Houvenaeghel G, Delpero J R, Rosello R, Resbeut M, Viens P, Jacquemier J, Noirclerc M, Guerinel G
Department of Surgery, Institut J. Paoli-I, Calmettes, Marseille, France.
Surg Gynecol Obstet. 1993 Sep;177(3):231-6.
Between January 1988 and April 1991, 57 patients with advanced gynecologic carcinoma were preoperatively evaluated by gynecologic examination and endosonography (ESG) using general anesthesia. Abdominopelvic computed tomography (CT) was performed in 49 patients and magnetic resonance imaging (MRI) in 21 patients. There were 34 primary tumors and 23 instances of recurrence. Causes of gynecologic carcinoma were 38 carcinomas of the cervix uteri (26 primary and 12 recurrences), eight carcinomas of the ovary (four primary and four recurrences), three recurrences of carcinoma of the endometrium, five sarcomas of the uterus (one primary and four recurrences) and three primary carcinomas of the vagina. All of the patients were operated upon. This perspective study compares the data from clinical and imaging examinations to the data obtained from histologic examination of surgical sections. According to anterior or posterior tumor extension, the accuracy of clinical evaluation and preoperative imaging were studied for the posterior vesical wall and the vesicovaginal septum and the anterior rectal wall and the rectovaginal septum. Histologic examination revealed vesical involvement in 17 patients and of the involvement of vesicovaginal septum in 21 patients. The accuracy of the clinical examination, ESG, cystoscopy, CT and MRI was 83, 88, 87, 75 and 81 percent, respectively, for vesical extension. Cystoscopy was not taken into account for evaluation of extension to the vesicovaginal septum--accuracy was 80, 90, 67 and 86 percent for clinical examination, ESG, CT and MRI. Histologic examination showed involvement in the rectum in 14 patients and involvement in the rectovaginal septum in 19 patients. Rectoscopy was performed 13 times. The accuracy of clinical examination, ESG, CT and MRI was 91, 98, 89 and 71 percent, respectively, for extension to the anterior rectal wall. Rectoscopy was not taken into account for evaluation of extension to the rectovaginal septum--accuracy was 80, 96, 75 and 57 percent for clinical examination, ESG, CT and MRI. Endosonography would seem to be useful to complete examinations for regional extension of advanced gynecologic carcinomas. Its accuracy is superior to that of other examinations. Because it is performed using general anesthesia, there is no discomfort for the patient during this low cost procedure.
1988年1月至1991年4月期间，对57例晚期妇科癌患者在全身麻醉下进行妇科检查和超声内镜检查（ESG）进行术前评估。49例患者进行了腹盆腔计算机断层扫描（CT），21例患者进行了磁共振成像（MRI）。有34例原发性肿瘤和23例复发。妇科癌的病因包括38例子宫颈癌（26例原发性和12例复发）、8例卵巢癌（4例原发性和4例复发）、3例子宫内膜癌复发、5例子宫肉瘤（1例原发性和4例复发）以及3例阴道原发性癌。所有患者均接受了手术。这项前瞻性研究将临床和影像学检查的数据与手术切片组织学检查获得的数据进行了比较。根据肿瘤的前后扩展情况，研究了临床评估和术前影像学对膀胱后壁、膀胱阴道隔、直肠前壁和直肠阴道隔的准确性。组织学检查显示17例患者有膀胱受累，21例患者有膀胱阴道隔受累。对于膀胱扩展，临床检查、ESG、膀胱镜检查、CT和MRI的准确性分别为83%、88%、87%、75%和81%。评估膀胱阴道隔扩展时未考虑膀胱镜检查——临床检查、ESG、CT和MRI的准确性分别为80%、90%、67%和86%。组织学检查显示14例患者有直肠受累，19例患者有直肠阴道隔受累。进行了13次直肠镜检查。对于直肠前壁扩展，临床检查、ESG、CT和MRI的准确性分别为91%、98%、89%和71%。评估直肠阴道隔扩展时未考虑直肠镜检查——临床检查、ESG、CT和MRI的准确性分别为80%、96%、75%和57%。超声内镜似乎有助于完善晚期妇科癌区域扩展的检查。其准确性优于其他检查。由于它是在全身麻醉下进行的，在这个低成本的检查过程中患者不会感到不适。
