子宫肉瘤保留生育功能的手术治疗的回顾性研究

Retrospective Study on Fertility-sparing Surgery in Uterine Sarcoma

目的探索早期子宫肉瘤年轻未育患者采用保留生育功能手术治疗的可行性。方法回顾分析中山大学附属第一医院2002年1月至2009年12月期间住院的采用保留子宫手术治疗的Ⅰ期子宫肉瘤35岁以下未生育患者的病历及病理检查资料,搜集年龄、手术方式、病理类型、术后生育情况、病情转归等信息,探讨早期子宫肉瘤年轻未育患者采用保留生育功能手术的适用范围及安全性。结果符合条件的患者有6例,平均年龄26岁(20～34岁);6例均接受子宫肿瘤切除术。病理类型为子宫平滑肌瘤肉瘤变性的有2例,2例病理检查均提示肉瘤病灶局限在子宫平滑肌瘤内未侵及切缘,其中1例术后自然受孕并足月分娩1健康婴儿;另1例术后28个月未生育,因B超提示多发性子宫平滑肌瘤,应患者要求行全子宫切除术,术后病理检查未见肉瘤病灶。病理类型为低度恶性子宫内膜间质肉瘤的有4例,其中3例术后2～6个月复查B超,再次发现子宫肿物并行全子宫切除术,术后病理确诊子宫内膜间质肉瘤;另1例术后2个月应患者要求行全子宫切除术,术后病理检查未发现子宫内膜间质肉瘤病灶。结论子宫平滑肌瘤肉瘤变性的年轻未育患者,若肉瘤组织局限于子宫平滑肌瘤内且未侵及切缘,有可能通过保留子宫的手术治疗保留其生育能力;子宫内膜间质肉瘤患者采取子宫肿瘤切除术不易一次性将子宫内膜间质肉瘤病灶切除干净,难以达到生育目的 。

Objective To study the feasibility of application of fertility-sparing surgery in nulliparous patients with uterine sarcoma.Method Records of nulliparous patients younger than 35 years diagnosed as stage I uterine sarcoma admitted in the First Affiliated Hospital of Sun Yat-sen University treated with fertility-sparing surgery during Jan.2002 to Dec.2009 were reviewed.Results Six patients were enrolled in this study.Median age was 26 years（20～34 years）.Two of 6 patients were confirmed by pathological examination as sarcomatous degeneration of leiomyoma.Leiomyosarcoma was limited in leiomyoma with tumor-free surgical margin in both cases.One patient had cesarean section at term pregnancy subsequently.Another one had total hysterectomy as she requested 28 months later and pathological examination found no malignant tissue.Four of 6 patients were confirmed by pathological examination as low-grade endometrial stromal sarcoma.In 3 of 4 cases,low-grade endometrial stromal sarcoma lesions were found on the uterus during subsequent surgery because of later image evidence of occurrence of uterine tumor.In the other case,total hysterectomy was performed as the patient requested 2 months later and pathological examination found no malignant tissue.Conclusion With strict follow-up,selected cases of uterine sarcoma might be managed with fertility-sparing surgery.