子宫肉瘤106例临床及病理分析

摘要

目的探讨不同组织学类型的子宫肉瘤的临床病理特点及影响预后的因素。方法回顾性分析北京大学第一、人民及第三医院共收治的子宫肉瘤患者106例，其中子宫平滑肌肉瘤67例（63.2%），子宫内膜间质肉瘤23例(21.7%)，子宫恶性苗勒管混合瘤16例(15.1%)。Ⅰ期70例，Ⅱ期12例，Ⅲ期19例，Ⅳ期5例。结果（1）子宫平滑肌肉瘤和子宫内膜间质肉瘤的发病年龄较小，小于50岁者分别占70.1%（47/67）和60.9%（14/23），小于40岁者分别占29.9%（20/67）和39.1%（9/23）。子宫肉瘤的临床表现以阴道异常出血为主（67.0%），其次为下腹包块（32.1%）、阴道排液（27.4%）、下腹痛（28.4%）、下腹压迫症状（25.5%）及全身不适（28.3%）等。（2）术前诊断率为65.9%，子宫平滑肌肉瘤最低，为42.9%。（3）治疗方案，有17例(16.0%)行子宫及双侧附件切除术加盆腔淋巴结清扫术，80例(75.5%)行子宫及双侧附件切除术，术后79例(74.5%)加用化学治疗, 12例(11.3%)加用放射治疗，7例(6.6%)加用孕激素治疗。（4）年轻、分期较早的子宫平滑肌肉瘤患者的预后最好。结论子宫肉瘤的临床症状不典型，以阴道异常出血为主，预后较差；子宫平滑肌肉瘤发病年龄较轻，术前诊断率较低，但预后较好；子宫肉瘤的治疗以手术为主，可辅以放射治疗和化学治疗，预后与组织学类型、患者年龄及临床分期有关。%Objective　To analyze the clinical features and factors affecting the prognosis of uterine sarcoma with different histological types. Methods　One hundred and six cases with uterine sarcoma treated were analyzed retrospectively, among which there were 67 cases with leiomyosarcoma (63.2%), 23 with malignant endometrial interstitial sarcomas (21.7%), 16 with malignant Mullerian mixed tumor (15.1%). According to Union Internationale Contre le Cancer (UICC) staging, 70 cases were on stage Ⅰ, 12 cases were on stage Ⅱ, 19 cases belonged to stage Ⅲ, and 5 cases belonged to stage Ⅳ. Results　(1) The patients with leiomyosarcoma and endometrial interstitial sarcoma were relatively younger, the patients of them aged under 50 amounted to 70.1%（47/67） and 60.9%（14/23） respectively, and those aged under 40 amounted to 29.9%（20/67）and 39.1%（9/23） respectively. The patients usually manifested with abnormal vaginal bleeding (67.0%), palpable mass of lower abdomen (32.1%), vaginal discharge (27.4%), pain on lower abdomen (28.4%), symptoms of oppression (25.5%), and discomfort feeling (28.3%). (2) The rate of preoperative diagnosis was 65.9%, especially that of leiomyosarcoma was lowest (42.9%). (3) In treatment, 16.0% of patients was treated by hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy; 75.5% of them by hysterectomy and bilateral salpingo-oophorectomy; after operation, 74.5% of them were treated by chemotherapy, 11.3% by radiotherapy, 6.6% by additional progesterone. (4) The survival period of the patients was related to pathologic types and clinical stages and ages of the patients. The prognosis of the patients with leiomyosarcoma、younger、earlier stage was better. Conclusions　The clinical symptom of uterine sarcoma is nonspecific (mostly abnormal vaginal bleeding) and the prognosis is poor. The patients with leiomyosarcoma are younger and have better prognosis, but the rate of preoperative diagnosis is low. The prognosis of uterine sarcoma is related to pathologic types, clinical stage and ages of the patients.