31例子宫肉瘤的临床分析

Clinical analysis on 31 cases with uterine sarcoma

目的探讨子宫肉瘤的临床处理与预后的关系。方法回顾性分析该院收治的子宫肉瘤患者31例的临床资料,其中子宫平滑肌肉瘤14例(45.16%),子宫内膜间质肉瘤7例(22.58%),子宫恶性苗勒管混合瘤7例(22.58%),子宫(颈)葡萄状肉瘤3例(9.68%)。Ⅰ期13例,Ⅱ期4例,Ⅲ期12例,Ⅳ期2例。结果①子宫肉瘤的临床表现以阴道异常出血为主(67.74%),其次为下腹胀痛(25.81%)、下腹包块(22.58%)、阴道排液、下腹压迫症状及全身不适(均为6.45%)等;②术前诊断率为58.06%(18/31);③治疗方案,有15例行全子宫及双附件切除术(48.39%),3例行肿瘤细胞减灭术(9.68%),4例行次广泛性全子宫切除及盆腔淋巴结清扫术(12.90%),5例行广泛性全子宫及盆腔淋巴结清扫术(16.13%),3例单纯放射治疗(放疗)(9.68%),1例放弃治疗(3.22%)。58.06%(18/31)的患者术后辅以化学治疗(化疗)。结论子宫肉瘤的临床症状不典型,以阴道异常出血为主,预后较差;子宫肉瘤的治疗以手术为主,可辅以放疗和化疗,但手术方式和是否辅助化疗对改善患者预后并无影响。

Objective： To analyze the relation of the clinical treatment and the prognosis of uterine sarcoma. Methods： Thirty one cases with uterine sarcoma were analyzed retrospectively, among which there were 14 cases with leiomyosarcoma （45.16%）, 7 with malignant endometrial interstitialsarcomas （22. 58% ）, 7 with malignant Mullerian mixed tumor （22.58%）, 3 with sarcoma betryoides （9. 68% ）. 13 cases were on stage Ⅰ , 4 cases were on stage Ⅱ , 12 cases were on stage Ⅲ, and 2 cases belonged to stage Ⅳ. Results： （ 1 ） The patients usually manifested with abnormal vaginal bleeding （67.74%）, pain on lower abdomen （25.81%）, alpable mass of lower abdomen （22. 58% ）, vaginal discharge, symptoms of oppression and discomfort feeling （6. 45% ） . （2） The rate of preoperative diagnosis was 58.06% （ 18 / 31 ） . （3） In treatment, 48. 39% was treated by hysterectomy and bilateral Salpingo oophorectomy, 9. 68% was treated by removal of the bulk of tumor, 12. 90% was treated by less radical hysterectomy and pelvic lyphmadenectomy, 16. 13% was treated by radical hysterectomy and pelvic lyphmadenectomy; 9. 68% was treated by chemotherapy, and 58.06% was treated by chemotherapy after operation. Conclusion： The clinical symptom of uterine sarcoma is nonspecific （mostly abnormal vaginal bleeding） and the prognosis is poor. The treatment is mostly by operation. Chemotherapy and radiotherapy are given after operation. The prognosis of uterine sacoma is related to pathologic types, clinical stage and ages of the patients.