ABSTRACT
Objective:To summarize the case data of endometrial cancer (EC), analyze the related factors of lymph node metastasis, and establish the prediction model, so as to provide reference for clinical practice.Methods:191 patients with endometrial cancer who were diagnosed and treated in department of gynecology of Baoding Maternal and Child Health Hospital from January 2010 to December 2019 were selected as the research objects. The demographic and surgical pathological information of the patients were analyzed retrospectively. The risk factors of lymph node metastasis were analyzed by univariate and logistic regression analysis, and the predictive model was established.Results:A total of 191 patients with EC, aged 26-76(53.1±9.5)years old, body mass index (BMI)18.70-40.20(25.84±3.94)kg/m 2, 13 cases (6. 81%) had lymph node metastasis. Univariate analysis showed that lymph node metastasis was associated with obesity (BMI≥28 kg/m 2), pathological type (non endometrioid adenocarcinoma), degree of differentiation, depth of myometrial invasion (>1/2) and vascular invasion ( P<0.05). Logistic multivariate analysis showed that low differentiation ( OR=9.475, 95% CI: 1.840-48.799), vascular invasion ( OR=6.614, 95% CI: 1.457-30.024) and deep muscle invasion ( OR=4.997, 95% CI: 1.342-18.600) were independent risk factors ( P<0.05). The regression equation: Logit P=-4.488+ 1.609× myometrial infiltration depth+ 1.889×vascular infiltration+ 2.249×degree of tissue differentiation. The area under the receiver operating characteristic (ROC) curve (AUC) of EC lymph node metastasis probability P was 0.813 (95% CI: 0.688-0.938). The cut off value of 0.56 was ideal. At this time, the prediction sensitivity was 76.9% and the specificity was 79.2%. Conclusions:In clinical practice, gynecologists should consider the condition of EC patients and make operation plan to avoid over treatment or under treatment.
ABSTRACT
Objective To investigate the clinical value of hysteroscopy and combined laparoscopic surgery in the treatment of previous cesarean scar diverticulum (PCSD).Methods 36 cases of PCSD in our hospital from January 2013 to January 2015 were selected.Among them,13 cases were treated with hysteroscopy diverticulum incision (hysteroscopic surgery group),and 23 cases underwent hysteroscopy combined with laparoscopy diverticulectomy repair (combined operation group).The diagnosis and surgical treatment of PCSD patients were recorded and the pregnancy outcome was followed up.Results The operation time [(39.5 ± 17.1) min vs (92.3 ± 30.8) min],the amount of bleeding [(18.2 ± 5.6) ml vs (98.6 ± 24.4) ml] and the length of hospital stay [(2.3 ± 0.6) days vs (5.2 ± 1.1) days] in hysteroscopic surgery group were less than those of hysteroscopy combined with laparoscopy (P ＜ 0.05).The time of vaginal bleeding after operation [(6.3 ± 1.7) days vs (13.4 ± 2.7) days] & [(6.9 ± 2.2) days vs (14.0 ± 3.1) days] was significandy less than that before operation in two operation methods (P ＜ 0.05).8 cases effective,1 cases partially effective,3 cases invalid were in the hysteroscopy group,while 16 cases effective,5 cases partially effective,2 cases invalid were in the combined operation group.The difference of curative effect between the two surgical methods was not statistically significant (P ＞0.05).17 cases of fertility requiring patients underwent hysteroscopy combined with laparoscopy diverticulectomy repair,of which 8 eases were successfully delivered after operation.Conclusions Individualized clinical decision-making should be made for PCSD patients.Hysteroscopy and combined hysteroperitoneal surgery have the same effect,but the latter should be chosen for those with severe clinical symptoms or reproductive needs.