诊断早期子宫内膜癌与宫腔镜手术相关不良预后因素研究进展

Advances in the study of adverse prognostic factors associated with hysteroscopy in the diagnosis of early endometrial cancer

关键词:  子宫内膜肿瘤  宫腔镜  预后因素

Key words:  endometrial neoplasms  hysteroscopy  prognostic factors

摘要:

宫腔镜技术已成为早期筛查子宫内膜癌不可或缺的方法，宫腔镜检查能否增加腹腔冲洗液肿瘤细胞（PWC）阳性率有着截然不同的结论，有研究者认为宫腔镜检查能够增加PWC阳性率，但也有资料说明并未增加内膜癌细胞腹腔播散的风险。宫腔镜检查的PWC阳性率与宫腔镜检查的条件、宫腔镜检查与获取腹腔冲洗液的间隔时间、是否同时行诊刮术、疾病程度、肿瘤本身的生物学特性等因素有关。大量临床研究资料显示，宫腔镜检查所致PWC阳性并不影响子宫内膜癌患者的生存预后及增加内膜癌复发的风险。宫腔镜检查建议应用于影像学检查提示宫内占位病灶<1～2 cm的病例，采用最低的膨宫压力和液体流量，避免扩张宫颈管和同时行刮宫术，以宫腔镜下定位活检为宜。

Abstract:

Hysteroscopy technology has become the indispensable method for early screening of endometrial carcinoma. There is still debate on whether hysteroscopy increases the positive rate of peritoneal washing cytology (PWC). Some physicians believe that hysteroscopy increases the positive rate of PWC; however, there are also data suggesting that hysteroscopy does not increase the risk of endometrial cancer cells spread in abdominal cavity. The positive rate of PWC associated with hysteroscopy is related to condition of hysteroscopy, time interval between hysteroscopy and acquisition of peritoneal washing liquid, whether performing simultaneous diagnostic curettage, stage of the disease, tumor biological characteristics, and other factors. A large amount of clinical research data have shown that positive PWC caused by hysteroscopy examination does not affect the survival of endometrial cancer patients and does not increase the risk of endometrial cancer recurrence. It has been suggested that hysteroscopy examination should be applied in cases with an intrauterine lesion <1~2 cm by imaging study, be performed with the lowest uterine pressure and liquid flow, and avoid the expansion of cervical canal and curettage surgery at the same time. Hysteroscopy-guided biopsy is appropriate.