背景:自从腹腔镜子宫切除术出现以来,一些研究描述了人工制品,比如血管假性侵入,在这些标本的组织学评估中构成潜在的陷阱。经常建议使用宫内操纵器作为产生这些人工制品的因素。
目的:为了描述可能的伪像,比如血管假性侵入,子宫肌层裂隙,和子宫颈内腔中的肿瘤细胞,在浆膜上,在输卵管腔中,并将它们与临床和病理特征相关联。
方法:这是一项回顾性单中心研究,对60例接受良性(n=27,45%)或恶性(n=33,55%)子宫病变治疗的患者进行了研究。
结果:在13例(22%)腺癌和1例(2%)良性子宫病理中发现了血管假性侵犯。在16(27%)子宫中观察到子宫肌层内的裂隙。在六个(10%)子宫切除术中观察到输卵管腔中的细胞。真正的血管栓塞与子宫内操纵器的使用(p=0.47)或手术类型(p=0.21)无关。血管假性侵袭与子宫颈管腔中肿瘤细胞的存在(p=0.013)和子宫肌层中裂隙的存在(p<0.001)相关,但与研究的其他因素无关。
结论:总体而言,在我们的系列中,我们没有观察到在患有恶性或良性子宫病变的女性子宫切除术期间使用宫内操作器与存在真正的栓塞或血管假性侵犯之间的任何统计学关联.血管假性侵袭也与其他伪影的存在有关。
BACKGROUND: Since the advent of laparoscopic hysterectomy, several studies have described artefacts, such as
vascular pseudoinvasion, constituting potential pitfalls in the histological evaluation of these specimens. The use of an intrauterine manipulator is often suggested as the factor creating these artefacts.
OBJECTIVE: To describe possible artefacts, such as
vascular pseudoinvasion, myometrial clefts, and tumor cells in the lumen of the cervix, on the serosa, and in the tubal lumen, and to correlate them with clinical and pathological characteristics.
METHODS: This is a retrospective monocentric study of 60 patients having been treated for benign (n = 27, 45%) or malignant (n = 33, 55%) uterine pathologies.
RESULTS: Vascular pseudoinvasion was found in 13 (22%) adenocarcinomas and in one (2%) benign uterine pathology. Clefts within the myometrium were observed in 16 (27%) uteri. Cells in the tubal lumen were observed in six (10%) hysterectomies. True
vascular emboli were not correlated with the use of an intrauterine manipulator (p = 0.47) or the type of surgery (p = 0.21).
Vascular pseudoinvasion was correlated with the presence of tumor cells in the lumen of the cervix (p = 0.013) and the presence of clefts in the myometrium (p < 0.001), but not with the other factors studied.
CONCLUSIONS: Overall, in our series, we did not observe any statistical association between the use of an intrauterine manipulator and the presence of true emboli or vascular pseudoinvasion during hysterectomy in women with malignant or benign uterine pathologies.
Vascular pseudoinvasion was also associated with the presence of other artefacts.