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目的 探讨女性生殖系统的恶性中胚叶混合瘤(MMMTs)的临床特点、诊断治疗及预后。方法 回顾性分析北京协和医院1993-2002年收治的13例生殖系统的恶性中胚叶混合瘤的临床资料。结果 13例MMMTs中,宫颈MMMTs2例,子宫MMMTs 5例,输卵管MMMTs 1例,卵巢MMMTs 5例。宫颈MMMTs主要表现为不规则阴道出血、绝经后出血;子宫MMMTs可表现为长期的月经紊乱和绝经后出血;附件MMMT8表现为腹胀、腹痛、尿少等非特异性症状。6例术前CA125值大于35U/ml,肿瘤复发、未控及转移时CA125值均升高;确诊主要依据病理检查。所有患者均接受1-3次手术。12例术后辅助化疗,其中4例又合并放疗。宫颈MMMTs中2例均于1年内死亡;子宫MMMTs中2完全缓解,1例1年内死亡,2例两年内死亡;输卵管MMMTs 1例目前带瘤生存11个月;卵巢MMMTs中2例完全缓解6及61个月,2例带瘤生存20及14个月,1例1年内死亡。结论 恶性中胚叶混合瘤发生率极低,可以发生于女性生殖系统的各个部位且有各自不同的临床特点及相同的病理特点。对于宫颈、输卵管及卵巢MMMTs,CA125有利于疾病的诊断和病情的监测。手术是女性生殖系统恶性中胚叶混合瘤的主要治疗方法,术后应根据肿瘤的部位采取化疗、放疗等综合治疗。
Objective To investigate the clinical features, diagnosis, treatment and prognosis of malignant mesodermal mixed tumor (MMMTs) in the female reproductive system. Methods The clinical data of 13 patients with malignant mesodermal mixed tumor of reproductive system admitted from 1993 to 2002 in Peking Union Medical College Hospital were retrospectively analyzed. Results Among 13 MMMTs, 2 cases of cervical MMMTs, 5 cases of uterine MMMTs, 1 case of tubal MMMTs and 5 cases of ovarian MMMTs. Cervical MMMTs mainly for irregular vaginal bleeding, postmenopausal bleeding; uterine MMMTs can be manifested as long-term menstrual disorders and postmenopausal bleeding; appendix MMMT8 showed bloating, abdominal pain, oliguria and other non-specific symptoms. 6 cases of preoperative CA125 value greater than 35U / ml, tumor recurrence, uncontrolled and metastatic CA125 values were elevated; confirmed mainly based on pathological examination. All patients underwent 1-3 surgeries. Twelve patients received postoperative adjuvant chemotherapy, of which 4 were combined with radiotherapy. 2 cases of cervical MMMTs died within 1 year; 2 cases of MMMTs uterine complete remission, 1 case died within 1 year, 2 cases died within two years; tubal MMMTs 1 case with tumor survival 11 months; ovarian MMMTs 2 cases complete remission 6 And 61 months, 2 patients with tumor survival 20 and 14 months, 1 patient died within 1 year. Conclusion Malignant mesodermal mixed tumor incidence is very low, can occur in various parts of the female reproductive system and has its own different clinical features and the same pathological features. For cervical, fallopian tube and ovarian MMMTs, CA125 is good for disease diagnosis and condition monitoring. Surgery is the main treatment of malignant mesodermal mixed tumor in female reproductive system. After operation, chemotherapy, radiotherapy and other comprehensive treatment should be taken according to the tumor site.