子宫内膜癌患者的彩色多普勒超声参数及其与临床特征和预后的关系

目的探讨子宫内膜癌患者的彩色多普勒超声参数及其与临床特征和预后的关系。方法选择75例子宫内膜癌患者和70例子宫内膜增生患者,分别作为观察组和对照组。比较两组患者的彩色多普勒超声参数[阻力指数(RI)、搏动指数(PI)],分析不同临床特征子宫内膜癌患者的RI、PI。对子宫内膜癌患者进行2年随访,记录其预后情况,采用多元Logistic回归模型分析子宫内膜癌患者预后的影响因素。结果观察组患者的RI、PI均明显低于对照组,差异均有统计学意义(P﹤0.01)。不同年龄、组织学类型、淋巴结转移情况的子宫内膜癌患者的RI、PI比较,差异均无统计学意义(P﹥0.05)。不同临床分期、肌层浸润深度的子宫内膜癌患者的RI、PI比较,差异均有统计学意义(P﹤0.05)。Logistic回归分析结果显示,临床分期为Ⅲ~Ⅳ期、肌层浸润深度﹥1/2、RI≤0.41、PI≤0.53均是子宫内膜癌患者预后的独立危险因素(P﹤0.05)。结论彩色多普勒超声可显示子宫内膜癌患者的血流特征,为其预后评估提供可靠的影像学依据。     

阴道彩超血流参数与微血管密度参数鉴别子宫内膜病变类型及评估预后的价值

目的探讨阴道彩超血流参数阻力指数(RI)和搏动指数(PI)与微血管密度参数(MVD)鉴别子宫内膜病变类型及评估预后的价值。方法选取2017年7月至2019年11月间宝鸡市妇幼保健院收治的71例子宫内膜癌患者纳入子宫内膜癌组,纳入的126例子宫内膜增生患者纳入子宫内膜增生组。分别对各组患者采用阴道彩超测量其血流参数和组织切片微血管密度参数(MVD)值。结果子宫内膜癌组患者RI和PI水平低于子宫内膜增生组患者,MVD水平高于子宫内膜增生组患者,差异均有统计学意义(P <0.05)。子宫内膜癌Ⅰ、Ⅱ和Ⅲ期组患者的RI、PI和MVD水平比较,差异有统计学意义(P <0.05);子宫内膜癌Ⅰ组RI和PI均高于子宫内膜癌Ⅱ组和Ⅲ组,MVD低于子宫内膜癌Ⅱ组和Ⅲ组,差异均有统计学意义(P <0.05);子宫内膜癌Ⅱ组RI和PI均高于子宫内膜癌Ⅲ组,MVD低于子宫内膜癌Ⅲ组,差异有统计学意义(均P <0.05)。预后良好子宫内膜患者RI、PI水平均高于预后不良子宫内膜患者,MVD水平低于预后不良子宫内膜患者,差异均有统计学意义(均P <0.05)。经Pearson相关性分析显示,子宫内膜病变患者MVD与RI、PI值呈负相关,差异有统计学意义(P <0.05)。PI、RI、MVD联合对预测子宫内膜病变的敏感性、特异性显著高于单独检测,差异有统计学意义(P <0.05)。结论阴道彩超血流参数PI和RI及MVD水平变化与子宫内膜病变类型及预后密切相关,三者联合检测对子宫内膜病变患者预后评估有一定价值,可有效指导子宫内膜病变患者的治疗。     

子宫内膜癌三维超声血管血流参数与病理学预后指标的相关性

目的探讨子宫内膜癌三维超声血管血流参数与病理学预后指标的相关性。方法选择子宫内膜良性病变患者120例(良性组)与子宫内膜癌患者120例(癌变组),所有患者给予三维超声,记录血管血流参数;采用免疫组化法检测两组病灶病理学预后指标(IGF-1、IGF-2)表达情况并进行相关性分析。结果癌变组的超声病灶形态、内膜回声、增强强度、增强均度与良性组对比差异有统计学意义(P<0.05)。癌变组的IGF-1、IGF-2表达阳性率分别为90.8%、74.2%,显著高于良性组的28.3%、36.7%。癌变组中三维超声血流分级与良性组对比差异有统计学意义(P<0.05)。在癌变组中,直线相关分析显示三维超声血流分级与IGF-1、IGF-2表达阳性率呈显著正相关性(P<0.05)。结论子宫内膜癌患者多表现为IGF-1、IGF-2的高表达,三维超声血管血流分级程度比较高,两者存在相关性,可共同影响子宫内膜癌的发生。     

子宫内膜癌手术前后分期的相关性(附80例分析)

目的探讨子宫内膜癌临床分期与手术病理分期的差异及影响因素.方法对80例子宫内膜癌患者中术前有临床分期的67例患者与术后手术病理分期比较,分析两种分期的差异,并分析影响子宫内膜癌临床分期的因素.结果67例术前有临床分期的子宫内膜癌患者中48例与手术病理分期相符,误差为28.36%.分析80例子宫内膜癌患者临床分期的影响因素中绝经前后、孕产次对内膜癌肌层浸润及浸润深度影响有临床意义(P＜0.05),而合并子宫肌瘤、子宫腺肌症则对病灶肌层浸润及浸润深度影响无临床意义.结论对于子宫内膜癌患者术前行临床分期应综合多因素评估,以提高临床分期的准确性,正确指导治疗与改善预后.     

术前中性粒细胞/淋巴细胞比值与子宫内膜癌分期术患者预后的关系

目的探讨子宫内膜癌患者行分期术前中性粒细胞和淋巴细胞比值(NLR)对预后评估的价值。方法收集2009—2011年152例在徐州医科大学附属医院行子宫内膜癌分期术患者的临床资料,并做回顾性分析。以中位数NLR=2.78作为临界值,分为低NLR(NLR2.78)和高NLR(NLR≥2.78)两组,对两组患者的临床病理特征进行比较,单因素及Cox多因素评估NLR对子宫内膜癌复发及预后的影响。结果两组患者在手术病理分期、病理分级、肌层浸润深度、淋巴结转移及肿瘤标本大小的差异有统计学意义(P0.05)。单因素分析显示手术病理分期、病理类型、淋巴结转移及术后辅助治疗、NLR是患者预后的影响因素(P0.05)。Cox多因素分析显示手术病理分期、淋巴结转移和NLR是影响患者无瘤生存期的独立因素(P0.05),也是影响患者总生存期的独立因素(P0.05)。结论术前高NLR可作为子宫内膜癌分期术后复发的独立因素,也是影响其预后的独立因素。     

三维超声血管血流参数对子宫内膜癌患者腹腔镜治疗预后的评估价值

目的 分析三维超声血管血流参数对子宫内膜癌(EC)患者腹腔镜治疗预后的评估价值。方法 选择接受腹腔镜根治术治疗的160例EC患者为研究对象，术后随访24个月，将随访期间患者疾病复发情况作为预后观察指标并分组，分为预后不良组与预后良好组，调查并记录患者相关资料、随访期间最后一次检查时三维超声血管血流参数[平均灰阶值(MGV)、阻力指数(RI)、血管-血流指数(VFI)],分析三维超声血管血流参数对EC患者腹腔镜治疗预后的评估价值。结果 腹腔镜治疗后随访24个月，160例患者中预后不良20例，占12.50%。预后不良组患者三维超声血管血流参数RI值小于预后良好组患者，VFI值大于预后良好组患者，差异有统计学意义(P<0.05);RI、VFI单独及联合检测评估EC患者腹腔镜治疗预后不良的AUC分别为0.850、0.878、0.893,均有一定评估价值，且当RI、VFI分别取0.435、4.840时，可获得最佳评估价值。结论 三维超声血管血流参数对EC患者腹腔镜治疗预后具有一定评估价值。     

年轻妇女子宫内膜癌预后相关因素分析

目的探讨年轻妇女子宫内膜癌预后相关因素。方法回顾性分析2008年3月至2011年3月收治的年龄<40岁的年轻妇女子宫内膜癌患者185例,根据随访3年后的最终结果分为死亡组与生存组,对临床资料、预后相关因素进行分析。结果经随访3年发现,年轻妇女子宫内膜癌患者3年生存率为87.3%。死亡组与生存组患者比较,在BMI、ER(+)、PR(+)、合并PCOS、病理分期、肌层浸润深度、宫颈浸润情况和淋巴结转移方面差异有统计学意义(P<0.05)。结论 BMI、ER(+)、PR(+)、病理分期、淋巴结转移是影响子宫内膜癌预后的独立危险因素,BMI较大,ER(+)及PR(+)率较低,病理分期较晚,且有淋巴结转移的患者预后可能较差。     

I型子宫内膜癌患者血清维生素D与睾酮的水平及其临床意义

目的:探讨I型子宫内膜癌患者血清维生素D ［vitamin D,25（OH）D］与睾酮(testosterone，T)水平及其与临床病理特征的关系。方法:选取我院I型子宫内膜癌患者30例为观察组，另外选择同期入院的子宫内膜良性肿瘤患者30例为对照组。采用化学发光法对两组患者血清25（OH）D及T进行测定分析。比较两组患者血清25（OH）D及T水平，25（OH）D及T与临床病理参数间的关系。 结果:观察组患者血清25（OH）D水平显著低于对照组，而血清T水平显著高于对照组（P＜0.05)。观察组患者血清25（OH）D表达水平与I型子宫内膜癌患者绝经前后、ER、PR是否阳性无明显相关性(P＞0.05)，而与I型子宫内膜癌患者FIGO分期、分化程度、淋巴结有无转移、肌层浸润程度呈明显相关(P＜0.05)；血清T表达水平与I型子宫内膜癌患者绝经前后、ER、PR是否阳性无明显相关性(P＞0.05)，而与I型子宫内膜癌患者FIGO分期、分化程度、淋巴结有无转移、肌层浸润程度呈明显相关(P＜0.05)。观察组患者血清T与25（OH）D水平呈现负相关性。结论:I型子宫内膜癌患者血清25（OH）D水平明显降低，而T水平明显升高，二者呈现负相关关系，且二者分别与子宫内膜癌的不同临床病理参数相关，可能是I型子宫内膜癌患者发生、病程进展及预后的重要评价指标。     

子宫内膜癌组织中PCNA、MVD的检测及其意义

背景与目的:子宫内膜癌发病率呈逐年上升趋势,但其确切发病机制及预后因素尚不明确。本实验旨在研究增殖细胞核抗原(proliferating cell nuclear antigen.PCNA)指数、微血管密度microvessel density.MVD雪在子宫内膜癌组织中的表达,并结合肿瘤的手术病理分期、病理分级,进一步判断其价值。方法:采用免疫组织化学SP法,检测62例子宫内膜腺癌、22例正常子宫内膜组织的PCNA指数和MVD,结合肿瘤的临床分期、病理分级,对结果进行统计学分析。结果:子宫内膜癌组织中PCNA指数(54.49±9.29)和MVD(48.97±8.56)较正常子宫内膜明显增高(P<0.05);子宫内膜癌的期别越晚、分化越差,PCNA指数和MVD越高(P<0.05);在子宫内膜癌组织中,PCNA指数与MVD呈正相关。结论:PCNA指数、MVD增高与子宫内膜癌的发展有关;血管生成促进肿瘤细胞增殖。     

超声造影在早期子宫内膜癌分期诊断中的价值及临床病理特征分析

目的 分析超声造影在早期子宫内膜癌分期诊断中所体现的价值和临床病理特征.方法 采用随机取样法选取90例子宫内膜癌和20例子宫内膜良性病变进行超声造影检查;对IL-17在90例子宫内膜癌组织及周边组织、20例正常或良性病变组织中的基因序列表达应用免疫组织化学染色法(SP法)进行检测.结果 细胞质为IL-17在子宫内膜癌组织中的主要表达场所,其在癌组织及周边组织表达阳性或是弱阳性,但不表达于未发生病变的内膜组织.IL-17的表达水平在患者年龄、病变组织大小、分化进程多方面无明显统计学差异,但相较于淋巴结阴性组,该基因序列的表达发生概率在淋巴结转移组则明显偏高(P<0.05).子宫内膜癌微血管生成在IL-17高表达组增多,其表达水平和MVD正相关,取2组数据进行比较,差异有统计学意义(P=0.025);IL-17在子宫内膜癌组织中的高表达与时间-强度曲线"速升速降"型和超声造影"高增强"模式均呈现正相关,取2组数据进行比较,差异有统计学意义(P<0.05).结论微血管化促使IL-17的高表达,明显体现在子宫内膜癌并且发生转移的患者体内,表明子宫内膜癌形成过程极有可能受到IL-17的影响.IL-17在患者体内的高表达与高增强超声造影、TIC的结合对早期子宫内膜癌的分期诊断较为有效,具有临床应用价值.     

多普勒超声检查甲状腺癌患者的血流动力学指标及其与淋巴结转移的关系研究

目的探讨彩色多普勒超声检查甲状腺癌患者的血流动力学指标,以及血流动力学指标与颈部淋巴结转移的关系。方法将60例甲状腺癌患者根据颈部淋巴结是否转移分为淋巴结转移组和无淋巴结转移组,同时选取60名健康体检者作为对照组。使用多普勒超声进行血流成像,观察肿瘤的血流分布,并进行Adler血流分级,同时测算肿瘤血流速度(PSV)、搏动指数(PI)及阻力指数(RI)。结果淋巴结转移组和非淋巴结转移组甲状腺癌患者的PSV、PI和RI均明显高于对照组,差异均有统计学意义(P﹤0.01);同时淋巴结转移组甲状腺癌患者的PSV、PI明显高于无淋巴结转移组,RI明显低于无淋巴结转移组,差异均有统计学意义(P﹤0.01)。淋巴结转移组和无淋巴结转移组甲状腺癌患者Adler血流分级均主要集中在2级、3级,两组Adler血流分级,血流检出率和2、3级血流检出率比较,差异均无统计学意义(P﹥0.05)。结论多普勒超声检查能对甲状腺癌患者血流动力学指标进行有效评估,同时为术前评估患者是否伴有颈部淋巴结转移提供参考。     

Clinical usefulness of color Doppler ultrasound in patients with endometrial hyperplasia and carcinoma

BACKGROUND: The objective of this study was to examine the usefulness of transvaginal color Doppler ultrasound (TV-CDU) in differentiating between endometrial hyperplasia (EH) and endometrial carcinoma (EC) and in predicting tumor spread in patients with EC. METHODS: Seventy-one postmenopausal patients were enrolled with either EH or EC that had been diagnosed by endometrial biopsy. The presence or absence of intratumoral blood flow was assessed by TV-CDU. The intratumoral blood flow characteristics were analyzed using the resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). The endometrial thickness also was measured in all patients by gray-scale sonography. The correlation of these sonographic findings with histologic type, tumor grade, surgical stage, myometrial invasion, or the presence or absence of pelvic lymph node metastasis was then evaluated in patients with EC. RESULTS: Although there were no patients with EC with endometrial thickness measuring < 5 mm, no significant difference was found in the mean value of endometrial thickness between patients with EH (n = 18 patients; 16.2 mm +/- 15.9 mm) and patients with EC (n = 53 patients; 18.7 mm +/- 17.1 mm). Intratumoral blood flow was detected in significant numbers of patients who had EC (71.7%; 38 of 53 patients) compared with patients who had EH (5.6%; 1 of 18 patients; P < 0.0001). Thus, no patients with EH showed any blood flow in the endometrial lesions, except for one patient who had EH complicated by pyometra. In patients with EC, the positive rate of intratumoral blood flow was correlated significantly with myometrial invasion, tumor grade, and pelvic lymph node metastasis (P < 0.05; Cochran-Armitage trend test). No associations were found between RI, PI, or PSV and the clinicopathologic parameters examined, including surgical stage. CONCLUSIONS: TV-CDU may be more useful in differentiating between EH and EC than measuring endometrial thickness by transvaginal gray-scale sonography. For patients with EC, the detection of intratumoral blood flow may be helpful in distinguishing between low-grade and high-grade tumors and predicting myometrial invasion. However, intratumoral blood flow analysis using RI, PI, or PSV may not be useful for predicting tumor spread before surgery.     

经阴道彩色多普勒超声病灶内微血管与早期宫颈癌预后发展的关系

目的 探讨经阴道彩色多普勒超声病灶内微血管情况与早期宫颈癌的预后情况的关系,给予早期宫颈癌的诊疗及预后评估提供参考依据.方法 收集80例宫颈浸润癌患者的完整临床资料,采用统计学方法分析经阴道彩色多普勒超声早期宫颈癌病灶内血管生成、血流参数情况与其经手术治疗后的临床预后指标及病理特征的相关性.结果 宫颈癌病灶内微血管血流丰富与临床Ⅱ期、间质浸润≥10.0 mm、脉管受累、肿瘤直径≥15.0 mm、宫旁浸润≥10.0 mm、淋巴结转移相关(P<0.05);PI及RI与间质浸润深度、有无转移存在相关性(P<0.05),不同血流情况组术前超声早期宫颈癌病灶微血管情况(PI、RI、血流情况)比较差异有统计学意义(P<0.05),丰富血流组的PI、RI明显低于血流不丰富及血流不明显组(P<0.05).不同预后风险组术前超声早期宫颈癌病灶微血管情况(PI、RI、血流情况)比较差异有统计学意义(P<0.05),高风险组的PI、RI明显低于中、低风险组,血流也比低风险组更加丰富(P<0.05).结论 经阴道彩色多普勒超声病灶内微血管情况与早期宫颈癌的预后发展存在相关性,宫颈癌灶内血流情况及血流动力学参数可用于预测早期宫颈癌的预后.     

彩色多普勒超声对卵巢肿瘤血流参数与微血管密度相关性的评估价值

目的探讨卵巢肿瘤血流参数与微血管密度的相关性。方法收集卵巢肿瘤患者62例作为研究对象,依据术后病理确诊结果分为良性组30例以及恶性组32例。2组患者均于术前使用彩色多普勒超声及免疫组化检查。记录并比较2组彩色多普勒超声血流参数与微血管密度,探讨其相关性。结果恶性组患者彩色多普勒信号分级以Ⅲ~Ⅳ级为主,良性组患者以Ⅰ~Ⅱ级为主,不同FIGO分期患者彩色多普勒信号分级存在统计学差异(P<0.05)。恶性组患者血管波动指数(PI)及阻力指数(RI)均明显低于良性组患者,微血管密度明显高于良性组患者;FIGO分期越高,PI及RI越低,微血管密度越高(P<0.05)。卵巢肿瘤彩色多普勒超声血流参数PI及RI分别与微血管密度呈负相关(γ1=-0.563,P=0.001;γ2=-0.645,P=0.000)。结论卵巢肿瘤彩色多普勒超声血流参数与微血管密度存在负相关性,可用于早期诊断中血管形成情况的评估,具有重要的临床价值。     

静脉滴注缩宫素对子宫肌瘤患者超声检查的影响

目的探讨静脉滴注缩宫素对子宫肌瘤患者超声检查的影响。方法对收治的87例子宫肌瘤患者进行多普勒超声检查,分析静脉滴注缩宫素前后平均血流速度(Vm)、收缩期峰值速度(PSV)、阻力指数(RI)、动脉血流量、血管管径的变化。结果静脉滴注缩宫素后,子宫肌瘤周围及内部供血大动脉Vm、PSV、血流量、血管管径均显著降低,而RI明显增大,与滴注前差异有统计学意义(P<0.05)。结论静脉滴注缩宫素可以减少肌瘤血供,使超声血流信号参数发生改变,临床检查时要综合分析,避免发生误诊、漏诊。     

Correlative study of angiogenesis in endometrial cancer assessed by the color Doppler ultrasound and by the chick embryo chorioallantoic membrane

Angiogenesis is required for both tumor growth and progression and the degree of vascularization seems to correlate with prognosis in several human tumors including uterine malignant neoplasms. In this study we have investigated if three Doppler parameters, such as peak systolic velocity (PSV), resistance index (RI) and pulsatily index (PI), measured in patients with endometrial cancer, were correlated to the angiogenic response induced by grafting of bioptic specimens obtained from the same patients onto the chick embryo chorioallantoic membrane (CAM), a useful in vivo model for such an investigation. Results showed that only PSV was directly correlated to the degree of angiogenesis measured by means of the CAM assay. Moreover, these two parameters were also directly correlated to the malignancy grade of the disease.     

Transvaginal color Doppler ultrasonic characterization of benign and malignant ovarian cystic teratomas and comparison with serum squamous cell carcinoma antigen

BACKGROUND: The preoperative diagnosis of squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary remains difficult. The purpose of this study is to examine the usefulness of transvaginal color Doppler ultrasound (TV-CDU) in differentiating malignant (SCC) from benign cystic teratoma of the ovary. METHODS: Eighty-eight patients with an ovarian tumor showing gray scale sonographic appearances of mature cystic teratoma were preoperatively evaluated for the presence or absence of intratumoral blood flow by TV-CDU. The blood flow characteristics of the tumor vessels were analyzed using the resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). The serum levels of SCC antigen were also randomly examined preoperatively in 50 patients. RESULTS: Intratumoral blood flow was significantly detected in malignant teratomas (SCCs) (80.0%; 4 of 5) compared with benign teratomas (20.5%; 17 of 83) (P < 0.01). All malignant teratomas with intratumoral blood flow showed both RI less than 0.4 and PI less than 0.6, whereas no benign teratomas showed any such value except for 1 case with struma ovarii. In addition, both the mean RI and the mean PI values in the tumor vessels were significantly lower in the malignant teratomas (RI: 0.31 +/- 0.07; PI: 0.40 +/- 0.16) than in the benign teratomas (RI: 0.62 +/- 0.13; PI: 1.06 +/- 0.44) (P < 0.001). However, the mean PSV value of the malignant teratomas (PSV: 20.6 +/- 8.33) was not significantly different from the benign teratomas (PSV: 18.1 +/- 9.9). Elevation of serum SCC was found in 4 of 5 patients (80%) with malignant teratomas, whereas the elevation was found in 11 of 45 patients (24.4%) with benign teratomas (P < 0.05). The diagnostic accuracy using the RI (cutoff value 0.4) as well as the PI (cutoff value 0.6) was thus 95.2%, which was significantly superior to that obtained by using the serum SCC (76%) (cutoff value, 1.5 ng/mL). CONCLUSIONS: Evaluating the presence or absence of intratumoral blood flow, together with blood flow resistance, in tumor vessels using TV-CDU thus may be more useful to differentiate malignant (SCC) from benign cystic teratomas of the ovary than by measuring serum SCC levels.