64例子宫内膜间质肉瘤临床病理分析

发布时间：2018-05-06 07:05

本文选题：肉瘤 + 子宫间质肉瘤　；参考：《四川大学学报(医学版)》2015年02期

【摘要】：目的探讨子宫内膜间质肉瘤(endometrial stromal sarcomas,ESS)的临床病理特征、诊治及预后,提高临床诊治水平。方法回顾性分析四川大学华西第二医院收治的64例ESS患者的临床病理资料。结果2007年1月至2013年11月我院共诊治子宫体恶性肿瘤患者2 243例,其中ESS患者64例,占2.9%(64/2 243),平均年龄为44.6岁(17~66岁)。主要临床症状和体征为不规则阴道出血(50.0%,32/64)和子宫增大(54.7%,35/64)。22例患者行术前诊断性刮宫或宫颈赘生物活检,14例(14/22)病理确诊,术前诊断率为63.6%。所有患者均行手术治疗,其中15例行全子宫+双附件切除术,44例行全面分期手术或肿瘤细胞减灭术,2例行全子宫切除术,3例仅行病灶挖除术。按FIGO(2010年)手术病理分期,完成全面分期手术患者中Ⅰ期28例(63.6%,28/44),Ⅱ期8例(18.2%,8/44),Ⅲ期5例(11.4%,5/44),Ⅳ期3例(6.8%,3/44)。15例(23.4%,15/64)患者术后未加辅助治疗,32例(50%,32/64)补充了术后化疗,8例(12.5%,8/64)患者术后行化疗+放疗,仅2例(3.1%,2/64)术后加用了孕激素治疗。9例患者术后失访,其余患者随访至今,中位随访时间29月(2~73月),目前均无复发征象。结论 ESS发病率低,临床表现不典型,术前诊断率低,诊断性刮宫可提高术前诊断率,手术是其主要治疗手段,孕激素治疗应作为术后主要的辅助治疗手段。术后是否需要补充放化疗目前尚存在争议。
[Abstract]:Objective to investigate the clinicopathological features, diagnosis and prognosis of endometrial stromal sarcoma (stromal sarcomas), and to improve the clinical diagnosis and treatment. Methods the clinicopathological data of 64 patients with ESS in West China Hospital of Sichuan University were analyzed retrospectively. Results from January 2007 to November 2013, a total of 2 243 patients with malignant tumor of uterine body were diagnosed and treated in our hospital, of whom 64 were ESS patients, accounting for 2.9% 64 / 2 243, with an average age of 44.6 years and 1766 years old. The main clinical symptoms and signs were irregular vaginal bleeding (50.032 / 64) and uterine enlargement (54.7%). 22 patients were diagnosed by preoperative diagnostic curettage or cervical neoplasm biopsy (14 / 22). The preoperative diagnosis rate was 63.6%. All the patients were treated by operation, of which 15 cases were treated with total double appendage hysterectomy and 44 cases with total stage operation or tumor cell reduction. 2 cases with total hysterectomy and 3 cases with total hysterectomy only underwent excision of lesions. According to Figo (2010), Of the 28 patients with stage I, 28 with 63.6 / 28 / 44, 8 with 18.22 and 8 / 44, 5 with 11. 4 / 44 / 44, 3 with 6. 8 / 44 / 44, 3 with 6. 8 / 44 / 44 and 15 with 23. 4 / 15 / 64), 32 patients received no adjuvant treatment after operation. (8 cases with 12. 5% P / 64) received postoperative chemotherapy and radiotherapy. Only 2 cases (3. 1% / 64) were treated with progesterone after operation. The other patients were followed up to date. The median follow-up time was 29 months to 73 months. There were no recurrence signs at present. Conclusion the incidence of ESS is low, the clinical manifestation is not typical and the preoperative diagnosis rate is low. The diagnostic curettage can improve the preoperative diagnosis rate. Surgery is the main treatment method, and progesterone treatment should be used as the main adjuvant treatment after operation. The need for additional radiotherapy and chemotherapy after surgery is still controversial.
【作者单位】：四川大学华西第二医院妇产科;
【基金】：四川省学术带头人培养基金(No.2013RST00)资助
【分类号】：R737.33

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