子宫肉瘤20例临床特征分析

Clinical Analysis of 20 Cases of Uterine Sarcoma

目的:探讨子宫肉瘤的临床表现与诊断方法,提高早期诊断率。方法:回顾分析20例子宫肉瘤病例的临床资料,其中子宫平滑肌肉瘤10例,子宫内膜间质肉瘤6例,子宫恶性苗勒氏管混合瘤4例。结果:子宫肉瘤的临床表现主要为阴道异常出血(65%),其次为子宫肌瘤病史(55%),下腹痛(40%)、盆腔包块(30%)、全身症状(25%)、阴道排液(15%)及组织物脱出(15%)。术前行诊刮术且明确诊断者3例,术前误诊为子宫肌瘤者17例(85%)。子宫肉瘤的术前诊断率为15%。结论:子宫肉瘤的临床表现无特异性,以阴道异常出血为主,其术前诊断准确率低,诊断性刮宫对子宫肉瘤的诊断价值较大。若子宫肌瘤手术中肉眼见肿瘤切面呈鱼肉样,则提示肉瘤可能大,术中冷冻切片是决定术式、明确诊断的最佳选择。

Objective：To investigate the clinical value and evaluate diagnosis methods of uterine sarcoma. Methods： The clinical data of 20 eases of the uterine sarcomas were analyzed in the retrospective study,among which there were 10 with leiomyosarcoma,6 with endometrial stromalsareomas,4 with malignant Mullerian mixed tumor. Results： The patients with uterine sarcoma usually manifested with abnormal vaginal bleeding （65 % ）. history of uterine leiomyomas （55 % ）, pain on lower abdomen （40%）, palpable mass of lower abdomen（30% ） , Systemic signs （25% ）, vaginal discharge（ 15 % ） and tissue prolapse（ 15% ）. Four cases underwent diagnostic uterine scrape, 17 cases were misdiagnosed for uterine leiomyornas preoperatively. Conclusion： The clinical symptom of uterine sarcoma is nonspecific,but mostly is abnormal vaginal bleeding. The rate of preoperative diagnosisi is low. Diagnostic curettage is a cnedthod for diagnosis. Smaples diaplayed during operation showed fish flesh-like,intervals,and frozen slice should be examed immediately to decide the method of operation.