肌瘤粉碎机降低隐匿性子宫平滑肌肉瘤的无病生存期

Uterine myoma pulverizer in reducing disease-free survival of occulted leiomyosarcoma of uterus

目的评估腹腔镜手术中肌瘤粉碎机应用对隐匿性子宫平滑肌肉瘤患者的治疗结局所造成的影响。方法2008年1~12月共有33例隐匿性的、连续的子宫平滑肌肉瘤患者入组、随访(粉碎机组15例,非粉碎机组18例),观察指标为年龄、绝经状态、FIGO分期、核分裂象、补救性手术时间、是否行术后辅助化疗、随访情况(包括复发时间、复发部位)。结局指标为复发率、1年无病生存率与复发风险的比值比。结果肌瘤粉碎机的应用显著降低子宫平滑肌肉瘤患者无病生存期(P=0.045)。不做补救性手术(P=0.005)或者大于30 d后再做补救性手术(P=0.042)的无病生存期均显著地短于30 d以内做补救性手术。患者年龄、FIGO分期、核分裂象、术后辅助化疗等因素均与无病生存期无关。结论腔镜中应用肌瘤粉碎机会显著减少隐匿性子宫平滑肌肉瘤患者无病生存期。对于这些患者,初次手术后及早做补救性手术,可以显著改善预后。

Objective To evaluate the effect of the application of myoma pulverizer in laparoscopic surgery on the treatment outcome of patients with occulted leiomyosarcoma of uterus.Methods Thirty-three cases of occulted and continuous leiomyosarcoma from January to December 2018 were enrolled and followed up(15 cases in pulverizer group and 18 cases in non-pulverizer group).The observation indicators were age,menopausal status,FIGO stage,nuclear fission,time of remedial surgery,whether adjuvant chemotherapy was performed after surgery,and follow-up(including recurrence time and recurrence site).Outcome measures were the recurrence rate,1-year disease-free survival rate,and the odds ratio of recurrence risk.Results The application of myoma pulverizer can significantly reduce the disease-free survival of patients with uterine leiomyosarcoma(P=0.045).The disease-free survival of patients without remedial surgery(P=0.005)or with remedial surgery after more than 30 days(P=0.042)was shorter than that of patients with remedial surgery in 30 days.Age,FIGO stage,nuclear fission,and postoperative adjuvant chemotherapy were not associated with disease-free survival.Conclusion Endoscopic use of myoma pulverizer can significantly reduce disease-free survival in patients with occulted leiomyosarcoma of the uterus.For these patients,early remedial surgery after the initial operation can significantly improve the prognosis.