关于分碎术对未预料子宫肉瘤影响的55例病例对照研究  

A Case Control Study of 55 Cases about Morcellation on the Impact of Unexpected Uterine Sarcomas

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110004

出　　处：《国际妇产科学杂志》2016年第3期357-360,共4页Journal of International Obstetrics and Gynecology

摘　　要：目的:对腹腔镜及开腹手术中发现的未预料子宫肉瘤病例进行病例对照研究,以探讨分碎术对该病的影响,并分析患者的病例资料探讨该病的早期诊断。方法:选取2008年11月—2014年11月术后病理为子宫肉瘤而手术指征为子宫肌瘤的病例,其中腹腔镜组8例,开腹组47例,腹腔镜组使用分碎器而开腹组未使用,行对照研究并分析患者临床特点。结果:55例未预料子宫肉瘤患者中16例(腹腔镜组7例,开腹组9例)行二次手术;腹腔镜组二次手术率高于开腹组(87.5%vs.19.1%,P=0.000),二次手术中发现盆腔种植转移病例数多于开腹组(2 vs.0),术中病理确诊率低于开腹组(37.5%vs.76.6%,P=0.038)。结论:腹腔镜下分碎术可能增加了未预料子宫肉瘤的盆腔种植转移以及二次手术的概率,并降低了术中病理明确诊断率,这应该引起临床医师的注意并采取相应的措施规避此风险的发生。Objective：A case control study of unexpected uterine sarcomas between laparo scopy and laparotomy was done to determine the influence of morcellation on the disease and to explore the early diagnosis by analyzing their characteristics. Methods：Between November 2008 and November 2014, all of uterine sarcomas diagnosed after operation for benign uterine fibroid were abstracted and the patients were divided into two groups, laparoscopy（8 cases） or laparotomy（47 cases）.Morcellator was used in laparoscopy, but not in laparotomy. The clinical datas were reviewed. Results：The number of unexpected uterine sarcomas is 55 cases, 16 cases（7 laparoscopies and 9 laparotomies） underwent second surgery. Compared with laparotomy, laparoscopy had a higher risk of second surgery（87.5% vs. 19.1%, P=0.000） and pelvic planting and metastasis（2 cases vs. 0 case）, and a lower rate of pathologic diagnosis（37.5% vs. 76.6%, P=0.038）. Conclusions：Laparoscopic morcellation had a higher risk of second surgery and pelvic planting and metastasis, and a lower rate of pathologic diagnosis. This should be paid more attention by clinicians and some measures should be taken to avoid the risk.

关 键 词：肉瘤 子宫内膜间质 平滑肌瘤 腹腔镜 妇科外科手术 子宫肉瘤 分碎术 

分 类 号：R737.33[医药卫生—肿瘤]