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目的:探讨前列腺恶性间叶肿瘤(PMMT)的诊断方法、治疗手段及预后情况。方法:回顾性分析20例PMMT患者的临床资料,并对所有患者进行随访,结合文献就其诊治及预后进行讨论。结果:20例患者中,常规病理和免疫组化确诊7例为平滑肌肉瘤,5例为横纹肌肉瘤,3例为间质肉瘤,1例为软骨肉瘤,4例为未分型恶性间叶肿瘤。12例(12/20)行根治性前列腺切除术(其中3例同时行乙状结肠造瘘,1例同时行膀胱造瘘),2例(2/20)行盆腔肿块切除术(术前均动脉栓塞),1例(1/20)行全盆器官切除术,1例(1/20)行盆腔淋巴结活检+结肠造瘘术,4例(4/20)因术前影像提示肺、盆腔、骨骼等转移而行保守治疗。本组中9例(9/20)治疗后3个月内肿瘤全身转移而死亡;3例(3/20)分别为术后6、7及14个月死亡;3例(3/20)分别带瘤存活5、11、12个月;2例(2/20)无瘤存活至今已12、24个月,均为术后行周期性化疗者;3例(3/20)失访。结论:前列腺恶性间叶肿瘤恶性程度高、进展快,经直肠超声引导下穿刺活检仍是确诊PMMT的主要手段,临床分期是影响预后的重要因素,早期诊断和以根治性前列腺切除为主的综合治疗可以显著提高患者生存率。
Objective: To investigate the diagnosis, treatment and prognosis of malignant mesenchyme of prostate (PMMT). Methods: The clinical data of 20 patients with PMMT were retrospectively analyzed. All the patients were followed up, and their diagnosis and prognosis were discussed in combination with the literature. Results: Of the 20 patients, 7 were diagnosed as leiomyosarcoma by routine pathology and immunohistochemistry, 5 as rhabdomyosarcoma, 3 as stromal sarcoma, 1 as chondrosarcoma and 4 as undifferentiated malignant mesenchyme. Twelve cases (12/20) underwent radical prostatectomy (including 3 cases of sigmoid colostomy at the same time and 1 case of bladder ostomy at the same time) and 2 cases (2/20) of pelvic tumor resection ), Pelvic organ resection in 1 case (1/20), pelvic lymph node biopsy + colostomy in 1 case (1/20) and pulmonary (4/20) in 4 cases (4/20) Transfer and other conservative treatment. Three of the 9 patients (9/20) died of systemic metastasis within 3 months after treatment. Three patients (3/20) died at 6, 7 and 14 months respectively. Three patients (3/20) The tumor survived for 5, 11, and 12 months. Two cases (2/20) of tumor-free survivors had been 12 and 24 months old, both of whom were treated with recurrent chemotherapy after surgery. Three patients (3/20) were lost to follow-up. Conclusion: The malignant mesenchymal tumor of prostate has high malignant degree and progresses rapidly. The biopsy guided by transrectal ultrasound is still the main means of diagnosing PMMT. The clinical stage is an important factor affecting the prognosis. Early diagnosis and radical prostatectomy Treatment can significantly improve patient survival.