子宫内膜癌宫腔镜下特征的临床分析

目的探讨子宫内膜癌宫腔镜下的图像特征,提高临床医师宫腔镜下诊断子宫内膜癌的准确率。方法2003年1月至2005年12月,采用宫腔镜检查阴道异常流血妇女213例。首先,观察宫颈管的形态,有无异常隆起的新生物及其表面的血管形态。随后,检查宫底和宫腔前、后、左、右壁,再检查子宫角及输卵管开口,注意宫腔形态、有无子宫内膜异常,尤其注意有无异常新生物,并记录病变的部位、大小和血管走行,必要时对可疑之处进行定位活检。结果213例接受检查的患者镜下诊断为子宫内膜癌21例,其中病理组织学证实为子宫内膜腺癌20例,符合率达95.2%。本组病灶呈菜花样新生物者9例,占45.0%;弥漫型病变6例,占30.0%;局灶性息肉状物5例,占25.0%。宫腔镜下内膜癌病灶多呈灰白、灰黄或暗红色,且缺乏光泽,常伴有坏死、出血、感染;清除表面坏死、出血、感染分泌物后,可见病灶表面血管怒张,血管走向不规则、迂曲等恶性肿瘤的特征。结论宫腔镜下子宫内膜癌具有典型的特征性图像,直视下对可疑病灶进行的定位活检和病理学检查是临床诊断早期子宫内膜癌的主要方法。

Clinical analysis of endometrial carcinoma features under hysteroscope

Objective Probing image features of endometrial carcinoma(EC)under hysteroscope so as to promote accuracy in diagnosing EC under hysteroscope by clinicians.Methods During the period of January 2003 to December 2005,213 patients with abnormal vaginal bleeding were identified by examinations under hysteroscope.Cervical forms and vascular forms on the cervical surface were examined to see whether there were any abnormally projecting neoplasms,followed by checking the fundus of uterus;anterior,posterior,left and right walls of uterine cavities;uterine horn and oviduct mouth in order to observe the cervical forms and find whether there was any endometrial abnormity,especially any abnormally neoplasms.Pathologic sites and sizes and vascular paths were recorded,and if necessary,local biopsies were performed for suspicious areas.Results 21 cases out of the 213 cases taking part in the examination were diagnosed as EC under hysteroscope,of which 20 cases were confirmed as adenocarcinoma of endometrium by histopathology,with a consilient rate as 95.2%.As regards foci in the group,9 cases presented cauliflower-like neoplasms,accounting for 45.0% while 6 cases presented diffuse lesions,accounting for 30.0% and 5 cases presented something like focal polypi,accounting for 25.0%.Under hysteroscope,the majority of EC appeared as grayish white,grayish yellow or dark red,lack of lusters,and with necroses,hemorrhage,infections.Features characteristic of malignant tumors such as vascular engorgement,irregular and wound vascular paths could be easily identified after removal of surficial necroses,hemorrhage,infections.Conclusion EC is of typical images under hysteroscope.Local biopsies for suspicious foci under direct vision and pathological examinations are major methods to clinically diagnose early EC.