子宫肉瘤术后复发部位规律的探讨  

An Exploratory Analysis of Post-operative Recurrent Characteristics of Uterine Sarcoma

作　　者：梁立治[1] 黄欣[1] 李孟达[1] 熊樱[1] 

机构地区：[1]中山医科大学肿瘤医院妇科

出　　处：《中国实用妇科与产科杂志》1999年第8期477-479,共3页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的了解子宫肉瘤根治性手术后复发转移的规律。方法对３０例子宫肉瘤根治性手术后复发的临床资料进行回顾性分析。结果本组术后复发的发生率为３８０％。复发时间４３３％（１３／３０）发生于术后１年内，６６７％（２０／３０）发生于术后２年内。临床分期Ⅰ期２２例，Ⅱ期３例、Ⅲ期５例、无Ⅳ期患者。２７例为单灶复发，３例为多灶复发。复发部位依次为局部复发占４２４％，盆腔淋巴结复发占３３３％，肺９１９％，肝及大网膜各６１％，锁骨上淋巴结占３％。复发部位与病理类型有关，局部复发以平滑肌肉瘤多见，占１０／１６，盆腔淋巴结复发以子宫内膜间质肉瘤及恶性苗勒氏混合瘤多见，分别为５／６及３／５（Ｐ＜００１）。复发部位与首次手术方式无关（Ｐ＞００５）而与临床分期之关系有待于进一步研究。结论①子宫肉瘤患者在根治性手术后２年内应密切随诊。②大网膜是常见的转移复发部位，手术时应特别仔细探查，必要时行大网膜切除。③对子宫内膜间质肉瘤或恶性苗勒氏混合瘤，建议行广泛全子宫切除加盆腔淋巴结清扫。Objective\ To explore the recurrent characteristics of post-operactive uterine sarcoma.Methods\ Clinical data of 30 patients with recurrent uterine sarcoma after radical operation was analyzed retrospectively.Results\ The recurrent rate of whole group was 38 0% and the recurrence for 43 3% patients occurred within 1 year after the operation,while 66 7% within 2 years.The number of recurrent patients with stage Ⅰ,Ⅱ,Ⅲand Ⅳwere 27,3,5and 0 respectively.27 cases presented solitary lesion,while 3 cases with multi-lesion recurrence.The sites of recurrence and metastasis were associated with pathological classification.The frequency in turn were as follows :local 42 4%,pelvic lymphadenopathy 32 3%,lung 19 1%,liver and omentum were both 6 1% and supraclavicular 3%.Local recurrence occurred frequently in uterine sarcoma(10/16)and pelvic lymphadenopathy in endometrial stromal sarcoma(5/6)and maglinant mixed mullerian tumors(3/5).The site of recurrence was not related to primary operations and its relation to clinical staging remained to be studied.Conclusion\ ①All patients with uterine sarcoma should be carefully followed-up within 2 years after operation.②Omentum should be carefully examined and removed when necessary during operation because it was the common site of involvment.③Pelvic radical lymphadenectomy was recommended in the patient with endometrial stromal sarcoma and maglinant mixed mullerian tumors.

关 键 词：子宫肉瘤 复发 子宫肿瘤 手术后 

分 类 号：R737.33[医药卫生—肿瘤]