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目的探讨上、下级医生术中肉眼观察对判断子宫内膜癌肌层浸润深度的区别,以提高术中肉眼判断子宫内膜癌肌层浸润深度的准确性。方法收集2000年1月至2009年10月在阜阳市肿瘤医院经手术治疗、术后病理检查分期为Ⅰ期子宫内膜癌的患者41例,以术后病理诊断为金标准,比较上、下级医生术中肉眼观察对判断子宫内膜癌肌层浸润深度的区别。结果下级医生对肌层浸润总的诊断准确率为58.54%(24/41),对深肌层浸润判断的准确率为69.23%(9/13),而对浅肌层浸润判断的准确率为56.00%(14/25)。上级医生对肌层浸润总的诊断准确率为90.24%(37/41),对深肌层浸润判断的准确率为92.31%(12/13),而对浅肌层浸润判断的准确率为88.00%(22/25)。比较两级医生在判断子宫内膜癌肌层浸润方面的不同,上级医生肉眼观察判断的阳性和阴性预测值更好,可作为术中指导。结论通过反复比较,掌握正确的切开和观察方法及形态学诊断标准,积累病理学经验,可以不断提高下级医生术中肉眼观察对判断子宫内膜癌肌层浸润深度的准确率。
Objective To investigate the difference of the depth of myometrial invasion between the upper and lower doctors during the operation to improve the accuracy of intraoperative myometrial invasion depth. Methods From January 2000 to October 2009 in Fuyang Cancer Hospital by surgery, postoperative pathological staging stage Ⅰ endometrial cancer patients 41 cases, postoperative pathological diagnosis as the gold standard, comparing the upper and lower level Macroscopic observation of the doctor to determine the difference between the depth of myometrial invasion of endometrial cancer. Results The accuracy of the total diagnosis of subcutaneous myometrial invasion was 58.54% (24/41) and 69.23% (9/13) for the deep myometrial invasion, while the accuracy of subcutaneous myometrial invasion was 56.00% (14/25). The accuracy rate of the diagnosis of myometrial invasion was 90.24% (37/41), 92.31% (12/13) for the deep myometrial invasion, and 88.00% for the superficial myometrial invasion % (22/25). Comparing the two doctors in judging the different types of endometrial carcinoma invasion, the higher the doctor’s eye to determine the positive and negative predictive value is better, can be used as an intraoperative guidance. Conclusion Through repeated comparison and grasping of the correct incision and observation methods and morphological diagnostic criteria and the accumulation of pathological experience, the accuracy of intraoperative macroscopic observation to determine the depth of myometrial invasion can be continuously improved.