盆腔器官脱垂治疗意外发现子宫恶性肿瘤的临床分析  

Clinical analysis of unexpected discovery of uterine malignancy tumor during treatment of pelvic organ prolapse

作　　者：马静泽 史宏晖[2] 卓秀萍 朱兰[2] MA Jing-ze;SHI Hong-hui;ZHUO Xiu-ping;ZHU Lan(BeijingPuhua International Hospital,Beijing 100050;Peking Union Medical College Hospital,Peking Union Medical College/Chinese Academy of Medical Sciences,Beijing 100730)

机构地区：[1]北京天坛普华医院,北京100050 [2]中国医学科学院北京协和医学院北京协和医院,北京100730

出　　处：《生殖医学杂志》2020年第4期476-479,共4页Journal of Reproductive Medicine

摘　　要：盆腔器官脱垂治疗中意外发现子宫恶性肿瘤很少见,容易漏诊和救治不及时。本文回顾分析了北京协和医院2012年3月至2019年6月及北京天坛普华医院2018年12月至2019年6月期间从900例因盆腔器官脱垂行全子宫切除的患者中发现的4例子宫内膜癌及子宫内膜间质肉瘤病例,总结其一般情况、手术情况、随访情况,并结合国内外相关文献分析其特点。结果发现这4例患者分别为围绝经期阴道出血女性诊刮漏诊子宫内膜癌1例、绝经后无症状女性子宫内膜增厚诊刮漏诊子宫内膜间质肉瘤1例、不能根据现有诊疗规范完全避免的漏诊子宫内膜癌2例。由此可见盆腔器官脱垂治疗过程中根据现有的临床手段及诊断流程不能完全避免漏诊子宫恶性肿瘤,甚至无法通过目前的诊断方法来改善,因此对于盆腔器官脱垂选择保留子宫的手术病人应特别谨慎。Uterine malignant tumors are rarely found in treatment of pelvic organ prolapse,and they are easily missed and left untreated.Four cases of endometrial cancer or uterine sarcoma were found in 900 patients treated with hysterectomy due to pelvic organ prolapse in Peking Union Medical College Hospital from March,2012 to June,2019,and in Beijing Puhua International Hospital from December,2018 to June,2019.The clinical manifestations,diagnosis and treatment were summarized,and their characteristics were analyzed by combined with domestic and abroad relevant literatures.Of these 4 patients,2 were not diagnosed by hysteroscopic scraping,including 1 case of endometrial cancer in a perimenopausal women with vaginal bleeding and 1 case of endometrial stromal sarcoma in a postmenopausal women with asymptomatic endometrial thickening.The missed diagnosis of other 2 cases of endometrial cancer could not be completely avoided according to the existing diagnostic and treatment standards.It can be seen that it is difficult to have every case of uterine malignant tumors diagnosed in the process of pelvic organ prolapse treatment,and this situation even could not be improved by current diagnostic procedures.Therefore,it should be particularly cautious for the patients with pelvic organ prolapse who choose to retain the uterus.

关 键 词：盆腔器官脱垂 子宫内膜癌 子宫内膜间质肉瘤 诊刮术 

分 类 号：R711.23[医药卫生—妇产科学]