血小板及凝血指标对卵巢子宫内膜异位囊肿的诊断价值

目的：探讨血小板及凝血指标对卵巢子宫内膜异位囊肿的诊断价值。方法：回顾性分析2013年5月—2017年5月因卵巢囊肿于天津中医药大学第二附属医院妇科行手术治疗的患者病例资料。术后经病理证实为卵巢子宫内膜异位囊肿的患者为观察组,单纯卵巢囊肿的患者为对照组,观察2组患者的血小板计数（PLT）、血小板压积（PCT）、平均血小板体积（MPV）、血小板分布宽度（PDW）、大型血小板计数（P-LCR）、凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血酶时间（APTT）、纤维蛋白原（FIB）、凝血酶原国际比值（INR）、血浆D-二聚体及血清糖类抗原125（CA125）的变化,评价血小板及凝血指标对卵巢子宫内膜异位囊肿的诊断价值。结果：术前观察组的PLT、PCT、CA125高于对照组,PDW、APTT低于对照组,差异均有统计学意义（P<0.05）。观察组Ⅲ、Ⅳ期的PLT、PCT、MPV高于Ⅰ、Ⅱ期,PDW、P-LCR、APTT低于Ⅰ、Ⅱ期,差异均有统计学意义（P<0.05）。术前观察组CA125与MPV呈正相关,与PDW、P-LCR呈负相关。观察组术后PLT、PCT、MPV低于术前,PDW、P-LCR高于术前,差异均有统计学意义（P<0.05）。结论：血小板及凝血相关检测指标与卵巢子宫内膜异位囊肿发病有关,在临床上具有一定的诊断价值,但尚需进一步研究。     

宫腔镜检查与子宫内膜癌腹腔冲洗液细胞学相关因素的临床研究

目的:研究宫腔镜检查是否增加子宫内膜癌腹腔冲洗液细胞学的阳性率.方法:回顾性分析子宫内膜癌患者224例,其中经分段诊刮诊断184例,经宫腔镜诊断40例.比较两组腹腔冲洗液细胞学的阳性率,并同时分析组织学类型、肌层浸润深度、病灶分布、组织学分级、临床分期等与腹腔冲洗液细胞学的关系.结果:经宫腔镜检查的40例患者中,腹腔冲洗液细胞学的阳性率(25.00%)高于经诊刮诊断的184例患者的阳性率(21.74%),但两者差异无统计学意义.腹腔冲洗液细胞学阳性与组织学类型、肌层浸润深度、组织学分级无关(P＞0.05),但与病灶分布(弥漫型)、临床分期晚(Ⅱ期以上)有关(P＜0.05).经宫腔镜检查和经分段诊刮诊断的腹腔冲洗液细胞学阳性率在以上各因素下比较,差异均无统计学意义(P＞0.05).结论:宫腔镜检查并未增加子宫内膜癌患者腹腔冲洗液细胞学阳性率,经宫腔镜检查的子宫内膜癌患者同诊断性刮宫诊断者一样,腹腔冲洗液细胞学阳性率与临床分期晚、病灶分布弥漫因素有关.     

宫腔镜检查诊断子宫内膜癌的价值及与腹腔冲洗液阳性的关系探讨

目的:探讨宫腔镜检查对子宫内膜癌的诊断价值,以及是否增加腹腔冲洗液细胞学阳性率。方法:回顾性分析在本院行手术治疗后病理检查确诊为子宫内膜癌患者113例的临床资料,其中术前行单纯分段诊断性刮宫71例(分段诊刮组),行宫腔镜检查后再行分段诊刮42例(宫腔镜组)。比较两组手术前后的诊断、组织学分级、组织学类型符合率,腹腔冲洗液细胞学的阳性率,并同时分析组织学类型、组织学分级、肌层浸润深度、病灶分布、附件转移等与腹腔冲洗液细胞学的关系。结果:宫腔镜组42例患者,病理诊断符合率97.62%(41/42),高于分段诊刮组的病理诊断符合率83.10%(59/71),差异有统计学意义(P<0.05)。宫腔镜组腹腔冲洗液阳性率28.57%(12/42),高于分段诊刮组的阳性率25.35%(18/71),但两组比较差异无统计学意义(P>0.05)。113例子宫内膜癌患者腹腔冲洗液阳性与宫腔病灶范围大小有关(P<0.05),与附件转移、子宫肌层浸润深度、组织学类型、组织学分级无关(P>0.05)。结论:宫腔镜检查诊断子宫内膜癌准确性优于单纯分段诊刮,并且不增加腹腔冲洗液阳性率。腹腔冲洗液阳性率与宫腔病灶范围大小有关。     

子宫内膜癌卵巢转移危险因素的探讨

目的 探讨子宫内膜癌卵巢转移的危险因素及手术中保留卵巢的可行性.方法 回顾性分析1997年1月至2006年12月在江西省妇幼保健院首治为手术治疗的638例子宫内膜癌患者的临床病理资料.结果 36例(5.6%,36/638)患者发生卵巢转移.单因素分析显示,子宫内膜癌卵巢转移的相关因素为病理类型、病理分级、子宫肌层浸润、腹水或腹腔冲洗液细胞学检查阳性、盆腔淋巴结转移、宫旁浸润、腹主动脉旁淋巴结转移、子宫浆膜浸润(P均＜0.05),而年龄、脉管浸润、宫颈浸润与卵巢转移无明显相关性(P均＞0.05).多因素分析显示,子宫内膜癌卵巢转移的独立危险因素按危险强度排列为:盆腔淋巴结转移、腹水或腹腔冲洗液细胞学检查阳性、病理分级.结论 子宫内膜样腺癌、细胞高分化、无盆腔淋巴结转移、无腹主动脉旁淋巴结转移、元肌层浸润、腹水或腹腔冲洗液细胞学检查阴性、年轻的患者可考虑手术中保留卵巢.     

子宫内膜癌腹腔洗液细胞学检查与预后

目的 探讨腹腔洗液细胞学检查在评价子宫内膜癌患者预后中的价值。方法 对1992年1月～2000年1月我院收治临床分期Ⅰ-Ⅱ期的113例子宫内膜癌患者进行回顾分析及随访。结果 113例子宫内膜癌患者中,腹腔洗液细胞学检查阳性者23例(20.4％),其中4例(17.4％)死于术后复发;90例阴性的患者中,13例(12.56％)死于术后复发,Cox回归分析显示腹腔洗液细胞学检查结果与子宫内膜癌预后相关无显著性(P=0.9516);23例阳性患者中,6例(26％)为不良病理类型,9例(39％)有深肌层浸润,5例(21.7％)宫颈受累,5例(21.7％)有淋巴结转移,Logistic回归多因素分析表明与腹腔洗液细胞学检查阳性有显著相关(P<0.05)。结论 腹腔洗液细胞学检查不能独立作为评价子宫内膜癌患者预后的指标。与腹腔洗液细胞学检查阳性有关的高危因素有不良病理类型、深肌层浸润、宫颈受累和淋巴结转移。     

特殊类型子宫内膜癌的临床研究

目的:探讨特殊类型子宫内膜癌的临床病理特征、有效治疗方法及预后的相关因素。方法:回顾分析2005年1月至2014年12月我院收治的18例子宫浆液性癌(UPSC)和13例子宫透明细胞癌(UCCC)患者的临床资料,与同期32例子宫内膜样腺癌进行比较分析。结果:UPSC、UCCC患者的中位发病年龄及术前血清CA125升高(35U/ml)比例均大于子宫内膜样腺癌患者,差异有统计学意义(P0.05)。UPSC患者100%为绝经后患者。UPSC患者的腹腔冲洗液细胞学阳性率和大网膜转移率均高于UCCC和子宫内膜样腺癌患者,差异有统计学意义(P0.05)。UPSC、UCCC患者中晚期(Ⅲ~Ⅳ期)、低分化(G3)的比例、深肌层浸润和淋巴结阳性转移率均高于子宫内膜样腺癌患者,差异有统计学意义(P0.05)。UPSC和UCCC患者的复发率高于子宫内膜样腺癌患者,预后明显差于子宫内膜样腺癌。结论:UPSC和UCCC的临床特点和预后不同于子宫内膜样腺癌患者,治疗应有所区别。     

子宫内膜癌患者血清uPA和PAI-1的含量变化及临床意义

目的:探讨子宫内膜癌患者血清尿激酶型纤溶酶原激活物(uPA)及纤溶酶原激活物抑制物-1(PAI-1)含量的变化及其临床意义。方法:用ELISA法测定35例子宫内膜癌(内膜癌组)、18例子宫内膜增生(内膜增生组)和16例正常子宫内膜患者(正常对照组)血清uPA和PAI-1含量及计算两者的比值。结果:内膜癌组患者血清uPA和PAI-1含量及uPA/PAI-1值均显著高于内膜增生组及正常对照组,差异有极显著性(P均<0.01)。内膜增生组及正常对照组,差异无统计学意义(P>0.05)。内膜癌组Ⅲ~Ⅳ期患者血清uPA和PAI-1含量与Ⅰ期相比差异有极显著性(P<0.01),Ⅲ~Ⅳ期患者血清uPA和PAI-1含量高于Ⅱ期(P<0.05),Ⅱ期患者血清uPA、PAI-1含量高于Ⅰ期(P<0.05)。内膜癌组患者血清uPA、PAI-1含量及uPA/PAI-1值随着手术病理分期及组织学分级的增高、肌层浸润深度的增加及淋巴结的转移而升高,差异有显著性(P均<0.05),而与患者病理类型无关(P>0.05)。结论:子宫内膜癌患者血清uPA和PAI-1含量及uPA/PAI-1值明显升高,并与其手术病理分期、浸润转移有关,提示其可能在内膜癌的发生、发展及浸润过程中起重要作用。     

子宫内膜癌组织中胰岛素受体底物1的表达与活化及其临床意义

目的 研究子宫内膜癌组织中胰岛素受体底物1(ⅡlS-1)mRNA、蛋白的表达水平及酪氨酸磷酸化程度,并探讨其临床意义.方法 选择63例子宫内膜癌(内膜癌组)、21例子宫内膜不典型增生(不典型增生组)及22例正常子宫内膜(正常内膜组)患者进入本研究.收集其临床病理资料,酶联免疫法检测空腹血清胰岛素C肽水平,RT-PCR技术和蛋白印迹法分别检测子宫内膜组织中1RS.1 mRNA及蛋白的相对表达量,免疫共沉淀法检测IRS-1酪氨酸磷酸化程度.结果 内膜癌组患者血清C肽水平为(3.2±1.1)μg/L,高于正常内膜组[(2.5±0.7)μg/L],两组比较,差异有统计学意义(P=0.007).内膜癌、不典型增生及正常内膜组IRS-l mRNA、蛋白的相对表达量比较,差异均无统计学意义(F=0.695、0.003,P=0.502、0.997).内膜癌组IRS-1酪氨酸磷酸化程度[(62±36)%]高于不典型增生及正常内膜组[分别为(53士34)%、(35±33)%],分别比较,差异均有统计学意义(P=0.048、0.002);不典型增生组与正常内膜组比较,差异也有统计学意义(P=0.045).子宫内膜样腺癌患者IRS-1酪氨酸磷酸化程度[(69±33)%]高于非内膜样癌[(34±31)%],两者比较,差异有统计学意义(t=2.300,P=0.025).高手术病理分期、细胞分化不良、深肌层浸润及盆腔淋巴结转移者IRS-1酪氨酸磷酸化程度增高(P均<0.05).子宫内膜组织中IRS-1酪氨酸磷酸化程度与空腹血清C肽水平呈正相关关系(r=0.491,P=0.001).结论 子宫内膜癌组织中IRS-1的表达无明显变化,但存在IRS-1酪氨酸磷酸化程度增加,并与手术病理分期高、细胞分化不良、深肌层浸润及盆腔淋巴结转移等不良的临床病理特征相关.     

宫腔镜检查致子宫内膜癌细胞扩散的因素探讨

目的：探讨宫腔镜检查对子宫内膜部病人的腹腔冲液检查结果是否有影响。方法：采用回顾性分析经宫腔镜检查诊断和经分段诊刮诊断为子宫内膜癌的腹腔冲洗液检查结果共156例。结果：经宫腔镜检查诊断的59例病人中，腹腔冲洗液阳性率（20．3％），高于经分段诊刮诊断者（13．4％），但差异无统计学意义，在肌层浸润＜1／2的子宫内膜癌病人中，经宫腔镜癌病人中，经宫腔镜诊断者其腹腔冲洗液阳性率（22．6％）明显高于经分段诊刮诊断者（8．1％）。结论：宫腔镜检查用于诊断子宫内膜癌时有可能引起癌细胞的扩散。     

单酰甘油脂肪酶在子宫内膜癌中的表达及意义

目的:研究单酰甘油脂肪酶(MAGL)在子宫内膜癌中的表达及其临床意义。方法:应用免疫组化法检测18例正常子宫内膜、32例单纯性及复杂性增生子宫内膜、12例不典型增生子宫内膜和78例子宫内膜癌组织蜡块标本中MAGL表达,并分析MAGL的表达与临床病理指标之间的关系。对78例子宫内膜癌患者进行术后随访,分析MAGL的表达与预后的关系。结果:正常子宫内膜、单纯性及复杂性增生子宫内膜、不典型增生子宫内膜和子宫内膜癌组织中MAGL表达水平分别为0.445±0.313、0.878±0.529、1.461±0.573和0.658±0.655,4组间两两比较差异均有统计学意义(P0.05)。MAGL表达与患者的手术-病理分期、肌层浸润深度、妊娠次数、绝经延迟及体重指数有关(P0.05),MAGL表达与患者的体重指数呈正相关(r=0.236,P0.01);MAGL的表达与子宫内膜癌的分化程度、宫颈受累情况、组织学类型、淋巴转移、腹腔积液细胞学及患者是否合并高血压或糖尿病无关(P0.05)。与低值组比较,MAGL高值组的预后有较好的趋势,但差异无统计学意义(P0.05)。结论:MAGL的表达与子宫内膜癌的患病风险及侵袭性密切相关,MAGL可能在子宫内膜癌的发生发展中起到重要作用,有可能成为预防和治疗子宫内膜癌的新靶点。     

Five-year follow-up of endometrial ablation: endometrial coagulation versus endometrial resection

OBJECTIVE: A randomized, controlled trial was performed to compare the patient complication rate, effectiveness, and satisfaction rate of transcervical hysteroscopic endometrial coagulation versus endometrial resection in the treatment for heavy dysfunctional bleeding. METHODS: One hundred and twenty women requiring endometrial ablation for the treatment of heavy bleeding disorders entered the study. All patients were offered a clinical examination 24 months postoperatively and had a questionnaire by mail 5 years after the initial treatment. The number of complications during and after the operation, re-ablations, and hysterectomies were registered. A bleeding index and the patient satisfaction rate were stated. RESULTS: Sixty-one patients were treated by endometrial coagulation, and 59 were treated by endometrial resection. No differences between the two groups were observed concerning fluid absorption, bleeding, perforation, and infection. At the 5-year follow-up, 64% of the patients had only one ablation, 15% were treated twice, 15% had a hysterectomy, and 6% were lost to follow-up. After 5 years, the bleeding index was halved in patients with menses. Seventy-nine percent of the women would recommend the treatment to their best female friend. CONCLUSION: We found no significant differences in the frequency of complications. Only 15% of the women had a hysterectomy after 5 years. No significant difference was observed with respect to bleeding reduction and patient satisfaction in the two groups.     

Cytological findings on endometrial carcinoma and endometrial hyperplasia

The usefulness of endometrial cytology was studied for the purpose of early diagnosis of endometrial carcinoma in 423 patients. In the cytological examination, 15 patients were either "suspicious" or "positive". Histological findings revealed adenomatous hyperplasia in 6, atypical hyperplasia in 3 and endometrial carcinoma in 3 patients. All of these patients with positive histological findings had "suspicious" or "positive" in cytological examination. None had false negative. "Suspicious" or "positive" endometrial cytology was delineated in histologically positive lesions including endometrial carcinoma, atypical hyperplasia and adenomatous hyperplasia. Many cells with various acinous patterns were observed in patients with diseases more serious than atypical hyperplasia. The nuclei became larger and irregular in proportion to the progression of the lesion, though hypercytochromia of the nuclear chromatin was most marked in patients with adenomatous hyperplasia. There was a significant difference in the number of nucleoli between cells of adenomatous hyperplasia and those of atypical hyperplasia and endometrial carcinoma. Also, there was an apparent difference in the size and irregularity of the nucleoli between atypical hyperplasia and endometrial carcinoma. Phagocytosis of white blood cells was frequently observed in patients with endometrial carcinoma. Therefore, it is believed that endometrial cytology is useful not only in screening endometrial carcinoma and related diseases but also to some degree in the estimated diagnosis of these lesions.     

Tuberculosis endometrial

Genital tuberculosis follows an insidious course. Symptomatic disease usually presents with infertility, menstrual abnormalities, amenorrhea, postmenopausal bleeding, abdominal pain and/or pelvic mass. The definitive diagnosis should be confirmed by culture of menstrual blood or endometrial biopsy tissue for Mycobacterium tuberculosis. We report the case of a 78-year-old patient with pyometra in whom endometrial tuberculosis was confirmed by culture findings.     

Value of endometrial aspiration cytology in assessing endometrial status

Cytologic findings of endometrial aspiration from 135 women was correlated with pathologic diagnosis of endometrium. The results indicate that different endometrial changes, such as hyperplasia, carcinoma and other malignant endometrial lesions, different phases of normal menstrual cycle and senile atrophy can be distinguished by endometrial cytology. The author suggests that aspiration cytology may serve as a supplement to the biopsy or curettage in the assessment of the status of the endometrium.     

Incidence of endometrial carcinoma in patients with endometrial hyperplasia

OBJECTIVE: The purpose of this retrospective study was to establish the risk of developing endometrial adenocarcinoma in patients diagnosed with endometrial hyperplasia. MATERIAL AND METHODS: The incidence of endometrial hyperplasia and its relation with endometrial adenocarcinoma was evaluated in 1,139 patients who presented with abnormal bleeding between January 2000 and December 2004; D&C was performed in all cases. There were 591 (51.88%) cases of simple endometrial hyperplasia, out of which 110 (18.61% from 51.88%) cases had atypia, 60 (5.26%) cases of complex hyperplasia, out of which 19 (31.66% from 5.26%) had atypia, and the remaining 488 (42.84%) had different forms of mixed hyperplasia. RESULTS: The incidence of endometrial adenocarcinoma was 3.87% in atypical hyperplasia and 0.81% in other forms, and was related only to cases with atypia in which the incidence was 0.61%. CONCLUSIONS: The most indicated measure to prevent endometrial carcinoma in cases with complex endometria hyperplasia with atypia is hysterectomy, while for other forms of hyperplasia, hormonal treatment is used but only under strict control.     

Pipelle endometrial sampling in patients with known endometrial carcinoma

The purpose of this prospective clinical trial was to determine the reliability of the Pipelle endometrial biopsy instrument in recovering adequate tissue for confirmation of the diagnosis of endometrial cancer in patients with known endometrial carcinoma, and to compare endometrial histology of the sampling specimen with that of the subsequent hysterectomy specimen. Forty patients were enrolled in this study. All biopsies were performed in the office without anesthesia. The patients had a median age of 62 years (range 40-83). Discomfort was reported by the patient as mild, moderate, or severe; only two patients (5.0%) reported severe pain. There were no complications experienced with endometrial sampling. Thirty-nine of 40 specimens (97.5%) confirmed endometrial carcinoma; therefore, this study yielded a 97.5% sensitivity for the Pipelle endometrial sampling device. Comparing Pipelle and hysterectomy histology for individual patients, the histologic grade was the same in 29 (74.4%), while the Pipelle demonstrated a more advanced degree of differentiation in five (12.8%) and a lesser degree in five (12.8%). There was no residual tumor identified in one hysterectomy specimen (2.5%). Among the 12 patients who had a D&C for diagnostic purposes before referral, the Pipelle biopsy correlated with the D&C histology in ten of 12 (83.3%) and revealed a more advanced grade of tumor in one (8.3%) and a more differentiated grade in one (8.3%). In one patient, the D&C histology was adenocarcinoma grade 1, with the Pipelle demonstrating atypical hyperplasia and the hysterectomy specimen interpreted as endometrial adenocarcinoma in situ. This study demonstrates the Pipelle to be an accurate device for endometrial sampling in patients with endometrial carcinoma.     

Benign endometrial hyperplasia sequence and endometrial intraepithelial neoplasia.

Endometrial "hyperplasia," as currently diagnosed, includes the changes caused by an abnormal hormonal state and those caused by a separate category of monoclonal premalignant disease. The appearance of the disease in these 2 functional categories is discontinuous, permitting more specific diagnosis of the condition using the terms "benign endometrial hyperplasia" and "endometrial intraepithelial neoplasia" (EIN), respectively. Benign endometrial hyperplasia involves the entire endometrial compartment and, with protracted estrogen exposure, shows the progressive development of cysts, remodeled glands, vascular thrombi, and stromal microinfarcts. They are best construed as a sequence of changes whereby the appearance at any single time point is uniquely dependent on the preceding combination and the duration of hormonal exposures. In contrast, the premalignant clone of an EIN lesion is characteristically offset from the background endometrium by its altered cytology and crowded architecture. The use of an internal standard for cytology assessment, combined with the distinctive topography of a clonal process, enables the diagnosis of EIN lesions with a long-term cancer risk 45-fold greater than that of their benign endometrial hyperplasia counterparts. The resolution of hormonal and premalignant subsets of traditional "endometrial hyperplasias" is possible using redefined diagnostic criteria, enabling patient therapy to be appropriately matched with the underlying disease mechanisms.     

Long-term outcome of hysteroscopic endometrial ablation without endometrial preparation

OBJECTIVE: To describe the three-step hysteroscopic endometrial ablation (EA) technique without endometrial preparation, and its long-term outcomes. STUDY DESIGN: Four hundred and thirty-eight premenopausal women with menorrhagia or menometrorrhagia underwent three-step hysteroscopic EA, which consists of rollerball ablation of the fundus and cornual regions, a cutting loop endomyometrial resection of the rest of the cavity, and rollerball redessication of the whole pre-ablated uterine cavity. The main outcome measures were menstrual status, level of satisfaction with the procedure, and the need for repeat ablation or hysterectomy. Questionnaires were completed for 385 women (87.9%) with a mean follow-up of 48.2 months. RESULTS: One hundred and eighty-four responders (47.8%) reported amenorrhea; 177 (46%) had light to normal flow. One patient (0.3%) underwent repeat ablation and 20 (5.2%) underwent hysterectomy: 15 (3.9%) because of endometrial ablation failure and 5 (1.3%) because of indications unrelated to the ablation (three cases of atypical endometrial hyperplasia and two cases of fibroids). Two hundred and ninety-two patients (75.8%) were very satisfied, and 78 (20.3%) satisfied with the results. No major complications occurred and three women (0.8%) became pregnant during the follow-up period. CONCLUSIONS: EA is safe and effective means of treating of menorrhagia and menometrorrhagia in premenopausal women, and helps avoid hysterectomy in 95% of patients suffering from heavy bleeding, with or without uterine fibroids. Women should be informed that the procedure is not contraceptive and that pregnancy is possible after treatment.     

Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia

Objective

To evaluate the prevalence of concurrent endometrial carcinoma in women diagnosed with atypical endometrial hyperplasia (AEH) by endometrial biopsy.

Study design

We retrospectively analyzed the medical records of 126 patients who underwent hysterectomies for AEH diagnosed by endometrial biopsy from 1999 to 2008. AEH was initially diagnosed by dilatation and curettage (98 cases) or endometrial biopsy with a Z-sampler (24 cases). The remaining four cases were diagnosed by hysteroscopic polypectomy. The results of the endometrial biopsies were graded on an ordinal scale and were compared with pathologic features obtained at the hysterectomy.

Results

In patients preoperatively diagnosed with AEH by biopsy, hysterectomy specimens revealed a rate of simple or complex endometrial hyperplasia without atypia of 27% with AEH and normal proliferative phases found in 54.7 and 7.9% of specimens, respectively. The incidence of endometrial carcinoma was considerably high (13/126, 10.3%). Eleven of 13 cases were confined to the endometrium and the remaining two were located at the adenomyosis without myometrial invasion. All patients with endometrial carcinoma displayed coexisting atypical complex hyperplasia following hysterectomy.

Conclusions

Biopsy specimens showing AEH, particularly atypical complex hyperplasia, are associated with a risk of coexisting endometrial carcinoma. When considering management strategies for women with a biopsy diagnosis of AEH, clinicians should take into account the considerable rate of concurrent endometrial cancer and the discrepancy with pathologic diagnosis. Treatment modalities may differ depending on population as the rates of concurrent endometrial cancer with AEH and myometrial invasion vary by geographical location.     

子宫内膜不典型增生患者的内膜癌漏诊因素分析

目的:探讨子宫内膜不典型增生患者子宫内膜癌漏诊的因素及合理治疗方案。方法:回顾分析132例子宫内膜不典型增生子宫切除前后的临床病理资料。根据术前内膜取样方式分为宫腔镜组与诊刮组,比较两种方式的诊断符合率。比较术前病理与术中冰冻病理、术后常规病理,分析其主要临床病理资料。结果:132子宫内膜不典型增生患者中,术后证实为子宫内膜癌者42例(31.82%)。诊刮组的内膜癌漏诊率为32.99%(32/97),高于宫腔镜组28.75%(10/35),但无统计学差异(P0.05)。42例内膜癌患者中,95.24%(40/42)为子宫内膜样腺癌,ⅠA期38例(90.48%),高分化癌34例(80.95%)。术中行冰冻病理检查者115例,其中11例子宫内膜癌漏诊。长期月经紊乱、未生育患者子宫内膜癌漏诊的风险增高。结论:子宫内膜病理诊断为不典型增生的患者有子宫内膜癌漏诊的风险,尤其是长期月经紊乱、未生育的女性。子宫内膜不典型增生的治疗应采取个体化治疗方案。