恶性潜能未定型子宫平滑肌瘤（SMTUMP）的临床研究

发布时间：2018-05-05 01:40

本文选题：恶性潜能未定型子宫平滑肌瘤 + 富于细胞型子宫肌瘤　；参考：《山东大学》2017年硕士论文

【摘要】：研究目的:通过收集经由手术治疗然后经病理确明诊断为恶性潜能未定型子宫平滑肌瘤(Smooth Muscle Tumours Of Uncertain Malignant Potential,SMTUMP)、富于细胞型子宫肌瘤(CUL)及子宫平滑肌肉瘤(LMS)的192例患者的临床资料及术后随访情况,比较三种类型子宫肿瘤的发病年龄情况、临床表现特征、不同的手术方式及预后情况,对相关数据及资料进行分析总结,加强临床医师对SMTUMP的认识,并指导临床医师对上述类型子宫肿瘤的诊断和治疗。研究方法:本研是通过收集山东大学附属省立医院2005年1月至2015年12月期间住院并进行手术治疗的子宫肿瘤患者,经过术后石蜡病理检查明确诊断为恶性潜能未定型子宫平滑肌瘤(SMTUMP)共57例,富于细胞型子宫肌瘤(CUL)共120例,以及子宫平滑肌肉瘤(LMS)共15例患者的临床病理资料,采用回顾性分析,并全部进行术后随访,将随访及预后情况进行分析。总结并分析上述三种类型子宫肿瘤患者的年龄构成、临床表现、术前超声表现、手术方式比较及术后复发转移恶变等情况,应用统计学方法进行分析研究。研究结果:1.本研究中经术后石蜡病理确诊为恶性潜能未定型子宫平滑肌瘤(SMTUMP)的患者年龄范围在26至58岁,该组病例平均年龄42.9岁;富于细胞型子宫肌瘤(CUL)患者:年龄在21至54岁,平均年龄41.8岁;子宫平滑肌肉瘤(LMS)患者:年龄在14至79岁,平均年龄50.8岁。2.本研究中三组病例病程最短0.5个月,最长60个月,其中恶性潜能未定型子宫平滑肌瘤(SMTUMP)患者平均病程9.85个月,富于细胞型子宫肌瘤(CUL)患者平均病程9.39个月,两组病例中前者平均病程略长,但两者之间无统计学差异(p0.05),而子宫平滑肌肉瘤(LMS)组平均病程3.13月较前两组病例平均病程明显缩短,存在统计学差异(p0.05)。3.此次本研究的三种病理类型的子宫肿瘤病例之中恶性潜能未定型子宫平滑肌瘤(SMTUMP)及富于细胞型子宫肌瘤(CUL)病人中最常见的临床表现为以经量增多、经期延长为主诉的月经改变,其中恶性潜能未定型子宫平滑肌瘤(SMTUMP)组病人中月经改变为主要临床表现的患者占45.67%,富于细胞型子宫肌瘤(CUL)组以月经改变为主要临床表现的患者占46.69%,子宫平滑肌肉瘤(LMS)患者中最主要的临床表现为不规则阴道流血,占所研究组病例的46.67%。本研究中三组病例临床表现居第二位的为下腹部包块,瘤体较大者可伴有压迫症状(尿频、便秘、腰骶部坠痛等),其他临床表现如:下腹疼痛、原有肌瘤增大、痛经等较少见,另外研究组中有一部分恶性潜能未定型子宫平滑肌瘤(SMTUMP)及富于细胞型子宫肌瘤(CUL)患者平素无任何临床症状,仅仅是在健康查体的时候发现了子宫肿物。4.术前彩色多普勒超声表现:恶性潜能未定型子宫平滑肌瘤(SMTUMP)及富于细胞型子宫肌瘤(CUL)多表现为不均质回声或低回声声像团块,团块内可见丰富血流信号,多数边界清楚;子宫平滑肌肉瘤(LMS)多表现为低回声团块,与肌层分界不清,内见丰富血流信号,偶见肿瘤有包膜。超声无明显特异性表现。5.宫体或肿瘤体积的大小、病人的年龄、有无生育要求、全身营养状况及术中快速病理结果是患者进行手术治疗时,手术方式选择的重要依据,恶性潜能未定型子宫平滑肌瘤(SMTUMP)组病人行保留子宫手术者共34例,子宫全切术17例,子宫+双附件切除术6例;富于细胞型子宫肌瘤(CUL)患者行保留子宫手术69例,子宫全切手术41例,子宫+单侧附件切除手术6例,子宫+双侧附件切除手术4例;而子宫平滑肌肉瘤(LMS)组行广泛子宫+双附件切除+盆腔淋巴结切除手术4例,子宫+单侧附件切除手术2例,广泛子宫切除+双侧卵巢楔形活检手术1例,子宫+双附件切除手术3例,子宫双附件切除+盆腔淋巴结切除手术4例,1例行子宫双附件切除+盆腔肿瘤切除手术患者于术后8月复发,二次手术行腹膜后肿瘤切除术。6.对入组的所有患者进行术后随访:随访时间最短3.5月,最长8.5年,恶性潜能未定型子宫平滑肌瘤(SMTUMP)患者有2例分别于术后6.5月,及11.5月复发,在两组病例的随访中暂未发现恶变及转移病例;富于细胞型子宫肌瘤(CUL)患者复发3例,余患者均健在;子宫平滑肌肉瘤(LMS)组患者2例分别于术后6月及12月死亡,复发1例,术后定期化疗3例,未见复发,失联2例,余7例患者均健在。7.在本研究三组患者中,恶性潜能未定型子宫平滑肌瘤(SMTUMP)组行腹腔镜下子宫肌瘤挖除术并使用子宫肌瘤粉碎器者9例,随访时间6-39个月,未见复发转移及局部种植;富于细胞型子宫肌瘤(CUL)组行腹腔镜下子宫肌瘤挖除术并使用子宫肌瘤粉碎器者28例,随访时间6-48个月,未见复发转移及局部种植;子宫平滑肌肉瘤(LMS)组均采取开腹手术方式。结论:恶性潜能未定型子宫平滑肌瘤(SMTUMP)及富于细胞型子宫肌瘤(CUL)均无特异性的临床表现,与普通型子宫平滑肌瘤相似,术前超声无特异性表现,术前诊断困难,确诊仍依靠病理手段,两种类型子宫肿瘤手术治疗预后较好,但因存在复发率及恶变倾向,手术治疗可放宽子宫切除的指征,加强术后随访,术后短期随访表明:腹腔镜子宫肌瘤粉碎器的使用能让恶性潜能未定型子宫平滑肌瘤(SMTUMP)及富于细胞型子宫肌瘤(CUL)患者受益,仍需长期观察进行评估;子宫平滑肌肉瘤(LMS)因恶性程度高,早期发生复发转移种植几率也相对较高,故应完善术前检查,尽量避免子宫肌瘤粉碎器的使用。
[Abstract]:Objective: To compare the clinical data and follow-up of 192 patients with Smooth Muscle Tumours Of Uncertain Malignant Potential, SMTUMP, cell type uterine myoma (CUL) and uterine leiomyosarcoma (LMS), which were diagnosed by surgical treatment and then diagnosed as malignant potential unshaped uterine leiomyoma (SMTUMP), and were followed up with a comparison of three. The age, clinical features, different surgical methods and prognosis of different types of uterine tumors, analysis and summary of relevant data and data, strengthening the understanding of SMTUMP by clinicians, and guiding clinicians to diagnose and treat these types of uterine tumors. Research methods: this research is through the collection of Shandong University affiliated. The patients who were hospitalized in the provincial hospital from January 2005 to December 2015 were diagnosed with 57 cases of malignant potential unshaped uterine leiomyoma (SMTUMP), 120 cases of cell type hysteromyoma (CUL), and 15 cases of uterine leiomyosarcoma (LMS). Data, retrospective analysis, and all follow-up follow-up, follow up and prognosis analysis. Summarize and analyze the age composition of the three types of uterine tumors, clinical manifestations, preoperative ultrasound performance, surgical comparison and postoperative recurrence and metastasis of malignant change and other conditions, the application of statistical methods for analysis and research. Fruit: 1. in this study, patients with malignant potential undefined uterine leiomyoma (SMTUMP) diagnosed by paraffin pathology were aged from 26 to 58 years old. The average age of the group was 42.9 years old; the patients with cellular myoma (CUL) were aged from 21 to 54 years old, with an average age of 41.8 years; patients with uterine leiomyosarcoma (LMS): aged from 14 to 79 years old, flat. The course of the three group of 50.8 years old.2. was the shortest 0.5 months and the longest 60 months. The average course of the patients with malignant latent uterine leiomyoma (SMTUMP) was 9.85 months, and the average course of the patients with cell myoma (CUL) was 9.39 months. The average course of the former was slightly longer in the two group, but there was no statistical difference between the two groups (P0 .05), while the average course of the uterine leiomyosarcoma (LMS) group was 3.13 months compared with the average course of the first two groups, there was a statistically significant difference (P0.05) the most common presence of malignant potential undefined uterine leiomyoma (SMTUMP) and cell type hysteromyoma (CUL) in the three pathological types of uterine tumours in this study. The bed showed a menstrual change with increased menstruation and prolonged menstruation, of which 45.67% of the patients with malignant potential unshaped uterine leiomyoma (SMTUMP) were the main clinical manifestations, and 46.69% of the patients with cellular hysteromyoma (CUL) with menstrual changes as the main clinical manifestations, and uterine leiomyosarcoma (LMS). The main clinical manifestation of the patients was irregular vaginal bleeding. In the 46.67%. study of the study group, the clinical manifestations of the three groups were second in the lower abdominal mass. The larger body of the tumor could be accompanied by compression symptoms (frequency of urine, constipation, lumbosacral pain and so on), and other clinical manifestations such as lower abdominal pain, original myoma, dysmenorrhea and so on. In addition, some of the patients with malignant potential undefined uterine leiomyoma (SMTUMP) and cell type uterine myoma (CUL) have no clinical symptoms. Only in health examination, the color Doppler sonography before.4. was found: malignant potential unshaped uterine leiomyoma (SMTUMP) and rich. Cell type uterine fibroids (CUL) were characterized by heterogeneous echoes or hypoechoic masses, with abundant blood flow signals in the masses, and most of the boundaries were clear. Uterine leiomyosarcoma (LMS) was characterized by hypoechoic masses, indistinct demarcation with the myometrium, rich blood flow signals and occasional tumors with envelopes. There was no specific manifestation of.5. or swelling in ultrasound. The size of the tumor, the age of the patient, the age of childbirth, the nutritional status of the whole body and the rapid pathological results in the operation are the important basis for the surgical treatment, and 34 cases of the patients with malignant latent uterine leiomyoma (SMTUMP), 17 cases of hysterectomy, uterus plus double appendix excision. In 6 cases, 69 cases of uterine leiomyoma (CUL), 41 cases of hysterectomy, 6 cases of uterine plus unilateral adnexectomy, 4 cases of uterine + bilateral adnexectomy, 4 cases of uterine leiomyosarcoma (LMS) and 2 cases of uterus + unilateral adnexectomy, and 2 cases of unilateral adnexectomy, were performed in the group of uterine leiomyosarcoma (LMS). 1 cases of extensive hysterectomy plus bilateral ovarian wedge biopsy, 3 cases of uterine + double appendage resection, 4 cases of double appendage resection plus pelvic lymphadenectomy, 1 cases of double appendix resection plus pelvic tumor resection in August, and two operation for retroperitoneal swelling of the peritoneum in all patients after the operation of the two operation. Follow up: the shortest 3.5 months of follow-up, the longest 8.5 years, 2 cases of malignant potential unshaped uterine leiomyoma (SMTUMP) patients were 6.5 months after the operation, and 11.5 months of recurrence. In the two group of cases, no malignant change and metastasis were found; 3 cases of cell type uterine leiomyoma (CUL), the remaining patients were all alive; uterine leiomyosarcoma (LMS). 2 patients died in June and December after operation, 1 cases recurred, 3 cases of regular chemotherapy after operation, no recurrence, loss of union 2 cases, and 7 patients in the three group of the study, malignant potential unshaped uterine leiomyoma (SMTUMP) group underwent laparoscopic hysteromyoma dug and 9 cases of hysteromyoma comminator, and the follow-up time was 6-39. There was no recurrence and local implantation in the month, and 28 cases of uterine myoma (CUL) were performed laparoscopic hysteromyoma removal and uterine myoma comminution. The follow-up time was 6-48 months, no recurrence and local implantation were observed. The uterine leiomyosarcoma (LMS) group was operated by laparotomy. Conclusion: malignant potential unshaped uterus No specific clinical manifestations of leiomyoma (SMTUMP) and cell type uterine myoma (CUL) are similar to ordinary uterine leiomyoma. Preoperative ultrasound has no specific performance, preoperative diagnosis is difficult, and the diagnosis still depends on pathological methods. The prognosis of the two types of uterine tumors is better, but the surgical treatment is due to the recurrence rate and malignant tendency. The indications of hysterectomy can be relaxed and follow-up is strengthened. Short term follow-up after the operation shows that the use of laparoscopic myomarcoma can benefit the patients with malignant potential unshaped uterine leiomyoma (SMTUMP) and cell type uterine myoma (CUL). It still needs long-term observation, and the uterine leiomyosarcoma (LMS) is highly malignant and early in the early stage. The probability of recurrence and metastasis is relatively high. Therefore, preoperative examination should be perfected to avoid the use of uterine fibroid smashing device.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

【相似文献】