108例子宫内膜癌临床病理分析

目的 :阐明子宫内膜癌的临床病理特点 ,肿瘤的生物学行为 ,为临床早期诊断和选择合适手术提供参考。方法 :回顾性分析 1998年 2 0 0 2年门诊和住院手术的子宫内膜癌 10 8例 ,观察患者的发病年龄 ,症状特点 ,尤对 90例手术病例的病理特点、肿瘤的浸润转移情况作详细观察。结果 :发病年龄比以往文献报道略宽 ,阴道不规则出血占 97.2 % ,≤ 45岁确诊前平均流血时间 3 8.1个月 ,>45岁者为 7.8个月。就子宫颈受累情况而言 ,诊刮结果与全子宫切除标本符合率为 61.90 % ,假阳性率 3 9.71% ,假阴性率 3 1.3 %。浆乳癌和透明细胞癌子宫旁浸润率为 10 0 % ,卵巢、肠道、大网膜、盆腔淋巴结的转移率均为 66.7% ,明显高于内膜样腺癌 ,P <0 .0 5。腺鳞癌的淋巴结转移率高于普通内膜样腺癌 ,P <0 .0 5 ,病理分级越高 ,深肌层浸润率和淋巴结转移率越高 ,G3明显高于G1和G2 ,P <0 .0 5和P <0 .0 1。结论 :重视阴道不规则出血 ,及时诊断性刮宫是子宫内膜癌早发现、早诊断、早治疗的前提。颈管诊刮的假阳性率和假阴性均较高 ,是今后医疗工作中需注意的问题。子宫内膜癌旁浸润和卵巢转移率较高 ,术中须注意子宫旁组织和卵巢的处理。浆乳癌和透明细胞癌生物学行为最为恶劣 ,易子宫外浸润和盆外转移 ,手术范围宜广、宜彻底。

Clinical pathologic analysis of endometrial carcinoma in 108 cases

Objective To clarify the clinical pathologic characters and biological behavior of endometrial carcinoma to give reference to early diagnosis and rational operation treatment.Methods A retrospective study was done in 108 patients with endometrial carcinoma in out-patient and in-patient department from 1998 to 2002,to observe the episode (onset off illness),ages,symptom,characters,especially the pathologic characters,invasions and metastases in 90 operated patients.Results The oneset age was a little broader than it used to be reported.Abnormal vaginal bleeding accounted for 97.2%.The mean bleeding time before diagnosis was 38.1 months in the patients before the age of 45,and 7.8 months after 45.As cervical invasion was concerned about the coincidence rate of curettage and hysterectomy was 61.90%.The false-positive was 39.71%.The false-negative was 31.3%.The parauterine invasion rates of uterine papillary serous carcinoma(UPSS) and clear cell carcinoma were 100%,and the metastasis rate of ovary,bowel,omentum majus and pelvic lymph nodes was 66.7%,which was particularly higher than endometrioid adenocarcinoma(P<0.05).The nodal metastasis rate of adenosquamous carcinoma was higher than classic endometrioid adenocarcinoma(P<0.05).Higher pathologic grade was associated with higher rates of deep myometrial invasion and nodal metastasis.Grade 3 was obviously higher than grade 1 and 2(P<0.05 and P<0.01).Conclusion To think highly of abnormal vaginal bleeding and fractional curettage in time is the premise of early detection,early diagnosis,early treatment of endometrial carcinoma.It is particularly important to young patients.Adequate attention should be paid to the high false-positive and false-negative of endocervical curettage.The rates of parauterine invasion and ovarian metastasis of endometrial carcinoma are high,which should be noticed in the operation.The biological behavior of UPSC and clear cell carcinoma is the worst,and it is easy to metastasize to extrauterine and extrapelvic,so extensive operation is recommended.Adenosquamous carcinoma and endometrioid adenocarcinoma of grade 3 are also easy to invade and matastasize.Pelvic lymphadenectomy is necessary.