子宫腺肉瘤19例临床分析

Clinical analysis of 19 mullerian adenosarcoma of uterus

目的探讨子宫腺肉瘤的临床特征、诊断、治疗特点。方法回顾性分析浙江大学医学院附属杭州市第一人民医院及浙江省肿瘤医院2005—2015年收治的19例子宫腺肉瘤患者的临床表现和治疗方法。结果患者年龄28～70岁,平均51.9岁,绝经前与绝经后分别为9例及10例。主要临床表现为阴道异常流血、流液及宫颈赘生物,11例患者术前超声检查和8例患者术前磁共振检查为宫腔内有信号改变;16例患者接受术前病理检查(诊断性刮宫或宫颈活检),术前诊断准确率为87.5%(14/16);17例患者接受手术治疗,7例患者行化疗或术后辅助化疗。随访至2018年6月,随访时间11～148个月,7例死亡,其中1例为合并肾衰竭死亡,6例在术后5年内死亡,4例失访,8例存活。结论子宫腺肉瘤临床症状不典型,阴道异常流血、流液常为首发症状,诊刮术或宫颈活检术可提高临床诊断率,治疗以手术为主、化疗为辅。

Objective To investigate the clinical characteristics and treatment experience of mullerian adenosarcoma ofuterine.MethodsA retrospective analysis was conducted on the clinical data of 19 women with Mullerianadenosarcoma of uterus between January 2005 and December 2015.ResultsThe patients were 28 to 70 years old,withan average of 51.9 years old.9 were premenopause and 10 were postmenopause.The main clinical features are abnormalvaginal bleeding and cervical neoplasms.Preoperative b-ultrasound examination showed abnormal findings in 11 patientsand MRI examination in 8 patients.Sixteen patients received preoperative pathological examination(diagnosticcurretage or cervical biopsy),and the diagnosis accuracy reached 87.5%.Seventeen patients received surgical treatmentand 7 patients received postoperative chemotherapy.The patients were followed up until June 2018,for 11 to 148 months,and 7 died,of which one died from complicated renal failure and 6 died in 5 years after surgery.4 were lost to follow-up,and 8 survived.ConclusionClinical symptoms of Mullerian adenosarcoma of the uterus are not typical,and abnormalvaginal bleeding is often the first symptom.Endometrial curettage or cervical biopsy can improve the clinical diagnosisrate,and surgery and chemotherapy are the main treatment.