腹腔镜子宫肌瘤手术发现子宫恶性肿瘤15例的临床分析

The clinical analysis of 15 cases of unexpected uterine malignant tumors during l aparoscopic uterine myoma surgeries

目的:分析行腹腔镜子宫肌瘤手术、发现子宫恶性肿瘤患者的临床资料,以避免误诊和电动粉碎器的使用。方法:回顾分析2010年5月~2016年8月我院收治的行腹腔镜子宫肌瘤手术、术中或术后发现子宫恶性肿瘤的15例患者临床资料。结果:15例中子宫内膜腺癌2例,子宫内膜间质肉瘤5例,子宫平滑肌肉瘤8例。临床分期均为I期,术前均误诊为子宫肌瘤。患者主诉:阴道异常出血或月经改变7例(47%),自己发现盆腔包块1例(6%),体检发现子宫肌瘤7例(47%);超声下主要表现为子宫增大、肿块内部回声不均或低回声、肿块周边或内部血流信号。15例患者均手术治疗,首次手术行腹腔镜子宫肌瘤剔除术且使用电动粉碎器6例,术后辅以放疗或化疗5例。患者术后复发4例,死亡1例。结论:术前误诊为子宫肌瘤的主要是子宫肉瘤。腹腔镜手术中不除外恶性肿瘤者术中应仔细剖视标本,及时送冰冻病理,避免使用电动粉碎器。

Objective ：To analyze the clinical characteristics,treatment and prognosis of unexpected uterine ma- lignant tumors during laparoscopic uterine myoma surgeries,in order to prevent the misdiagnosis of these tu- mors and to avoid the usage of electrical morcellation.nethods：Retrospective analysis was made on the clini- cal characteristics and treatment methods of 15 cases of unexpected uterine malignant tumors during laparo- scopic uterine myoma surgeries in our department from May 2010 to August 2016.Results：Fifteen patients were all misdiagnosed as uterine myomas before operation,2 cases were endometrial carcinomas,5 cases were endometrial stromal sarcomas,and 8 cases were uterine leiomyosarcomas.Seven cases （47%）presented with ir- regular bleeding or menstruation change,1 case（6%）found a pelvic mass by herself and 7 cases（47%）detected ＂myomas＂ by health check with no abnormal symptoms.The ultrasound findings included enlarged uteri,irregu- lar echo or low echo in lesions,and blood flow around lesions.All the patients accepted surgery,5 patients took adjuvant radiotherapy or chemotherapy postoperatively.Four patients developed reccurence,and 1 patient died.Conclusion：The main type of these 15 patients with unexpected uterine malignant tumors are uterine sarcomas during laparoscopic uterine myoma surgeries.To avoid the electrical morcellation applied to the sus- pected malignant tumor,the operator should check the tissue specimen carefully and send it for frozen section examination.