子宫肉瘤40例临床分析

Review of 40 Cases of Uterine Sarcoma

目的:探讨子宫肉瘤的临床病理特征、超声表现、诊治及预后,以期提高对该病的认识。方法:回顾性分析40例子宫肉瘤患者的临床病理资料及诊治情况。结果:平均年龄58.6岁。40例中绝经后22例(55.0%);阴道不规则流血18例(45.0%);病理分型中子宫内膜间质肉瘤19例(47.5%)。仅9例(27.3%,9/33)术前确诊为子宫肉瘤。超声下主要表现为子宫增大、肿块内部回声不均、界限不清、肿块周边或内部血流信号。均手术治疗并辅以化疗。总3年及5年生存率分别为65.0%和45.0%。是否绝经及不同临床分期患者的3年及5年生存率比较,差异均有统计学意义(P<0.05);不同病理类型患者的5年生存率比较,差异有统计学意义(P<0.01)。结论:子宫肉瘤早期症状以阴道流血为主,但无特异性,术前诊断困难。超声下表现具有一定特异性,应受到重视。病理类型以子宫内膜间质肉瘤为多见。手术治疗为主,综合治疗是关键。绝经后、临床分期晚、恶性中胚叶混合瘤患者的预后差。

Objective： To evaluate the clinical data,including diagnosis,therapy,survival rate,and prog- nostic factors, in uterine sarcoma. Methods： retrospectively analysis of the clinical characteristics of 40 pa- tients with uterine sarcoma treated in our hospital during the past 12 years. Results：the patients were 58.6 years old in average, including 22 postmenopausal cases（55.0% ） ,18 cases presented with irregular bleed- ing（45.0%） ,and 19 cases（47. 5%）of endometrial stromal sarcoma in pathology. Diagnoses of sarcoma were confirmed pre-operatively only in 9 cases（27.3% ）. the ultrasound findings included enlarged uterus, ir- regular echo in lesion, unclear boundary, and blood flow around lesion. The main treatment approach was surgical treatment and post-surgical chemotherapy. The 3- and 5-year overall survival rates were 65. 0%, 45.0% （all sarcomas）. In multivariate analysis, clinical stage and menopausal status were independent fac- tors for the 3-and 5-year survival rate of patients（ P 〈0. 05） ,and the pathologic type was independent factor for the 5-year survival rate of patients（ P 〈 0.01 ）. Conclusions.In this study,survival rates were better than in nearly all previous retrospective studies of uterine sarcomas. It seems that higher parity could have a nega- tive influence on survival in cases of uterine sarcoma.