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目的了解子宫肉瘤根治性手术后复发转移的规律。方法对３０例子宫肉瘤根治性手术后复发的临床资料进行回顾性分析。结果本组术后复发的发生率为３８０％。复发时间４３３％（１３／３０）发生于术后１年内，６６７％（２０／３０）发生于术后２年内。临床分期Ⅰ期２２例，Ⅱ期３例、Ⅲ期５例、无Ⅳ期患者。２７例为单灶复发，３例为多灶复发。复发部位依次为局部复发占４２４％，盆腔淋巴结复发占３３３％，肺９１９％，肝及大网膜各６１％，锁骨上淋巴结占３％。复发部位与病理类型有关，局部复发以平滑肌肉瘤多见，占１０／１６，盆腔淋巴结复发以子宫内膜间质肉瘤及恶性苗勒氏混合瘤多见，分别为５／６及３／５（Ｐ＜００１）。复发部位与首次手术方式无关（Ｐ＞００５）而与临床分期之关系有待于进一步研究。结论①子宫肉瘤患者在根治性手术后２年内应密切随诊。②大网膜是常见的转移复发部位，手术时应特别仔细探查，必要时行大网膜切除。③对子宫内膜间质肉瘤或恶性苗勒氏混合瘤，建议行广泛全子宫切除加盆腔淋巴结清扫。
Objective To understand the regularity of recurrence and metastasis after radical surgery of uterine sarcoma. Methods The clinical data of 30 cases of uterine sarcoma recurrence after radical surgery were retrospectively analyzed. Results The incidence of postoperative recurrence was 38.0%. The recurrence time of 43. 3% (13/30) occurred within 1 year after operation, and 66.7% (20/30) occurred within 2 years after operation. Clinical stage I was 22 cases, stage II 3 cases, stage III 5 cases, and stage IV patients. Twenty-seven cases had recurrence of single lesions, and three cases had multifocal recurrence. The recurrence sites were 42.4% for local recurrence, 33. 3% for pelvic lymph node recurrence, 9 9% for lung, 6 1% for liver and greater omentum, and 3% for supraclavicular lymph nodes. The location of recurrence was related to the pathological type. Local recurrence was more common in leiomyosarcoma, accounting for 10/16, and pelvic lymph node recurrence was common in endometrial stromal sarcoma and malignant Mullerian mixed tumor, which were 5/6 and 3/5 ( P<001). The recurrence site was not related to the first surgical procedure (P>005) and the relationship with clinical staging needs further study. Conclusion 1 Patients with uterine sarcoma should be closely followed up within 2 years after radical surgery. 2 omentum is a common site of metastasis and recurrence, and should be carefully examined during surgery. If necessary, omentum resection is performed. 3 For endometrial stromal sarcoma or malignant Mullerian mixed tumors, extensive hysterectomy plus pelvic lymph node dissection is recommended.