子宫肌瘤手术意外发现的子宫肉瘤临床处理分析  

Clinical analysis of unexpected uterine sarcoma during laparoscopic surgeries for uterine myoma

作　　者：刘福军 梁海燕[1] 梁静[1] 冯定庆[1] 闫克芹[1] 陈庆云 凌斌[1,2] 

机构地区：[1]中日友好医院妇产科,北京100029 [2]北京协和医学院研究生院,北京100730

出　　处：《中国实用妇科与产科杂志》2018年第2期195-198,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨腹腔镜下子宫肌瘤手术使用分碎器意外发现子宫肉瘤患者的概率及对患者预后的影响,避免其应用于子宫肉瘤患者。方法通过回顾性分析2011年1月至2016年12月中日友好医院收治的2072例初步诊断为子宫肌瘤拟行子宫肌瘤剔除或子宫次全切除患者的病例资料,分为腹腔镜手术组(1944例)和开腹手术组(128例)。结果 1944例患者接受了腹腔镜手术且术中使用了分碎器,其中5例患者意外发现子宫肉瘤(0.3%),使用子宫肌瘤分碎器意外发现的子宫肉瘤患者的概率为0.3%;128例开腹手术组有2例意外发现子宫肉瘤(1.6%),两组意外发现子宫肉瘤的概率比较差异无统计学意义(P>0.05);7例患者随访2~45个月,均存活,腹腔镜组子宫肉瘤患者术后复发3例,开腹手术组患者术后无复发。结论腹腔镜下使用分碎器行子宫肌瘤手术可能导致子宫肉瘤患者预后恶化,分碎器应避免应用于子宫肉瘤患者。Objective To analyze the occurrence of uterus morcellation applied to unexpected uterine sarcoma during laparoscopic surgeries for uterine myoma and its influence on prognosis,and to prevent its occurrence. Methods Retrospective analysis was made in 2072 patients with uterine myoma in China-Japan Friendship Hospital treated from January 2011 to December 2016,who accepted myomectomy or subtotal hysterectomy.These patients were divided into laparoscopy group（1944）and laparotomy group（128）. Results Totally 1944 patients accepted morcellation during the laparoscopic procedure,and 5 of them were definitely diagnosed with uterine sarcoma.The occurrence of laparoscopic morcellation applied to unexpected uterine sarcoma was 0.3% during laparoscopic surgeries.Two of 128 patients were definitely diagnosed with uterine sarcoma during the laporotomic procedure. There was no significant difference in the occurrence of unexpected uterine sarcoma between the laparoscopic procedure and laporotomic procedure（P〉0.05）.The 7 patients were followed up for 2 to 45 months and they all survived.Three patients who accepted laparoscopic procedure,whereas no paitents who accepted laporotomic procedure had relapse.Conclusion The use of morcellation during the procedures may lead to a worse prognosis,so we should prevent the use of electrical morcellation during the uterine sarcoma surgeries.

关 键 词：子宫肌瘤 腹腔镜 分碎器 子宫肉瘤 

分 类 号：R713.4[医药卫生—妇产科学]