子宫肉瘤29例临床分析

Clinical Analysis of 29 Cases of Uterine Sarcoma

目的探讨子宫肉瘤的临床特点、预后相关因素及改进治疗的可能性。方法回顾性分析1990年1月至2006年12月29例子宫肉瘤临床资料。结果子宫平滑肌肉瘤14例(48.28%),内膜间质肉瘤11例(32.93%),恶性苗勒管混合瘤3例(10.34%),淋巴肉瘤1例。Ⅰ期22例、Ⅱ期3例、Ⅲ期2例、Ⅳ期1例、未确定分期1例。临床症状不典型,术前确诊率为34.48%。治疗以手术为主,全子宫及附件切除术10例。术后24例(82.76%)加用了化疗,3例(10.34%)加用了放疗。总的2年生存率为79.31%,5年生存率为48.28%,死亡2例。结论子宫肉瘤发病率较低,预后较差,临床表现缺乏特异性,早期诊断困难,力争术前或术中确诊,作较广泛切除,术后辅以放疗或化疗,以减少复发和提高存活率。

Objective To investigate the clinical characteristics, prognostic factors and the possibility to improve the treatment results of the uterine sarcoma. Methods Data of 29 patients with uterine sarcoma who were managed at the Sun Yat Sen Second affiliated hospital between 1990 and 2006 were analyzed retrospectively. Results 14 patients （48.28%） had leiomyosarcoma （ LMS）, 11 patients （32.93%） had endometrial stromal sarcoma（ESS） ,3 patients （ 10.34% ） had malignant mixed mullerian tumor （MMMT）,and 1 patient had lymphosarcoma. 22 patients had stage Ⅰ disease,3 patients had stage Ⅱ disease,2 patients had stage Ⅲ and 1 patient had stage Ⅳ disease. There was no characteristic clinical features of uterine sarcoma, and deftnite diagnosis coule only be made preoperatively in 34.48% patients. Surgery （ abdominal hysterectomy and bilateralsalpingo-oo- phorectomy） was the main treatment ,24（ 82.76% ） patients received postoperative chemotherapy and 3 （10.34%）patients received postoperative radiotherapy. The 2 and 5 year overall survival rates were 79.31% and 48.28%. Conclusion Uterine sarcomas are aggressive tumors with poor prognosis. There are no characteristic clinical features of the tumors. Surgical treatment consisting of radical hysterdctomy followed by adjuvant chemotherapy or radiotherapy can decrease the relapse and mortality rate.