

The value of hysteroscopy in the diagnosis of endometrial cancer

Objective: To evaluate the value of hysteroscopy in the diagnosis of endometrial cancer. Methods: One hundred and two patients with endometrial cancer were diagnosed and the operations were performed in our department from Jan. 1990 to June 1997. They were divided into two groups. There were 39 patients in the first group who were diagnosed by hysteroscopy and fractional curettage, and the other 63 patients were in the second group who were diagnosed only by fractional curettage. The accuracy rates for diagnosis of cervical canal involvement and peritoneal cytology at the time of laparotomy were compared between the two groups. Results: There was no statistic difference in patients' age, stage, grade and histological type of the disease between the two groups. The accuracy rate for diagnosis of cervical canal involvement was higher in the first group (97.4%, 38/39) than in the second group (76.2%,48/63), P <0.01, and the false positive rate for diagnosis of cervical canal involvement was lower in the group with hysteroscopy (0, 0/35) than in the group without hysteroscopy (21.6%, 11/55), P <0.01. No ascites was found in the patients of the two groups. Peritoneal washing cytology was examined in eighty six patients (84.3%, 86/102) at the time of laparotomy. The positive peritoneal cytology was found in 3 patients (8.8%, 3/34) in the first group and 7 patients (13.5%, 7/52) in the second group, and the positive rate of peritoneal cytology was no difference between the two groups. Conclusion: Hysteroscopy is valuable for the diagnosis of endometrial cancer and cervical canal involvement, but might have no effect on cytological malignancy in the peritoneal cavity. Hysteroscopy should be used in the diagnosis of uterine cavity diseases.