子宫内膜间质肉瘤八例临床分析

Clinical analysis of 8 cases of endomerial stromal sarcoma

目的 分析子宫内膜间质肉瘤 (ESS)的发病情况、临床表现、诊断和治疗等临床资料。方法 回顾性分析 1991年 5月至 2 0 0 3年 5月我们收治的 8例ESS患者的临床资料。结果 ESS占我院同期妇科肿瘤的 3% ,占宫体恶性肿瘤的 5 .9%。术前月经不规律 6例 ,子宫增大 5例 ,术前诊断性刮宫符合率 2 9% ;宫腔镜直视下电切取材 4例 ,与术后病理符合率 10 0 % ;阴道彩超 5例 ,报道宫壁回声不均匀、回声增强 5例 ,与术后病理相符 ;术前外周肿瘤标记物 (CA12 5)测定 5例 ,升高 1例。 7例行全子宫加双附件切除术 ,1例行全子宫加单侧附件切除术 ;7例术后予以化疗 ,1例术后拒绝化疗。结论 明确诊断者根据分期行全子宫加双附件切除术或广泛子宫加双附件切除术加盆腔淋巴清扫术 ,术后辅以化疗或放疗。

Objective To investigate the incidence,clinical characteristics,diagnosis and treatment of endometrial stromal sarcoma and to probe the method of diagnosis before treatment.Methods Clinical data of 8 patients with endometrial stromal sarcoma confirmed by pathological findings admitted to our hospital during May 1991 to May 2003 were analyzed retrospectively.Results The incidence of endometrial stromal sarcoma was 3% of total gynecological tumor.6 patients had irregular menstruation,5 had enlarge uterus,6 had dilation and curettage.The diagnostic accuracy was 29%.4 cases were diagnosed by hysteroscopic biopsy.All were confirmed after operation.5 were diagnosed by transvaginal ultraso-nography,urequally strony echo of uterine wall were observed.The pathological examination after operation confirmed the diagnosis.CA125 was tested in 5 cases before operation,but with only one beyond normal value.7 patients had total hysterectomy and bilateral salping-oophenrectomy.While 1 had otal hysterectomy with single salping-oophenrectomy.Chemotherapy were initiated in 7 cases after operation,1 patients refuse to have chemotherapy.Conclusions Endometrial stromal sarcoma should be suspected in patients with irregular menstruation.D&C and colorDoppler flow imaging and hysteroscopic biopsy are important.Hysterectomy+bilateral salping-oophenrectomy+polvic lymphadenectomy followed by chemotherapy should be carried out after the diagnosis is confirmed.