对子宫内膜异位症发生恶变过程的连续观察

The continue observation of malignant transformation of endometriosis

目的:通过对子宫内膜异位症(EMT)患者的随访,追踪反复发作的顽固病例,以观察其恶变情况.方法:将1991年1月～2003年12月在本院确诊的各期EMT患者作为研究对象,共4 519例.每年随访1次,对症状顽固的病例则密切追踪观察.结果:随访率79%～82%,恶变1例,占0.02%.此1例最初为阴道残端EMT恶变,之后发展为异位子宫内膜不典型增生,最后转变为子宫内膜样腺癌.经历了从良性病变、癌前病变到癌变的完整演变过程.本例病变发展的特点是病灶顽固生长、反复发作,虽然患者激素水平一直处于绝经状态,但病灶仍然继续生长,最终恶变.结论:异位的子宫内膜可以发生恶性变,但恶变率很低,恶变前可以经历癌前病变的过程,其生长转变似乎不依赖卵巢分泌的性激素.

Objective： To observe the malignant condition by investigating the endometriosis patients＇ results and following up the recurrent patients. Methods： 4 519 patients from January 1991 to December 2003 confirmed endometriosis were followed up once a year and observed closely to the recurrent ones. Results： The following up rate was 79% - 82% and ratio of malignancy was only 0. 02%. This was first the endometriosis at the end of vagina and developed to atypical endometrium then, at last endometrium adenocarcinoma. The change covered from benign to malignant. The developing of the lesion was uncontrolled and recurrent even though the level of patients ovarian hormone was very low after menopause.. Conclusion： Endometriosis can be malignant, but the malignant is rare. . The process of malignancy is covered pre - carcinoma and its development dose not relate with ovarian hormone secretion..