Cerrahpasa School of Medicine, Obstetrics and Gynecology, Istanbul University, Akademiler Sitesi, B/37 Kat. 8, Zincirlikuyu, Besiktas, Istanbul, Turkey.
Arch Gynecol Obstet. 2011 Nov;284(5):1209-21. doi: 10.1007/s00404-011-2031-6. Epub 2011 Aug 12.
Although intrauterine procedures are essential for endometrial evaluation in many cases, the significance of the amount of tumor cell dissemination during these procedures, the viability and invasive potential of the endometrial cancer (EC) cells, and their impact on prognosis remain elusive.
An extensive search was performed in the Cochrane Central Trials Registry, the Web of Science, and PubMed for publications about the role of hysteroscopy (H/S), saline infusion sonography (SIS) and laparoscopy (L/S) in dissemination of EC cells and prognostic significance of positive peritoneal washings (PPW), between 1988 and 2010 and English language. All eligible trials were included.
PPW rates vary between 0-14% after dilatation and curettage (D&C), 0-83% after H/S, 0-10% after L/S and 12-52% after SIS. The majority of the studies about EC cell dissemination during H/S and SIS suggest that they increase the risk of spill. There is not enough evidence to support the association between tumor spill and pressure, type and volume of distension medium, duration of the procedure, stage, grade and interval between H/S or SIS and laparotomy. Investigation into the rate of spill of EC cells during laparoscopic surgery is in the early stages and not yet definitive. There are too few in vivo and in vitro studies to comment definitively on the viability of the disseminated EC cells. The limited data we do have, however, questions the ability of disseminated EC cells to maintain and grow. Most published studies support the idea that prognosis is not affected by PPW in stage I EC. The changes in FIGO 2009 staging of EC appears to have merit when considering the sum of the data. H/S and SIS probably increase the risk of spill, however this increase does not seem effect prognosis. Although peritoneal washings are still expected to be performed, PPW itself does not necessitate additional treatment.
尽管在许多情况下，宫内手术对于子宫内膜评估至关重要，但这些手术过程中肿瘤细胞播散的程度、子宫内膜癌（EC）细胞的活力和侵袭潜能及其对预后的影响仍不清楚。
在 Cochrane 中心试验注册库、Web of Science 和 PubMed 中广泛搜索了 1988 年至 2010 年间关于宫腔镜检查（H/S）、盐水灌注超声检查（SIS）和腹腔镜检查（L/S）在 EC 细胞播散中的作用以及阳性腹膜灌洗（PPW）的预后意义的出版物，检索语言为英语。所有符合条件的试验均被纳入。
在扩张和刮宫术（D&C）后，PPW 发生率为 0-14%；在 H/S 后，PPW 发生率为 0-83%；在 L/S 后，PPW 发生率为 0-10%；在 SIS 后，PPW 发生率为 12-52%。大多数关于 H/S 和 SIS 过程中 EC 细胞播散的研究表明，它们会增加溢出的风险。目前尚无足够的证据支持肿瘤溢出与压力、扩张介质的类型和体积、手术持续时间、分期、分级以及 H/S 或 SIS 与剖腹术之间的间隔之间存在关联。对腹腔镜手术中 EC 细胞溢出率的研究仍处于早期阶段，尚未定论。关于体外和体内扩散 EC 细胞活力的研究还很少，因此无法对此做出明确的评论。然而，我们现有的有限数据对扩散 EC 细胞的存活能力提出了质疑。大多数已发表的研究支持这样一种观点，即 PPW 不会影响 I 期 EC 的预后。考虑到数据的总和，FIGO 2009 分期的变化在 EC 分期中似乎具有一定的意义。H/S 和 SIS 可能会增加溢出的风险，但这种增加似乎不会影响预后。尽管仍然需要进行腹膜灌洗，但 PPW 本身并不需要额外的治疗。
