基于磁共振指导的宫腔镜精准一步电切诊断早期子宫内膜癌可疑肌层浸润的价值
R737.33; 目的 开发一种基于MRI指导的宫腔镜精准一步电切评估早期子宫内膜癌(endometrial cancer,EC)影像学疑似子宫肌层浸润(myometrialinvasion,MI)的综合方案,评估其诊断价值,探讨影像学可疑肌层浸润对保育治疗结局的影响.方法 纳入65例有保留生育功能需求的早期内膜癌患者,其中41例经MRI检查排除肌层浸润(参照组),24例提示可疑肌层浸润并进行病灶定位,通过宫腔镜下一步电切术(整体切除内膜病灶、下方基底层和 3～5 mm肌层)进行病理检查.病理排除肌层浸润的患者,接受保育治疗,其临床特征和保育治疗结局与参照组进行对比.结果 利用基于MRI指导的...
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| Published in | 复旦学报（医学版） Vol. 50; no. 3; pp. 345 - 353 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
复旦大学附属妇产科医院妇科,上海 200011%复旦大学附属妇产科医院放射科,上海 200011%复旦大学附属妇产科医院病理科,上海 200011%复旦大学附属妇产科医院宫颈科 上海 200011
30.05.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1672-8467 |
| DOI | 10.3969/j.issn.1672-8467.2023.03.005 |
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| Abstract | R737.33; 目的 开发一种基于MRI指导的宫腔镜精准一步电切评估早期子宫内膜癌(endometrial cancer,EC)影像学疑似子宫肌层浸润(myometrialinvasion,MI)的综合方案,评估其诊断价值,探讨影像学可疑肌层浸润对保育治疗结局的影响.方法 纳入65例有保留生育功能需求的早期内膜癌患者,其中41例经MRI检查排除肌层浸润(参照组),24例提示可疑肌层浸润并进行病灶定位,通过宫腔镜下一步电切术(整体切除内膜病灶、下方基底层和 3～5 mm肌层)进行病理检查.病理排除肌层浸润的患者,接受保育治疗,其临床特征和保育治疗结局与参照组进行对比.结果 利用基于MRI指导的宫腔镜精准一步电切的诊断方案,24例疑似肌层浸润的患者中6例经电切病理证实肌层浸润,纳入MI组,接受手术治疗;余18例电切病理未见肌层浸润证据的患者被纳入非MI组,接受保育治疗.非MI组的累积完全缓解率在治疗早期与参照组无明显差异,在保育治疗第 8 个月(27.8％vs.61.0％,P= 0.024)和第 18个月(82.5％vs.94.8％,P=0.037)低于参照组.非MI组完全缓解后随访 12个月的累积复发率高于参照组(50.0％vs.0,P<0.001),3例非肌层浸润复发患者经再次保育治疗后全部再次完全缓解.非MI组和参照组的妊娠率差异无统计学意义,非MI组有1例成功妊娠并足月分娩.结论 MRI指导下的宫腔镜精准一步电切联合病理检查是综合评估早期内膜癌肌层浸润的有效手段,与MRI评估相比,帮助了约 75％的患者得以保留生育能力,但临床对待这类病例应当谨慎诊治、密切随访. |
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| AbstractList | R737.33; 目的 开发一种基于MRI指导的宫腔镜精准一步电切评估早期子宫内膜癌(endometrial cancer,EC)影像学疑似子宫肌层浸润(myometrialinvasion,MI)的综合方案,评估其诊断价值,探讨影像学可疑肌层浸润对保育治疗结局的影响.方法 纳入65例有保留生育功能需求的早期内膜癌患者,其中41例经MRI检查排除肌层浸润(参照组),24例提示可疑肌层浸润并进行病灶定位,通过宫腔镜下一步电切术(整体切除内膜病灶、下方基底层和 3～5 mm肌层)进行病理检查.病理排除肌层浸润的患者,接受保育治疗,其临床特征和保育治疗结局与参照组进行对比.结果 利用基于MRI指导的宫腔镜精准一步电切的诊断方案,24例疑似肌层浸润的患者中6例经电切病理证实肌层浸润,纳入MI组,接受手术治疗;余18例电切病理未见肌层浸润证据的患者被纳入非MI组,接受保育治疗.非MI组的累积完全缓解率在治疗早期与参照组无明显差异,在保育治疗第 8 个月(27.8％vs.61.0％,P= 0.024)和第 18个月(82.5％vs.94.8％,P=0.037)低于参照组.非MI组完全缓解后随访 12个月的累积复发率高于参照组(50.0％vs.0,P<0.001),3例非肌层浸润复发患者经再次保育治疗后全部再次完全缓解.非MI组和参照组的妊娠率差异无统计学意义,非MI组有1例成功妊娠并足月分娩.结论 MRI指导下的宫腔镜精准一步电切联合病理检查是综合评估早期内膜癌肌层浸润的有效手段,与MRI评估相比,帮助了约 75％的患者得以保留生育能力,但临床对待这类病例应当谨慎诊治、密切随访. |
| Author | 张宏伟 陈晓军 郝萌昕 宁程程 罗雪珍 马凤华 陶祥 朱勤 |
| AuthorAffiliation | 复旦大学附属妇产科医院妇科,上海 200011%复旦大学附属妇产科医院放射科,上海 200011%复旦大学附属妇产科医院病理科,上海 200011%复旦大学附属妇产科医院宫颈科 上海 200011 |
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| Author_FL | MA Feng-hua ZHANG Hong-wei ZHU Qin CHEN Xiao-jun LUO Xue-zhen NING Cheng-cheng TAO Xiang HAO Meng-xin |
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| Keywords | 子宫内膜癌(EC) 宫腔镜 子宫肌层浸润(MI) 磁共振成像(MRI) |
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| Title | 基于磁共振指导的宫腔镜精准一步电切诊断早期子宫内膜癌可疑肌层浸润的价值 |
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