| Background and ObjectiveEndometrial carcinoma(EC)is a group of malignant lesions that occur in the endometrium.Adenocarcinoma derived from endometrial glands is the most common.In recent years,with the development of social economy,changes in national lifestyles,delay in women's reproductive age,and application of hormone replacement therapy in menopausal women,the incidence of endometrial cancer has been increasing worldwide.At the same time becoming younger.At present,the pathogenesis of endometrial cancer is not very clear,but after standardized treatment,the prognosis of early endometrial cancer is better,so early detection,early diagnosis and early treatment are particularly important.There is no doubt that histopathological diagnosis is still regarded as the "gold standard" for the diagnosis of endometrial cancer,Clinically,how to obtain endometrial tissue for pathological examination while ensuring the accuracy of diagnosis and minimizing adverse influence factors is worthy of in-depth research.With the development of laparoscopic technology and the development of minimally invasive concepts,hysteroscopy has been widely popularized and applied in the clinic due to its advantages of visualization and image magnification,but it also brings new challenges.It is still controversial whether hysteroscopy will lead to positive cytology of peritoneal lavage fluid in the diagnosis of early endometrial cancer and its relationship with prognosis.At the same time,there are different opinions about the effect of positive ascites cells on the prognosis.The purpose of this study was to analyze the relationship between hysteroscopy and cytology and prognosis of peritoneal lavage fluid of early endometrial cancer,and to explore the relationship between positive cytology of ascites and prognosis,So as to provide a certain reference for the application of hysteroscopy in early endometrial cancer.Materials and methodsA retrospective analysis of 304 patients who were admitted to Zhengzhou University's Second Affiliated Hospital from September 2009 to February 2015 and underwent a comprehensive staging operation,and postoperative histopathological examination confirmed early endometrial cancer.According to the differences in the way to obtain lesion tissue before comprehensive staging,they were divided into observation group(hysteroscopy group)and control group(diagnosis and curettage group),including 121 patients in observation group and 183 patients in control group.By comparing the age,pregnancy,parity,medical complications,ascites cytology(yin/yang),preoperative diagnostic curettage or hysteroscopy between the two groups of patients,the time between complete staging,postoperative pathology and follow-up Related situations,etc.The relationship between hysteroscopy and ascites cytology and the positive factors of ascites cells were analyzed,and the influence of hysteroscopy and positive ascites cells on the prognosis of patients were analyzed.The data were analyzed using SPSS 2:2.0 statistical software.The measurement data is expressed by(x ± s),and the t-test is used to verify the differences between the groups;the count data is expressed as a percentage(%),and the ?2 test is used to verify the differences between the groups;the log-rank test is used to compare the survival rates between the groups.Kaplan-Meier method was used to analyze the survival curve;P<0.05 indicated that the difference was statistically significant.Results(1)Comparison of general data of two groups of patientsAmong the 304 patients with early endometrial cancer,121 patients were diagnosed with hysteroscopy before surgery and 183 patients were diagnosed with traditional diagnostic curettage before surgery.The two groups were compared for age,pregnancy,parity,and internal medicine.The time between the traditional diagnostic curative curettage or hysteroscopy before surgery and comprehensive staging surgery showed that there was no difference in the comparison of general information(P>0.05).(2)Comparison of cytology of peritoneal lavage fluid between two groups of patientsIn all cases,there were 9 patients with positive results of peritoneal lavage cytology,the total positive rate is 2.96%;including 3 patients with positive ascites cells in hysteroscopy group,with a positive rate of 2.48%.The total number of patients with positive ascites cells in diagnostic curettage group were In 6 cases,the positive rate was 3.29%.There was no difference in the positive rate of ascites cells between the two groups(P>0.05).(3)Comparison of prognosis related results between the two groups of patientsIn all patients,there were 27 relapses in 5 years,with a total recurrence rate of 8.88%,9 deaths,and a total survival rate of 97.04%.Among the patients in the hysteroscopy group,5 relapsed in 5 years,the recurrence rate was 10.74%,and 5 died.The survival rate was 95.87%;in the curettage group,14 patients had recurrence in 5 years,the recurrence rate was 7.65%,4 patients died,and the survival rate was 97.81%;After Log-rank analysis,there was no statistically significant difference in the recurrence rate(x2=0.861,P=0.353)and survival rate(?2=0.893,P=0.345)between the two groups.(4)Influencing factors of ascites positive cytology and its relationship with patient prognosisAmong the 304 patients,9 were ascites positive and 295 were ascites negative.Comparing the clinical and pathological conditions of all patients,the factors affecting the ascites positive rate were mainly age(?2=6.450,P=0.011),The depth of muscular infiltration(?2=4.519,P=0.034),and Cervical interstitial invasion(?2=5.949,P=0.015);a total of 3 patients with positive ascites cells relapsed with a recurrence rate of 33.33%,Of which 1 case had a local recurrence,a local recurrence rate of 11.11%,2 cases had a distant recurrence,and a distant recurrence rate of 22.22%;24 cases of ascites cell-negative patients had a recurrence,the recurrence rate was 8.14%,of which 14 cases had a local recurrence and a local recurrence The rate was 4.75%,distant recurrence was 10 cases,and the distant recurrence rate was 3.39%.There was a difference in the total recurrence rate and distant recurrence rate between patients with positive ascites cells and negative patients with ascites cells(P<0.05).Statistical significance(P>0.05);The 5-year overall survival rates of ascites-positive and negative patients were 77.78%and 97.63%,respectively.Log-rank analysis revealed that the 5-year survival rates of ascites-positive patients and patients with ascites cells were negative(?2=13.570,P=0.000).ConclusionsPreoperative hysteroscopy does not increase the positive rate of ascites cells in patients with early endometrial cancer,and it does not change the recurrence rate and survival rate of patients.It is a safer preoperative method for early endometrial cancer;The influencing factors of positive peritoneal lavage fluid cytology in patients with early endometrial cancer are muscular layer infiltration depth,cervical infiltration depth,and age.At the same time,the prognosis of patients with positive ascites cells is worse than that of patients with negative ascites cells.Clinical attention should be paid. |
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