Department of Obstetrics and Gynecology, University Medical School of Bari, 70124 Bari, Italy.
Menopause. 2010 May-Jun;17(3):511-5. doi: 10.1097/gme.0b013e3181c8534d.
Concerns exist about the risk of endometrial cancer cells spreading into the peritoneal cavity after fluid minihysteroscopy. The aim of our study was to evaluate the 5-year incidence of pelvic recurrences in women affected by early-stage endometrial carcinoma (stage IA or IB) who did or did not undergo preoperative hysteroscopy with low pressure (<70 mm Hg) saline uterine distention.
A total of 140 women were randomized into two groups of 70 women who underwent or did not undergo diagnostic fluid minihysteroscopy before surgical staging. Women were followed up every 6 months for at least 5 years. Diagnosis of pelvic recurrence was based on a positive result at clinical examination and/or at vaginal cytology and/or at magnetic resonance imaging/positron emission tomography scan. Univariate analysis of disease-free survival was performed with the Kaplan-Meier method and survival curves were compared using the long-rank test.
No difference in peritoneal cytology was observed between the two groups (5.7% and 8.5% of cases in the hysteroscopy and control group, respectively). After a mean duration of follow-up of 62 months, 2 (2.85%) pelvic recurrences in the hysteroscopy group and 3 (4.28%) in the control group were found. No significant difference was found between the two groups when the recurrence rate was compared. Overall survival rates and disease-free survival projected by Kaplan-Meier curves were not significantly different for the two groups.
Preoperative low-pressure fluid minihysteroscopy does not increase the risk of intraperitoneal transport of endometrial carcinoma cells during the examination or the risk of pelvic recurrence at the 5-year follow-up. It does not seem to modify the recurrence rate, disease-free survival, and overall survival, although multicenter randomized trials and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure.
人们对液性宫腔镜检查后子宫内膜癌细胞扩散至腹腔的风险存在担忧。本研究旨在评估行或不行低压（<70mmHg）生理盐水子宫扩张术的术前宫腔镜检查对早期子宫内膜癌（IA 期或 IB 期）患者盆腔复发的 5 年发生率的影响。
共 140 例患者随机分为两组，每组 70 例，分别行或不行诊断性液性宫腔镜检查。所有患者均进行至少 5 年的随访，每 6 个月随访一次。盆腔复发的诊断依据为临床检查和/或阴道细胞学检查和/或磁共振成像/正电子发射断层扫描检查阳性。采用 Kaplan-Meier 法进行无病生存的单因素分析，采用长期秩检验比较生存曲线。
两组间腹膜细胞学检查结果无差异（宫腔镜组和对照组分别为 5.7%和 8.5%的病例）。平均随访 62 个月后，宫腔镜组有 2 例（2.85%）盆腔复发，对照组有 3 例（4.28%）。两组间复发率无显著差异。Kaplan-Meier 曲线预测的总生存率和无病生存率在两组间无显著差异。
术前低压液性宫腔镜检查不会增加检查过程中子宫内膜癌细胞腹腔内转移的风险，也不会增加 5 年随访时盆腔复发的风险。虽然需要多中心随机试验和长期随访来评估该操作的总体肿瘤学结局，但该检查似乎不会改变复发率、无病生存率和总生存率。
