子宫内膜增生手术前后病理差异性比较及分析*

Analysis of difference between preoperative and postoperative pathological diagnoses of endometrial hyperplasia

摘要:

目的 探讨子宫内膜不典型增生患者子宫切除术后诊断与术前诊断的病理差异，分析其原因，以提 高子宫内膜不典型增生术前诊断的准确率。方法 回顾性分析2016年1月—2019年12月秦皇岛市妇幼保健院收治 行子宫切除的69例子宫内膜不典型增生患者的主要临床特征和诊断方法，比较手术前后病理诊断的差异。结果 43例手术前后诊断一致，符合率为62.3%，7例手术后未见不典型增生，8例手术后恶变或升级诊断为子宫内膜癌。 44例手术后病灶位于宫腔前后及侧壁或位于宫底及宫角，多灶者为63.8%。结论 规范正确的首诊过程是避免误诊 和漏诊的关键，病变部位取材到位、规范的病理诊断标准是诊断和治疗子宫内膜增生的必备条件。

Abstract:

Objective To compare 69 cases of the preoperative diagnoses of atypical endometrial hyperplasia with the diagnoses after hysterectomies, and to analyze the reason for their inconsitency between the preoperative and postoperative diagnoses to improve the preoperative diagnostic accuracy. Methods From January 2016 to December 2019, 69 cases of patients, who were underwent the hysterectomy on the basis of preoperative diagnoses of atypical endometrial hyperplasia, were recuited in Qinhuangdao Maternal and Child Health Hospital, and were retrospectively analyzed their clinical features, diagnostic methods, as well as the diagnostic complexity and inconsistence, between the preoperative and postoperative diagnoses. Results The preoperative diagnoses of 43 patients were identical to those of postoperation, with coincidence rate of 62.3% (43/69). 7 cases of atypical endometrial hyperplasia disappeared and 8 cases of lesion were upgraded to endometrial carcinoma after surgery. 44 cases of lesion were located in anterior, posterior, and lateral walls of uterus. Multifocal lesions (63.8%) were in fundus and cornu uteri. Conclusions The normal and accurate first diagnostic process is crucial to avoiding misdiagnoses and missed diagnoses. The adequate and accurate dissection, and normal pathological diagnosis were essential to the diagnosis and therapy of atypical endometrial hyperplasia.