前列腺恶性间叶肿瘤的临床及预后研究（附20例报告）

发布时间：2018-06-19 03:25

  本文选题：恶性间叶肿瘤 + 前列腺　； 参考：《浙江大学》2014年硕士论文

【摘要】：背景： 前列腺恶性间叶肿瘤(prostatic malignant mesenchymal tumors, PMMT)指发生于前列腺的各类罕见的恶性间叶肿瘤,如平滑肌肉瘤、胚胎横纹肌肉瘤、恶性纤维组织细胞瘤、骨肉瘤、软骨肉瘤、恶性外周神经鞘瘤、间质肉瘤等。虽然PMMT种类繁多,但发病率却极低。国外文献报道前列腺肉瘤发生率占前列腺恶性肿瘤的0.10%-0.24%。由于肿瘤进展快,且早期无明显症状,就诊时大都已局部或全身转移,加之临床诊疗方法尚不统一,疗效不确实,故总体预后较差,已引起学者的重视。 鉴于此,本研究通过对我院近十年来收治的20例前列腺恶性间叶肿瘤患者的临床资料作整理分析并文献复习,旨在提高对该病的认识和诊治水平。材料与方法： 本文收集了浙江大学附属第一医院泌尿外科自2003年1月-2013年1月诊治的20例PMMT患者的临床资料,通过病史、体格检查、实验室检查、彩色多普勒超声、CT、MRI、前列腺穿刺活检和术后标本常规病理检查和免疫组化等结果,采用生存分析方法(Kaplan-Meier)进行比较分析并绘制生存曲线,Log-Rank检验生存率差异(统计软件采用SPSS软件19.0版本)。并结合文献来探讨PMMT的诊断、治疗及预后。 结果： 20例患者中,常规病理和免疫组化确诊7例为平滑肌肉瘤,5例为横纹肌肉瘤,3例为间质肉瘤,1例为软骨肉瘤,4例为未分型恶性间叶肿瘤。13例行根治性前列腺切除术,其中6例行术前或术后放化疗(包括Ⅰ期2例,Ⅱ期3例,Ⅲ1例)；2例行盆腔肿块切除术(术前均行动脉栓塞),1例(1/2)行术后化疗(Ⅱ期1例,Ⅲ1例)；1例行全盆器官切除术(Ⅱ期1例)；1例因盆腔内多发转移瘤并两侧精囊腺累及,行姑息性结肠造瘘术+盆腔淋巴结活检术(Ⅲ1例)；3例因术前影像提示已肺、盆腔、骨骼等转移而行化疗放疗和中药等保守治疗(Ⅳ期3例)。本组中9例(9/20)治疗后3月内肿瘤全身转移而死亡；3例(3/20)分别为术后6月、7月及14月死亡；3例(3/20)分别带瘤存活5月、11月、12月；2例(2/20)无瘤存活至今已12月、24月,均为术后行周期性化疗者；3例(3/20)失访。 结论： 前列腺恶性间叶肿瘤发病年龄轻,恶性程度高,进展快,总体预后较差；诊断PMMT通常以经直肠超声引导下穿刺活检完成,确诊主要依靠病理和免疫组化；临床分期是影响预后的重要因素,早期诊断和以根治性前列腺切除为主的综合治疗可以显著提高患者生存率。
[Abstract]:Background:
Prostatic malignant mesenchymal tumors (PMMT) refers to a variety of rare malignant mesenchymal tumors occurring in the prostate, such as leiomyosarcoma, embryonic rhabdomyosarcoma, malignant fibrous histiocytoma, osteosarcoma, chondrosarcoma, malignant peripheral neurilemmoma, stromal sarcoma, and so on. Although a wide variety of PMMT, the incidence of the disease However, it is reported that the incidence of prostatic sarcoma in foreign literature accounts for the 0.10%-0.24%. of the malignant tumor of the prostate, which is rapidly progresses and has no obvious symptoms at the early stage. Most of them have local or systemic metastases at the time of treatment. In addition, the clinical diagnosis and treatment methods are not uniform and the curative effect is not true. Therefore, the general precondition is poor, which has aroused the attention of the scholars.
In view of this, the clinical data of 20 cases of malignant mesenchymal tumor of the prostate were analyzed and reviewed in our hospital for the last ten years. The purpose of this study was to improve the understanding and diagnosis and treatment of the disease.
The clinical data of 20 patients with PMMT from the Department of Urology, the First Affiliated Hospital of Zhejiang University, from January 2003 -2013 January, were collected. The results of the medical history, physical examination, laboratory examination, color Doppler ultrasound, CT, MRI, prostate biopsy and routine examination of postoperative specimens and immunohistochemistry were used, and the survival analysis method was used (K Aplan-Meier) make a comparative analysis and draw a survival curve, Log-Rank test the difference of survival rate (the statistical software uses SPSS software version 19). Combined with the literature to explore the diagnosis, treatment and prognosis of PMMT.
Result锛，

本文编号：2038181