术后病理意外发现子宫肉瘤的临床病理分析及处理

目的:回顾性分析行子宫肌瘤手术意外发现子宫肉瘤的患者的临床病理资料,探讨如何提高此类患者的术前诊断率,并采取何种治疗方式来改善患者的预后。方法:选取2011年12月至2019年10月以诊断为子宫肌瘤在外院行手术治疗,术后病理确诊为子宫肉瘤然后在我院行后续治疗的患者。分析其临床病理资料并随访其预后。结果:共计25例行子宫肌瘤手术意外发现的子宫肉瘤患者,患者平均年龄(43.68±6.66)岁,子宫平滑肌肉瘤15例,子宫内膜间质肉瘤9例,子宫癌肉瘤1例,FIGO I期22例,II期3例,行子宫全切除术12例,子宫次全切除术7例,子宫肌瘤切除术6例,开腹手术17例,腔镜手术8例,术后行二次手术者18例,术后单纯化疗者8例,同步放化疗者13例,4例患者未采取术后辅助治疗。随访至2020年2月,平均随访(31.48±16.40)个月,复发11例,死亡5例。平均复发时间(11.4±5.8)个月,中位无进展生存期41个月,中位总体生存期数据尚未观察到。结论:应加强提高子宫肉瘤的术前诊断率,对于意外发现子宫肉瘤的患者应根据患者的病情选择合适的手术及辅助治疗方案以提高患者的生存率。

Clinicopathology and Management of Postoperative Uterine Sarcoma

Objective:To retrospectively analyze the clinical data of patients with unexpected uterine sarcomas after surgery for uterine fibroids,in order to explore how to improve the preoperative diagnosis rate of such patients and what kind of treatment can improve the survival rate of these patients.Methods:From December 2011 to October 2019,patients who were diagnosed as uterine fibroid and pathologically confirmed as uterine sarcoma after surgery were selected to analyze their clinicopathological data and follow up their prognosis.Results:There were 25 cases of unexpected uterine sarcomas,inclu-ding 15 cases of leiomyosarcoma,9 cases of endometrial stromal sarcoma and 1 case of uterus carcinosarcoma.The mean age of the patients was 43.68±6.66 years old.22 cases were in FIGO stage I and 3 cases were in FIGO stage II.12 cases underwent hysterectomy,7 cases underwent supracervical hysterectomy,and 6 cases underwent myomectomy;17 cases underwent open surgery,8 cases underwent laparoscopic surgery.After surgery,18 cases underwent another surgery;8 cases received chemotherapy,13 cases received concurrent radiochemotherapy,4 cases did not receive adjuvant treatment.Follow-up was conducted till February 2020.The median follow-up time was(31.48±16.40)months.11 cases of recurrence and 5 cases of death were observed.The mean recurrence time was 11.4 months,and the median progression free survival was 41 months,the median overall survival was not observed.Conclusion:In order to improve the survival rate of patients with unexpected uterine sarcoma,we should raise the preoperative diagnosis rate of uterine sarcoma and choose appropriate surgery and adjuvant treatment according to patients’condition.