宫腔镜在诊断子宫内膜癌及癌前病变中的价值

目的 探讨宫腔镜检查对子宫内膜癌和子宫内膜癌前病变的诊断价值。方法 回顾分析1994年4月至1999年2月206例具有临床症状伴子宫内膜癌高危因素行宫腔镜检查病列。结果 宫腔镜诊断子宫内膜癌及可疑癌37例（18.0%）,经病理证实为癌者22例（10.7%）,19例进行了手术,术后病理证实宫颈管受侵4例,未受侵15例,与之相比,手术前宫镜诊断符合率为94.7%。术中腹水细胞学检查15例,阴性13例,阳性1例,可疑1例。206例中经病理证实I～Ⅲ级非典型增生12例,而宫腔镜下诊断为可疑癌4例,增生4例,正常或萎缩子宫内膜3例,内膜结核1例。结论 宫腔镜检查直观病灶,准确活检,适用于早期诊断,同时明确病灶部位和范围,提高宫颈管受侵与否的诊断率,但是宫腔镜下难以区别各类型子宫内膜增生性质。     

宫腔镜下全面评估和病灶去除在子宫内膜癌保留生育治疗中的价值

宫腔内多部位、多灶性病变是子宫内膜癌的主要特点之一,通过药物或机械方法全面抑制病灶增殖或去除病灶是提升子宫内膜癌保留生育功能治疗完全缓解率的重要一环.另一方面,作为承担胚胎种植和发育重要功能的器宫,在子宫内膜癌治疗过程中尽最大可能保护正常子宫内膜功能是改善子宫内膜癌保留生育治疗完全缓解后妊娠率和妊娠结局的关键因素.如何...     

年轻早期子宫内膜癌保留生育功能治疗

随着女性生育年龄的推迟,年轻早期子宫内膜癌患者比例将会逐步升高。考虑到多数年轻早期子宫内膜癌患者具有肿瘤分化程度好、病变局限和对孕激素治疗有效等特点,保留生育功能的治疗方式逐渐受到重视。文章就此问题进行简要阐述。     

磁共振在子宫内膜癌诊治中的应用

子宫内膜癌是最常见的女性生殖系统三大恶性肿瘤之一,严重威胁女性健康。磁共振(MRI)具有良好的软组织分辨率,能多方位、多序列成像,在子宫内膜癌术前诊断和分期中起着重要的作用。常规序列在子宫内膜癌的诊断中具有重要价值,但也存在局限性,以扩散加权成像和动态增强MRI为代表的功能成像在子宫内膜癌的诊断和分期方面有着巨大的潜能。文章就MRI的常规扫描技术、功能成像技术以及子宫内膜癌MRI诊断的现状展开讨论。     

宫腔镜在子宫恶性肿瘤诊治中的应用与思考

宫腔镜检查加直视下活检诊断子宫内膜癌较超声、诊断性刮宫等方法可靠,对萎缩性子宫内膜的诊断更具优越性。宫腔镜手术治疗子宫恶性肿瘤正在探索中。宫腔镜检查有促使瘤细胞腹腔内扩散的可能,是否影响患者预后尚无定论。     

宫腔镜技术诊断子宫内膜癌的临床应用

宫腔镜检查目前是对可疑患有子宫内膜癌女性的金标准检查手段。但子宫内膜肿瘤细胞有机会在宫腔镜检查过程中脱落,并随着液体流入腹腔而发生被动转移。因此,宫腔镜在子宫内膜癌患者中的应用仍存在争议。文章阐述了对可疑患有子宫内膜癌的女性,接受诊断性宫腔镜检查中肿瘤转移风险的认识,保证手术安全所需的条件,以及宫腔镜在早期子宫内膜癌患者保留生育能力中的应用。根据目前的数据,可得出如下结论：（1）宫腔镜检查用于诊断早期子宫内膜癌是安全有效的方法。（2）操作过程中必须严格控制膨宫压力,以减少子宫内膜肿瘤细胞在腹腔内被动转移的风险。（3）在早期子宫内膜癌患者中,宫腔镜手术联合药物治疗是保留生育能力最有效的治疗方法。     

子宫内膜癌保留生育功能的治疗进展

子宫内膜癌是最常见的妇科恶性肿瘤之一,5%发生在40岁以下的妇女,年轻子宫内膜癌患者常强烈要求保留生育功能。生育年龄子宫内膜癌患者症状(月经异常)出现早,多为早期、分化程度好、且多数为性激素依赖型,预后较好。现已有早期子宫内膜癌采用保守手术及激素(通常为孕激素)治疗成功且保留生育功能、成功分娩的报道,现就子宫内膜癌保留生育功能治疗的现状做一综述。     

宫腔镜手术诊治子宫内膜癌的研究

子宫内膜癌发病率逐年上升,寻找有效诊治手段愈显重要。宫腔镜检查直观、可定位活检,已成为子宫内膜癌诊断和分期的重要手段。宫腔镜检查可提高早期子宫内膜癌诊断率,但是否引起癌细胞腹膜腔内扩散有争议。利用宫腔镜注射追踪剂探测前哨淋巴结安全可行,可为子宫内膜癌的治疗提供新手段。宫腔镜手术微创,可保留子宫,不破坏盆腔解剖结构,不影响卵巢功能,已逐渐尝试性用于治疗有手术禁忌证的子宫内膜癌患者。宫腔镜检查还可用于子宫内膜癌腔内放疗前准确定位、放疗后观察疗效与随访。     

早期子宫内膜癌生育力保护的治疗和长期管理

强烈渴望保留生育功能的高分化子宫内膜样癌、无肌层浸润的年轻患者可以保留生育功能。可采用的治疗方案包括：体重管理、大剂量孕激素、左炔诺孕酮宫内缓释系统、其他抗雌激素类药物[促性腺激素释放激素激动剂（GnRH-a）或芳香化酶抑制剂]、宫腔镜病灶切除手术以及二甲双胍治疗。辅助生殖技术可以显著增加患者的妊娠率,并且不影响患者生存。在完成生育功能后需进行根治性手术,年轻患者可考虑保留双侧卵巢。     

宫腔镜对诊断子宫内膜癌的价值

目的 探讨宫腔镜检查对子宫内膜癌和子宫内膜增生的诊断价值。方法 对206例具有临床症状伴子宫内膜高危因素者行宫腔镜检查的结果进行回顾性分析。结果 宫腔镜下诊断为子宫内膜癌及可疑癌共37例(18.6％),经病理证实为子宫内膜癌22例,其中19例进行了手术,术后病理报告宫颈管未受侵15例,受侵4例,与术前宫腔镜诊断符合率94.7％。术中腹水细胞学检查阴性13例,阳性1例,可疑1例。206例中经病理证实Ⅰ～Ⅲ级非典型增生12例,宫腔镜诊断分别为:可疑癌4例,子宫内膜增生3例,正常或萎缩宫内膜4例,内膜结核1例。结论:宫腔镜检查直观病灶,准确定位活检,尤其适用于早期诊断。另外宫腔镜检查能够明确病灶部位和范围,提高宫颈管术前是否受侵的诊断率。     

子宫内膜癌保留生育功能的治疗

对于年轻未生育子宫内膜癌患者的治疗目前存在较多争议。文章结合临床实践体会和文献报道,重点就其适应证选择、治疗前评估、治疗方案、疗效评价、病情监测、治疗后的生育问题、完成生育后的处理等做一阐述。     

腹腔镜在子宫内膜癌治疗中的应用

随着腹腔镜和能量设备的不断发展以及腹腔镜手术技术的日益提高,腹腔镜下子宫内膜癌手术成为最早成熟的妇科恶性肿瘤手术方式,无论在总生存率、无瘤生存率、手术时间、术中出血以及并发症和生活质量等方面都获得了与开腹手术相同或更好的结果,其在子宫内膜癌治疗中的作用日益显现,成为医生最易于应用和患者乐于接受的首选治疗方式。     

宫腔镜直视下活检及分段诊刮术与单纯分段诊刮术在子宫内膜癌诊断中的应用价值

目的对照研究宫腔镜直视下活检及分段诊刮术与单纯分段诊刮术在子宫内膜癌诊断中的应用价值。方法北京大学人民医院从2002年7月至2010年2月收治子宫内膜癌患者287例,分为宫腔镜直视下活检及分段诊刮(A)组90例,和单纯分段诊刮(B)组197例,比较两组术前病理诊断子宫内膜癌的准确性,判断宫颈受累的可靠性,比较两组腹腔冲洗液阳性率的差别及3年和5年总生存率的差异。结果 A组术前病理诊断的准确率为97.8%(88/90),B组为88.8%(175/197),差异有统计学意义(P<0.05)。A组宫颈受累估计的敏感度、准确率、阳性预测值、阴性预测值分别为77.8%,97.8%,100%和97.6%;B组分别为65.3%,85.8%,74.4%和89.0%。A组腹腔冲洗液阳性率为5.56%(5/90),B组为6.09%(12/197),差异无统计学意义(P>0.05)。A组3年总生存率为91.7%(33/36),5年总生存率为82.4%(14/17),B组分别为95.6%(87/91)和86.7%(39/45)。3年和5年总生存率间比较,差异均无统计学意义(P>0.05)。结论宫腔镜直视下活检及分段诊刮可提高术前子宫...     

Re-evaluation of hysteroscopy in the diagnosis of uterine endometrial cancer

To evaluate the clinical value of hysteroscopy in the management of endometrial cancer, findings in 3,681 patients with endometrial cancer treated between 1985 and 1989 at 167 hospitals in Japan were analyzed. In 1,040 of these patients, hysteroscopy was performed before operation. Pre-operative staging by fractional curettage with or without hysteroscopy was compared with post-operative histological diagnoses. The accuracy rates of diagnosis at final stages I and II were 91.4% and 79.4%, respectively, with hysteroscopy. There figures were not significantly different from those of 91.4% and 77.7% without hysteroscopy. The accuracy rate for diagnosis at the final stage I was 98.0% with the hystero-fiberscope and significantly higher than that with rigid hysteroscopy (86.0%). Tumor cells in the pelvic cavity were examined at the time of operation in 1,115 patients. Tumor cells were found in 8.5% of those in stage I, 18.8% of those in stage II, 64.7% of those in stage III and 75.0% of those in Stage IV by hysteroscopy. These values were not significantly different from those of 7.3%, 22.7%, 57.1% and 81.1%, respectively, observed without hysteroscopy. These findings indicate that hystero-fiberscopy might be valuable for the pre-operative diagnosis of endometrial cancer, but has no effect on cytological malignancy in the peritoneal cavity.     

Coexisting endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia

AIM: To investigate the possibility of coexisting endometrial cancer (EC) in patients with atypical endometrial hyperplasia (AEH). METHODS: Forty-six consecutive women who underwent hysterectomy for AEH were analyzed. RESULTS: Final histopathological evaluation of hysterectomy specimens revealed EC in 11 patients (23.9%). Preoperative diagnosis of AEH was established by pipelle biopsy in eight patients and curettage was performed in the remaining patients. Of the patients with pipelle biopsy, two had a diagnosis of EC (25%), whereas nine women who underwent curettage, were further diagnosed as having EC (23.7%) (P > 0.05). Four (13.3%) of 30 women who had frozen sections at hysterectomy, were diagnosed with EC. Diagnosis of EC was missed in two patients (50%) at frozen section. In contrast, seven of 16 women (43.7%) who did not have frozen section, had EC. CONCLUSION: A relatively high incidence of EC is seen in patients with a diagnosis of AEH. Diagnostic results of pipelle biopsy and curettage were comparable. Frozen sections of hysterectomy specimens does not guarantee to exclude the possibility of EC, especially in patients with no myometrial invasion.     

The role of hysteroscopy in early diagnosis of endometrial cancer

The aim of this retrospective study was to compare stage, disease-free survival and overall survival in patients suffering from endometrial cancer who underwent hysteroscopy and those who did not. Between January 1, 1990 and June 30, 2001, 181 patients were referred to our Gynaecologic Department for primary endometrial carcinoma; from clinical charts we reviewed the personal and pathological data of all patients. Patients were divided into two groups: those with hysteroscopy (69 patients) and those without (112 patients). Endometrial biopsy was performed at the end of hysteroscopy. We compared symptoms at diagnosis, stage and survival. Hysteroscopy demonstrates a high diagnostic accuracy for endometrial cancer. In our case series we obtained a sensitivity of 93.10%, specificity of 99.96%, positive predictive value of 98.18% and negative predictive value of 99.85%; when hysteroscopy was associated with endometrial biopsy the sensitivity was 96.55% and specificity 100%. In this study we had a significant difference in stage Ia; in the group with hysteroscopy, stage Ia cases were 23.2% while in the group without, stage Ia cases were 15.2%. Survival in stage Ia only was 100% and 91.7%, respectively, at three and five years. In conclusion hysteroscopy was found to have a very important role in the early diagnosis of endometrial cancer, especially when it is limited to the mucosal surface.     

The role of hysteroscopy in diagnosis and management of endometrial cancer

Endometrial sampling for histopathology examination is essential to diagnose endometrial cancer. There are many ways to obtain the specimen including endometrial biopsy or hysteroscopy. Hysteroscopy provides an accurate evaluation of the endometrial cavity and allows directed sampling of suspected lesion. However, there have been concerns that endometrial cells could be flushed into the fallopian tubes and the peritoneal cavity. We performed a literature search using the key words “endometrial cancer,” ”endometrial sampling,” “dilation and curettage” (D&C), “hysteroscopy,” and “cancer cells dissemination” and conducted the search in the Medline, EMBASE, and the Cochrane of Database of systematic reviews. Endometrial cell dissemination could occur after hysteroscopy as well as after endometrial biopsy and D&C. Hysteroscopic distension media and intrauterine pressure play a role in endometrial cell dissemination. Hysteroscopy is an additional tool in the diagnosis of endometrial cancer. However, its use in the initial workup is still controversial. In order to minimize the small risk of cancer dissemination, hysteroscopy should be performed with an intrauterine pressure of less than 80 mmHg, and the duration of the procedure should be as short as possible.