子宫肿瘤微创手术后肿瘤转移原因分析  

Analysis of tumor metastasis caused by minimally invasive surgery of uterine neoplasm

作　　者：刘琦[1] 滕慧[1] 张承[1] 张秦[1] 钱敏[1] 管群[1] 陈小祥[2] 

机构地区：[1]南京军区南京总医院妇产科,南京医学博士210002 [2]江苏省肿瘤医院妇瘤科,南京210008

出　　处：《医学研究生学报》2016年第5期522-524,共3页Journal of Medical Postgraduates

摘　　要：目的妇科微创手术是近年来流行的肿瘤治疗方式,但应用不当易导致肿瘤转移。文中分析6例子宫肿瘤微创手术治疗后,出现肿瘤转移的原因及预防措施。方法回顾性分析2013年1月1日至2015年6月30日间南京军区南京总医院收治的6例初次采用微创治疗后出现肿瘤转移患者的临床资料与病理学特征,并对相关文献进行复习。结果 6例患者年龄39～52岁,初次手术方式包括宫腔镜2例、腹腔镜3例、射频消融1例。初次病理诊断包括：子宫肉瘤4例（低度恶性子宫内膜间质肉瘤2例、子宫平滑肌肉瘤2例）,分别于初次手术后3～16个月发现转移,并于15～48个月内死亡;子宫肌瘤2例,分别于初次手术后60和108个月发现腹腔及穿刺孔转移,再次手术切除后预后佳。结论宫腹腔镜以及射频治疗在应用不当的情况下易加剧肿瘤细胞的扩散转移。临床医师应充分了解缺乏病理情况下子宫肿瘤微创手术存在的潜在风险,避免手术引起的肿瘤转移。Objective Gynecologic minimally invasive surgery has become popular in the treatment of tumor therapy in recent years,but improper application can result in tumor metastasis. In this paper,we presented 6 uterine neoplasm cases of tumor metastasis after minimally invasive surgery and analyzed the causes and the preventive measures. Methods Retrospective analysis was made on the clinical data and pathology characteristics of the 6 uterine neoplasm cases of tumor metastasis after primary minimally invasive surgery in our department from January 1,2013 to 2015 June 30,and related literature were reviewed. Results The ages of 6patients were 39- 52 years old. The primary operation methods included 2 cases of hysteroscopic myomectomy,3 cases of laparoscopic myomectomy and 1 case of radiofrequency ablation. The pathological diagnosis after primary operations were 4 cases of uterine sarcoma（ low grade endometrial stromal sarcoma in 2 cases and leiomyosarcoma in 2 cases） who were found metastatic tumor at 3- 16 months after primary surgery and finally died of the disease and 2 cases of uterine fibroids who were found metastatic tumor in abdominal cavity and puncture hole at 60 months and 108 months respectively after primary operation followed by a good prognosis after the second surgical resection. Conclusion Owing to uterine neoplasm by hysteroscopy, laparoscopy often needs certain pressure and morcellation which may result in easy plantation of crushing tumor tissue or metastasis with circulation and puncture under pressure. Radiofrequency ablation lack of histopathologic diagnosis has heating effect which is inclined to speed up the spread and transfer of tumor cells once it is diagnosed as malignant. Therefore,clinicians should know the defects and risk of being lack of histopathologic diagnosis,diagnostic curettage pathology and fast pathology to avoid tumor metastasis induced by minimally invasive surgery.

关 键 词：子宫肿瘤 微创手术 转移 腹腔镜 宫腔镜 

分 类 号：G737.33[文化科学—教育学]