子宫肉瘤初次正确诊断对预后的影响  

Original correct diagnosis affects the prognosis of patients with uterine sarcomas

作　　者：田可歌[1] 傅才英[1] 夏风玲[2] 张泽松[3] 

机构地区：[1]解放军总医院,北京100853 [2]河北省唐山市中医院 [3]湖北医科大学附属医院

出　　处：《解放军医学杂志》2004年第7期634-635,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的　分析子宫肉瘤常见的误诊原因 ,探讨提高初诊正确率的措施。方法　回顾性分析 4 0例子宫肉瘤的诊断治疗情况。结果　研究组 (I组 ) 2 5例 ,为初次手术时误诊者 ,占 6 2 5 %。其中 15例 2次手术 ,7例 3次手术 ,近期复发率高达 6 4 0 %。对照组 (II组 )15例 ,为初诊确诊子宫肉瘤者 ,占 37 5 % ;其中 4例复发 ,复发率为 2 6 7%。I组中位年龄 (4 3岁 )较II组 (5 0岁 )小 ,Ⅰ组 88%术前误诊为子宫平滑肌瘤而行局部切除 ,增加复发率和血行播散的机会。与Ⅱ组比较 ,I组再次手术的术中出血量及输血量显著增加。结论　初次正确诊断并选择根治性手术方式是改善子宫肉瘤预后的最重要因素 ;术前重视分析临床资料 ,利用现代辅助诊断手段 ,提高初诊正确率 。Objective To analyze the causes of misdiagnosis of uterine sarcomas and to explore the measures to reduce these errors. Methods A retrospective study of 40 cases of uterine sarcomas admitted between January 1980 and June 2002 to our hospital was performed. Results Uterine sarcomas were easily misdiagnosed as leiomyomas. A correct diagnosis of uterine sarcoma was made at primary operation in 15 cases (37.5%). A wrong diagnosis was made in 25 cases (62.5%), and among them re-operation was done in 15 cases. In 7 patients, three operations were performed. Recurrence rate was as high as 64.0%. The rate of hematogenous dissemination was also high. The patients in whom a misdiagnosis was made at their primary operation were younger in age than the patients in whom a correct diagnosis was made (43 years vs 50 years). The amounts of bleeding and transfusion during operations were increased in patients with misdiagnosis. Conclusions Atypical manifestations and lack of knowledge about the diseases were the main causes for misdiagnosis of uterine sarcomas. Misdiagnosis might be avoided by a comprehensive analysis of all clinical information. Radical resection of the primary tumor was the most significant means to ensure a better prognosis.

关 键 词：子宫肿瘤 肉瘤 误诊 预后 

分 类 号：R737.33[医药卫生—肿瘤]