子宫平滑肌肉瘤27例临床分析

Clinical analysis of 27 cases of uterine leiomyosarcoma

目的:探讨子宫平滑肌肉瘤(leiomyosarcoma,LMS)的临床特点及影响预后的因素,以达到早期诊断、提高疗效及生存率。方法:对27例LMS临床特点、临床分期、疗效及预后等进行回顾性分析和总结。结果:①子宫平滑肌肉瘤的发病年龄多在40～60岁(63%);LMS的主要临床表现为不规则阴道流血(29.6%)、月经不规则(18.5%)、腹痛(18.5%)、下腹部包块(11.1%)等。②术前或术中确诊7例,占25.9%;误诊为子宫肌瘤、子宫肌腺瘤17例,卵巢肿瘤3例,误诊率达74.1%。③8例Ⅰ期行单纯手术治疗,19例Ⅱ期及以上患者行手术加用化学治疗。④Ⅰ期患者5年生存率为87.5%,Ⅱ、Ⅲ期患者5年生存率分别为70.0%、20.0%,Ⅳ期为0%。结论:LMS发病年龄及临床表现无特异性,易被误诊,早期诊断较困难,手术是LMS的主要治疗方式;LMS预后与年龄、临床分期有关。力争术前或术中确诊,术后加以辅助治疗以减少复发和提高生存率。

Objective： To explore the clinical characteristics of leiomyosarcoma （LMS） and the factors influencing prognosis. Methods： The clinical data of 27 patients with LMS were retrospectively analyzed and summarized, including clinical features, pathological type, curative effect and prognosis. Results： The patients with LMS were most aged between 40 to 60 years old. The main symptom of LMS was irregular menses （29.6%）, followed by climacteric irregular colporrhagia （18.5%）, celialgia （18.5%） and bythus lump（11.1%）. The diagnosis rate before operation and during operation was 25.9%; 17 cases were misdiagnosed as hysteromyoma or uterus adenomyosis, 3 cases were misdiagnosised as tumor of the ovary, and the misdiagnosis rate was 74.1%. Eight cases at stage Ⅰwere treated by surgery simply, and 19 cases at stage Ⅱ,Ⅲ and Ⅳwere treated by surgery combined with chemotherapy. The 5-year survival rate of the patients at stage Ⅰ was 87.S%. The average 5-year survival rate of patients behind stage Ⅱ was 42.1%. The 5-year survival rate of patients at stage Ⅱ , mand Ⅳ was 70.0%, 20.0%, 0%,respectively. Conclusion： LMS could be easily misdiagnosed. It was fairly difficult to make an early diagnosis. The main treatment method of LMS was surgery. The prognosis of LMS is obviously related with age and clinical staging. To reduce recurrent and to increase survival rate, it is important to confirm the diagnosis before or during operation and combine with adjunctive therapy after surgery.