21例子宫恶性苗勒氏管混合瘤临床分析

Analysis of Uterine Mixed Mullerian Tumor Clinical Features in 21 Cases

［目的］探讨子宫恶性苗勒氏管混合瘤（ＭＭＴ）的诊断与治疗，寻求改善预后的方法。［方法］回顾性分析１９６３年１０月至１９９７年１０月收治的２１例子宫ＭＭＴ的临床资料。［结果］子宫ＭＭＴ无特异临床表现，术前诊断困难，必须重视术前诊刮、宫颈口结节活检及术中冰冻检查。单纯手术６例，手术加化疗１０例，手术加放疗和化疗３例。总的２年、５年生存率为５７％和 ３０％，Ⅰ和 Ⅱ期 ５年生存率分别为 ４５．４％和 ９％，Ⅲ和 Ⅳ期病人均于 ２年内死亡。子宫小于 ３个月妊娠， ５年生存率为４６％，大于３个月妊娠为２５．５％，绝经前与绝经后的５年生存率分别为３３％和２１．４％。［结论］预后与临床期别、病理类型、子宫大小、绝经情况和治疗方法等相关。治疗以手术为主，术后辅以化疗可减少和延缓肿瘤复发和转移。化疗和放疗对治疗局部复发和远处转移有一定疗效。

Purpose] To study the clinical data of uterine Mullerian Tumors (MMT) in 21 cases and try to find the better way to improve overall survival as well as diagnosis and treatment. [Methods] To retrospectively evalute prognostic factors and treatment modalities. [Result] There were no special clinical signs and symptoms for uterine MMT.Six cases underwent surgery alone; 10, surgery plus postoperative chemotherepy; 3, surgery plus chemotherapy and irradiation.The overall 2 - year and 5 - year survival rate was 57% and 30% respectively.The 5 - year survival rate for stage Ⅰ and Ⅱ was 45 .4% and 9% respectively. All Patients of stage Ⅲ and Ⅳ died within 2 years. When the uterus was smaller than or larger than the size of 3 months pregnant uterus, the 5 - year survival rate was 46% and 25.5% respectively. The 5 - year survival rate in premenopause and postpause was 33% and 21 .4% respectively. [Conclusion] The prognosis of uterine MMT is close related to clinical stage, histologic type, uterine size, pre- or post- menpausalas status and primary treatment. The mainstay of the treatment is surgery. Postoperative chemotherapy can decreased recurrence and matastasis. Chemotherapy and irradiation is of benefit to those recurrent and matastatic cases.