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目的子宫肉瘤是恶性程度较高的女性生殖道恶性肿瘤,由于无特异性表现,临床误诊率高达50%以上。方法为提高临床术前的诊断率,防止手术范围不当,本文回顾分析北京大学人民医院自2005年1月至2015年1月诊治的子宫肉瘤38例,其中子宫平滑肌肉瘤(LMS)17例(44.7%),子宫内膜间质肉瘤(ESS)15例(39.5%),子宫未分化肉瘤(UUS)2例(5.3%),腺肉瘤4例(10.5%)。分析其临床表现、影像学资料及血清肿瘤标志物,统计其与术前诊断及漏诊的相关性。结果 38例子宫肉瘤患者中,24例术前或术中明确诊断,14例漏诊。其中LMS漏诊率47.1%,ESS漏诊率26.7%,UUS漏诊率100%,腺肉瘤漏诊率0%。有压迫症状患者及有多种症状的LMS患者更易漏诊,与确诊组相比差异有统计学意义(P值分别为0.018及0.029)。影像学分析中,10例阴道彩超提示可疑恶性的患者均在术前或术中明确诊断,在未提示恶性的28例患者中14例(50.0%)漏诊。术前宫腔镜或分段诊刮12例,11例明确诊断,1例LMS漏诊。18例患者进行了术中冰冻病理检查,2例ESS漏诊。结论对比ESS及腺肉瘤,UUS和LMS更易漏诊。对于存在压迫症状及多个症状的患者应小心肉瘤的可能。术前B超影像学能很好地提示可疑肉瘤的诊断。对可疑肉瘤的患者进行术前内膜活检,必要时术中冰冻病理检查能很好地防止手术范围不当。
Purpose Uterine sarcoma is a high degree of malignancy of the female genital tract cancer, due to non-specific performance, clinical misdiagnosis rate as high as 50%. Methods 38 cases of uterine sarcoma diagnosed and treated by Peking University People’s Hospital from January 2005 to January 2015 were retrospectively analyzed. Among them, 17 cases of uterine leiomyosarcoma (LMS) (44.7% 15 cases (39.5%) of endometrial stromal sarcoma (ESS), 2 cases (5.3%) of uterine undifferentiated sarcoma (UUS) and 4 cases (10.5%) of adenosarcoma. Analysis of its clinical manifestations, imaging data and serum tumor markers, statistics and preoperative diagnosis and missed diagnosis. Results Among the 38 patients with uterine sarcoma, 24 cases were diagnosed preoperatively or intraoperatively and 14 cases were missed. Among them, LMS misdiagnosis rate was 47.1%, ESS misdiagnosis rate was 26.7%, UUS misdiagnosis rate was 100% and adenosarcoma misdiagnosis rate was 0%. Patients with compression symptoms and LMS patients with multiple symptoms were more likely to misdiagnose, with significant differences from the diagnosed group (P = 0.018 and 0.029, respectively). Imaging analysis, 10 cases of vaginal ultrasound scan prompted suspicious malignant patients were diagnosed before or during surgery, 14 cases (50.0%) were missed in 28 cases without malignancy. Preoperative hysteroscopy or segmental curettage in 12 cases, 11 cases of definite diagnosis, 1 case of missed LMS. Eighteen patients underwent intraoperative frozen pathological examination, 2 cases of ESS missed diagnosis. Conclusions Compared with ESS and adenosarcoma, UUS and LMS are easier to miss. For patients with oppression symptoms and multiple symptoms should be sarcoma may be. Preoperative B-ultrasound imaging can well suggest the diagnosis of suspicious sarcoma. Patients with suspected sarcoma preoperative biopsy, if necessary, intraoperative frozen pathological examination can well prevent the surgical range improper.