分碎术在次全子宫切除术中用于未预料子宫恶性肿瘤病例对照研究  

A case-control study about morcellation applied to unexpected uterine malignant tumors in supracervical hysterectomy

作　　者：赵万成[1] 杨清[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110001

出　　处：《现代妇产科进展》2015年第12期919-922,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨分碎术用于子宫恶性肿瘤的机率以及对其预后的影响。方法:选取2008年11月至2014年11月以子宫肌瘤为主诊断行腹腔镜或开腹次全子宫切除术的患者1088例,按手术方式将患者分为腹腔镜组(312例)和开腹组(776例)。比较两组发生未预料子宫恶性肿瘤的机率,并分析患者的临床资料和随访其预后。结果:腹腔镜组中有3例(0.96%)未预料子宫恶性肿瘤(肉瘤2例,内膜癌1例);开腹组中有6例(0.77%)未预料子宫恶性肿瘤(肉瘤4例,内膜癌2例)。两组发生未预料子宫恶性肿瘤的机率比较,差异无统计学意义(P=0.502)。腹腔镜组在子宫肉瘤盆腔种植转移率(50%,1/2)及复发率(50%,1/2)方面均高于开腹组(0%,25%)。结论:分碎术在腹腔镜次全子宫切除术中的应用可能有引起未预料子宫恶性肿瘤(尤其是子宫肉瘤)盆腹腔内种植转移及增加术后复发机会的风险,应引起临床医师重视。Objective ：To analyze the ratio of morcellation applied to unexpected uterine malignant tumors and its influence on prognosis. Methods ： From Nov. 2008 to Nov. 2014, 1088 cases were collected, and their main diagnosis was uterine fibroid and their surgical method was laparoseopic or transabdominal superacervical hysterectomy. They were divided into two groups, laparoscopy （312 cases） and laparotomy （776 cases）. The clinical data was reviewed. Results：There were 3 cases of unexpected uterine malignant tumors （2 cases of uterine sarco- ma, 1 case of endometrial cancer） in laparoscopy, and the ratio was 0.96%. 6 unexpected uterine malignant tumors （4 cases of uterine sarcoma,2 cases of endometrial cancer） occurred in laparotomy,and the ratio was 0.77%. There was no statistical difference in the ratio between the two groups （P = 0. 502）. The uterine sarcoma pelvic metastasis and planting rate （50% vs 0% ） and the recurrence rate （50% vs 25% ） in laparoscopy was higher than those in laparoto- my. Conclusions ：Laparoscopie morcellation in supracervical hysterectomy maybe cause the risk of increased pelvic metastasis and planting rate and recurrence rate of unexpected uterine malignant tumors （especially uterine sarcomas）. The risk should be paid more attention to by clinicians.

关 键 词：腹腔镜 分碎术 子宫肌瘤 子宫肉瘤 子宫内膜癌 

分 类 号：R713.4[医药卫生—妇产科学]