摘要
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(P>0.05)。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。
Objective：To determine the incidence of endometrial cancer in patients un-dergoing hysterectomy for atypical endometrial hyperplasia,and study the factors that may be as-sociated with the misdiagnosis of endometrial carcinoma. Method：Perform a retrospective re-view of 132 women,who underwent hysterectomy for a preoperative diagnosis of endometrial a-typical hyperplasia. Value the missed diagnostic rate between hysteroscopy group and diagnostic curettage group. Compare the pre-operative, Intra-operative and post operative pathology. Re-sult：42 of the 132 patients had a endometrial carcinoma in the hysterectomy specimens. In the carcinoma cases 90. 38% wasⅠA stage,80. 95% was high differentiated. The misdiagnosis rate of endometrial carcinoma for hysteroscopy was 28. 57%,which was lower than that in diagnostic curettage cases of 32. 99%. We did not find any statistical association between anyone of age, menopausal status,body mass index,hypertension,diabetes mellitus and endometrial carcinoma cases. Long history of menstrual disorders,and no reproductive history suggests high risk of en-dometrial carcinoma. Conclusion：The missed diagnostic rate of endometrial carcinoma is high in the patients who has been diagnosed with endometrial atypical hyperplasia by diagnostic cu-rettage or hysteroscopy diagnosis,especially the ones who have a long time of menstrual disor-ders,or with no baby. Individual treatment scheme should be established for the endometrial a-typical hyperplasia patients.
出处
《现代妇产科进展》
CSCD
2014年第7期553-555,559,共4页
Progress in Obstetrics and Gynecology
基金
卫生行业科研专项(No:201002013)
关键词
子宫内膜不典型增生
子宫内膜癌漏诊
诊断性刮宫
宫腔镜检查
术中冰冻病理
Endometrial atypical hyperplasia
Missed diagnosis of endometrial carci-noma
Diagnostic curettage
Hysteroscopy diagnosis
Intra-operative frozen pathology
