15例子宫肉瘤的临床分析

目的:对子宫肉瘤(uterine sarcomas,US)不同病理类型的临床资料进行分析。方法:收集2016年5月至2019年4月中国科学技术大学附属第一医院妇科收治的US患者15例,对其临床表现、年龄、绝经时间、术前实验室、影像学检查、手术及术后随访情况进行回顾性分析。结果:1)子宫平滑肌肉瘤(leiomyosarcoma,LMS)患者年龄(56.38±10.24)岁,包块(91.75±52.37) mm,糖类抗原125(carbohydrateantigen125,CA125)(31.9±21.81)U/m L,乳酸脱氢酶(lactatedehydrogenase,LDH)(222.68±146.58)U/L,术后2人予以放射与化学药物治疗结合,4人行化学药物治疗,在随访过程中3人出现转移。2)子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)患者年龄(58.4±13.35)岁,包块直径(92.6±23.11) mm,CA125 (25±13.04) U/m L,LDH (237.6±78.72) U/L,术后1人予以放射与化学药物治疗结合,1人行化学药物治疗,随访均存活。3)子宫腺肉瘤(adenosarcoma,AS)患者平均年龄42岁,包块直径75 mm,CA125 39.63 U/m L,LDH 163 U/L,术后均行化学药物治疗,在随访过程中1人死亡。结论:US患者多以盆腔包块及阴道流血就诊,LDH>199 U/L及盆腔包块直径≥8 cm,包块快速增长可作为鉴别指标。手术中淋巴结清扫对患者是否有益尚不明确,术前评估淋巴结有无转移值得研究。US虽好发于围绝经期和绝经女性,但对于盆腔包块伴阴道流血年轻女性,需考虑子宫腺肉瘤的可能性,避免延误病情。

Clinical analysis of 15 cases of uterine sarcoma

Objective:To analyze the clinical data of different pathological types of uterine sarcoma.Methods:From May 2016 to April 2019,15 patients with uterine sarcoma were treated in the Gynecology Department of the First Affiliated Hospital of University of Science and Technology of China.Clinical features,age,menopausal time,preoperative laboratory,imaging examination,operation and postoperative follow-up were analyzed retrospectively.Results:1)The average age of uterine leiomyosarcoma patients was(56.38±10.24)years old;the size of the mass was(91.75±52.37)mm,carbohydrate antigen 125(CA125)(31.9±21.81)U/mL,lactate dehydrogenase(LDH)(222.68±146.58)U/L.After surgery,2 patients received chemoradiotherapy;4 received chemotherapy;and metastasis occurred in 3 patients during follow-up.2)The average age of patients with endometrial stromal sarcoma was(58.40±13.35)years old;the size of the mass was(92.60±23.11)mm,CA125(25.00±13.04)U/mL,LDH(237.60±78.72)U/L.One patient received chemotherapy and radiotherapy,and one patient received chemotherapy.All patients survived during follow-up.3)The average age of uterine adenosarcoma patients was 42 years old;the mass size was 75 mm,CA12539.63 U/mL,and LDH 163 U/L.All patients received chemotherapy after surgery.One patient died during follow-up.Conclusion:Patients with uterine sarcoma are mostly treated with pelvic mass and vaginal bleeding.LDH>199 U/L and pelvic mass≥8 cm in diameter,the rapid growth of mass can be used as distinguishing indicators.It is unclear whether lymph node dissection has benefited patients during surgery,and it is worth studying whether the lymph node metastasis is evaluated before surgery.Although uterine sarcoma occurs in perimenopausal and menopausal women,for young women with pelvic mass and vaginal bleeding,the possibility of uterine adenosarcoma should be considered to avoid worsening the patient condition.