子宫肉瘤153例临床分析  

A Clinical Analysis of 153 Uterine Sarcomas

作　　者：白萍[1] 孙建衡[1] 晁红霞[1] 仇铁珍 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院妇科

出　　处：《中华妇产科杂志》1997年第3期163-167,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：分析１５３例各型子宫肉瘤的临床资料，以了解与其预后有关的因素，寻求治疗的改进方法。方法：回顾性分析１９６０年５月至１９９４年４月我院收治的子宫肉瘤１５３例临床资料。包括平滑肌肉瘤４８例，中胚叶混合瘤４７例，癌肉瘤８例，葡萄状肉瘤４例，内膜间质肉瘤３７例，纤维肉瘤１例，恶性淋巴瘤８例。临床分期为Ⅰ期８１例，Ⅱ期１１例，Ⅲ期３３例，Ⅳ期１１例。手术治疗３８例，手术加放疗２４例，手术加化疗５０例，手术加放疗加化疗２３例，单纯放疗４例，单纯化疗３例，放疗加化疗１１例。结果：总５年生存率４９．０％。平滑肌肉瘤５年生存率４６．９％，中胚叶混合瘤３４．１％，内膜间质肉瘤６９．３％，三者比较，Ｐ＜０．０１。肿瘤局限于子宫（Ⅰ期＋Ⅱ期）患者的５年生存率为５９．６％，侵及盆腔（Ⅲ期）者为２５．６％，转移至上腹部或远处者为１０．０％（Ｐ＜０．０１）。当子宫体积＜妊娠３个月子宫时，５年生存率为４９．９％，而≥３个月时为１８．８％（Ｐ＜０．０５）。绝经前患者５年生存率为５６．３％，绝经后为２８．９％（Ｐ＜０．０１）。结论：子宫肉瘤预后与病理类型、临床及手术病理分期、子宫大小及绝经前后有明显关系。单纯放、化疗仅为姑息治疗。术后辅?Objective: To evaluate the prognostic factors and treatment methods of 153 uterine sarcomas.Methods: 153 cases of th uterine sarcoma were eligible for this retrospective study. Of the 153 cases, 48 were leiomyosarcomas, 47 mixed mesodermal sarcomas, 37 endometrial stromal sarcomas, 8 carcinosarcomas, 4 sarcoma botryoides, 1 fibrosarcoma, and 8 malignant lymphomas.81 cases were in stage Ⅰ, 11 stage Ⅱ, 33 stage Ⅲ and 11 stage Ⅳ.38 cases were treated by surgery alone , 24 by surgery combined with radiation therapy, 50 by surgery plus chemotherapy, 23 by surgery plus radiation therapy and chemotherapy, 4 by radiation therapy alone, 3 by chemotherapy alone, and 11 by radiation therapy plus chemotherapy. Results:The overall 5 year survival rate was 49.0%, and that of leiomyosarcomas, mixed mesodermal sarcomas and endometrial stromal sarcomas was 46.9%, 34.1% and 69.3% respectively ( P <0.01).The 5 year survival rate of lesions limited to the uterus (stage Ⅰ+Ⅱ), and that of pelvic cavity invasion (stage Ⅲ) and distant metastases was 59.6%, 25.6% and 10.0% respectively ( P <0.01)。When the uterus was smaller than a 3 months pregnant uterus, the 5 year survival rate was 49.9%. When the uterus size larger than a 3 months pregnant uterus, the survival rate was 18.8% ( P <0.05). Premenopausals surviving 5 year accounted for 56.3% and postmenopausals 28.9% ( P <0.01). Conclusions: The prognosis of uterine sarcoma is significantly associ ated with histologic type, clinical and surgico pathological stage, uterine size and pre or post menopausal status.Radiation or chemotherapy alone is palliative.Postsurgical adjuvant radiotherapy significantly decreased vaginal and pelvic recurrences rates. A combination of surgery, radiotherapy and chemotherapy can reduce pelvic recurrence as well as enhance survivals.

关 键 词：子宫肿瘤 肉瘤 预后 临床分析 

分 类 号：R737.33[医药卫生—肿瘤]