本文選題：惡性潛能未定型子宮平滑肌瘤 + 富于細(xì)胞型子宮肌瘤�。� 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究目的:通過收集經(jīng)由手術(shù)治療然后經(jīng)病理確明診斷為惡性潛能未定型子宮平滑肌瘤(Smooth Muscle Tumours Of Uncertain Malignant Potential,SMTUMP)、富于細(xì)胞型子宮肌瘤(CUL)及子宮平滑肌肉瘤(LMS)的192例患者的臨床資料及術(shù)后隨訪情況,比較三種類型子宮腫瘤的發(fā)病年齡情況、臨床表現(xiàn)特征、不同的手術(shù)方式及預(yù)后情況,對相關(guān)數(shù)據(jù)及資料進(jìn)行分析總結(jié),加強(qiáng)臨床醫(yī)師對SMTUMP的認(rèn)識,并指導(dǎo)臨床醫(yī)師對上述類型子宮腫瘤的診斷和治療。研究方法:本研是通過收集山東大學(xué)附屬省立醫(yī)院2005年1月至2015年12月期間住院并進(jìn)行手術(shù)治療的子宮腫瘤患者,經(jīng)過術(shù)后石蠟病理檢查明確診斷為惡性潛能未定型子宮平滑肌瘤(SMTUMP)共57例,富于細(xì)胞型子宮肌瘤(CUL)共120例,以及子宮平滑肌肉瘤(LMS)共15例患者的臨床病理資料,采用回顧性分析,并全部進(jìn)行術(shù)后隨訪,將隨訪及預(yù)后情況進(jìn)行分析。總結(jié)并分析上述三種類型子宮腫瘤患者的年齡構(gòu)成、臨床表現(xiàn)、術(shù)前超聲表現(xiàn)、手術(shù)方式比較及術(shù)后復(fù)發(fā)轉(zhuǎn)移惡變等情況,應(yīng)用統(tǒng)計(jì)學(xué)方法進(jìn)行分析研究。研究結(jié)果:1.本研究中經(jīng)術(shù)后石蠟病理確診為惡性潛能未定型子宮平滑肌瘤(SMTUMP)的患者年齡范圍在26至58歲,該組病例平均年齡42.9歲;富于細(xì)胞型子宮肌瘤(CUL)患者:年齡在21至54歲,平均年齡41.8歲;子宮平滑肌肉瘤(LMS)患者:年齡在14至79歲,平均年齡50.8歲。2.本研究中三組病例病程最短0.5個(gè)月,最長60個(gè)月,其中惡性潛能未定型子宮平滑肌瘤(SMTUMP)患者平均病程9.85個(gè)月,富于細(xì)胞型子宮肌瘤(CUL)患者平均病程9.39個(gè)月,兩組病例中前者平均病程略長,但兩者之間無統(tǒng)計(jì)學(xué)差異(p0.05),而子宮平滑肌肉瘤(LMS)組平均病程3.13月較前兩組病例平均病程明顯縮短,存在統(tǒng)計(jì)學(xué)差異(p0.05)。3.此次本研究的三種病理類型的子宮腫瘤病例之中惡性潛能未定型子宮平滑肌瘤(SMTUMP)及富于細(xì)胞型子宮肌瘤(CUL)病人中最常見的臨床表現(xiàn)為以經(jīng)量增多、經(jīng)期延長為主訴的月經(jīng)改變,其中惡性潛能未定型子宮平滑肌瘤(SMTUMP)組病人中月經(jīng)改變?yōu)橹饕R床表現(xiàn)的患者占45.67%,富于細(xì)胞型子宮肌瘤(CUL)組以月經(jīng)改變?yōu)橹饕R床表現(xiàn)的患者占46.69%,子宮平滑肌肉瘤(LMS)患者中最主要的臨床表現(xiàn)為不規(guī)則陰道流血,占所研究組病例的46.67%。本研究中三組病例臨床表現(xiàn)居第二位的為下腹部包塊,瘤體較大者可伴有壓迫癥狀(尿頻、便秘、腰骶部墜痛等),其他臨床表現(xiàn)如:下腹疼痛、原有肌瘤增大、痛經(jīng)等較少見,另外研究組中有一部分惡性潛能未定型子宮平滑肌瘤(SMTUMP)及富于細(xì)胞型子宮肌瘤(CUL)患者平素?zé)o任何臨床癥狀,僅僅是在健康查體的時(shí)候發(fā)現(xiàn)了子宮腫物。4.術(shù)前彩色多普勒超聲表現(xiàn):惡性潛能未定型子宮平滑肌瘤(SMTUMP)及富于細(xì)胞型子宮肌瘤(CUL)多表現(xiàn)為不均質(zhì)回聲或低回聲聲像團(tuán)塊,團(tuán)塊內(nèi)可見豐富血流信號,多數(shù)邊界清楚;子宮平滑肌肉瘤(LMS)多表現(xiàn)為低回聲團(tuán)塊,與肌層分界不清,內(nèi)見豐富血流信號,偶見腫瘤有包膜。超聲無明顯特異性表現(xiàn)。5.宮體或腫瘤體積的大小、病人的年齡、有無生育要求、全身營養(yǎng)狀況及術(shù)中快速病理結(jié)果是患者進(jìn)行手術(shù)治療時(shí),手術(shù)方式選擇的重要依據(jù),惡性潛能未定型子宮平滑肌瘤(SMTUMP)組病人行保留子宮手術(shù)者共34例,子宮全切術(shù)17例,子宮+雙附件切除術(shù)6例;富于細(xì)胞型子宮肌瘤(CUL)患者行保留子宮手術(shù)69例,子宮全切手術(shù)41例,子宮+單側(cè)附件切除手術(shù)6例,子宮+雙側(cè)附件切除手術(shù)4例;而子宮平滑肌肉瘤(LMS)組行廣泛子宮+雙附件切除+盆腔淋巴結(jié)切除手術(shù)4例,子宮+單側(cè)附件切除手術(shù)2例,廣泛子宮切除+雙側(cè)卵巢楔形活檢手術(shù)1例,子宮+雙附件切除手術(shù)3例,子宮雙附件切除+盆腔淋巴結(jié)切除手術(shù)4例,1例行子宮雙附件切除+盆腔腫瘤切除手術(shù)患者于術(shù)后8月復(fù)發(fā),二次手術(shù)行腹膜后腫瘤切除術(shù)。6.對入組的所有患者進(jìn)行術(shù)后隨訪:隨訪時(shí)間最短3.5月,最長8.5年,惡性潛能未定型子宮平滑肌瘤(SMTUMP)患者有2例分別于術(shù)后6.5月,及11.5月復(fù)發(fā),在兩組病例的隨訪中暫未發(fā)現(xiàn)惡變及轉(zhuǎn)移病例;富于細(xì)胞型子宮肌瘤(CUL)患者復(fù)發(fā)3例,余患者均健在;子宮平滑肌肉瘤(LMS)組患者2例分別于術(shù)后6月及12月死亡,復(fù)發(fā)1例,術(shù)后定期化療3例,未見復(fù)發(fā),失聯(lián)2例,余7例患者均健在。7.在本研究三組患者中,惡性潛能未定型子宮平滑肌瘤(SMTUMP)組行腹腔鏡下子宮肌瘤挖除術(shù)并使用子宮肌瘤粉碎器者9例,隨訪時(shí)間6-39個(gè)月,未見復(fù)發(fā)轉(zhuǎn)移及局部種植;富于細(xì)胞型子宮肌瘤(CUL)組行腹腔鏡下子宮肌瘤挖除術(shù)并使用子宮肌瘤粉碎器者28例,隨訪時(shí)間6-48個(gè)月,未見復(fù)發(fā)轉(zhuǎn)移及局部種植;子宮平滑肌肉瘤(LMS)組均采取開腹手術(shù)方式。結(jié)論:惡性潛能未定型子宮平滑肌瘤(SMTUMP)及富于細(xì)胞型子宮肌瘤(CUL)均無特異性的臨床表現(xiàn),與普通型子宮平滑肌瘤相似,術(shù)前超聲無特異性表現(xiàn),術(shù)前診斷困難,確診仍依靠病理手段,兩種類型子宮腫瘤手術(shù)治療預(yù)后較好,但因存在復(fù)發(fā)率及惡變傾向,手術(shù)治療可放寬子宮切除的指征,加強(qiáng)術(shù)后隨訪,術(shù)后短期隨訪表明:腹腔鏡子宮肌瘤粉碎器的使用能讓惡性潛能未定型子宮平滑肌瘤(SMTUMP)及富于細(xì)胞型子宮肌瘤(CUL)患者受益,仍需長期觀察進(jìn)行評估;子宮平滑肌肉瘤(LMS)因惡性程度高,早期發(fā)生復(fù)發(fā)轉(zhuǎn)移種植幾率也相對較高,故應(yīng)完善術(shù)前檢查,盡量避免子宮肌瘤粉碎器的使用。
[Abstract]:Objective: To compare the clinical data and follow-up of 192 patients with Smooth Muscle Tumours Of Uncertain Malignant Potential, SMTUMP, cell type uterine myoma (CUL) and uterine leiomyosarcoma (LMS), which were diagnosed by surgical treatment and then diagnosed as malignant potential unshaped uterine leiomyoma (SMTUMP), and were followed up with a comparison of three. The age, clinical features, different surgical methods and prognosis of different types of uterine tumors, analysis and summary of relevant data and data, strengthening the understanding of SMTUMP by clinicians, and guiding clinicians to diagnose and treat these types of uterine tumors. Research methods: this research is through the collection of Shandong University affiliated. The patients who were hospitalized in the provincial hospital from January 2005 to December 2015 were diagnosed with 57 cases of malignant potential unshaped uterine leiomyoma (SMTUMP), 120 cases of cell type hysteromyoma (CUL), and 15 cases of uterine leiomyosarcoma (LMS). Data, retrospective analysis, and all follow-up follow-up, follow up and prognosis analysis. Summarize and analyze the age composition of the three types of uterine tumors, clinical manifestations, preoperative ultrasound performance, surgical comparison and postoperative recurrence and metastasis of malignant change and other conditions, the application of statistical methods for analysis and research. Fruit: 1. in this study, patients with malignant potential undefined uterine leiomyoma (SMTUMP) diagnosed by paraffin pathology were aged from 26 to 58 years old. The average age of the group was 42.9 years old; the patients with cellular myoma (CUL) were aged from 21 to 54 years old, with an average age of 41.8 years; patients with uterine leiomyosarcoma (LMS): aged from 14 to 79 years old, flat. The course of the three group of 50.8 years old.2. was the shortest 0.5 months and the longest 60 months. The average course of the patients with malignant latent uterine leiomyoma (SMTUMP) was 9.85 months, and the average course of the patients with cell myoma (CUL) was 9.39 months. The average course of the former was slightly longer in the two group, but there was no statistical difference between the two groups (P0 .05), while the average course of the uterine leiomyosarcoma (LMS) group was 3.13 months compared with the average course of the first two groups, there was a statistically significant difference (P0.05) the most common presence of malignant potential undefined uterine leiomyoma (SMTUMP) and cell type hysteromyoma (CUL) in the three pathological types of uterine tumours in this study. The bed showed a menstrual change with increased menstruation and prolonged menstruation, of which 45.67% of the patients with malignant potential unshaped uterine leiomyoma (SMTUMP) were the main clinical manifestations, and 46.69% of the patients with cellular hysteromyoma (CUL) with menstrual changes as the main clinical manifestations, and uterine leiomyosarcoma (LMS). The main clinical manifestation of the patients was irregular vaginal bleeding. In the 46.67%. study of the study group, the clinical manifestations of the three groups were second in the lower abdominal mass. The larger body of the tumor could be accompanied by compression symptoms (frequency of urine, constipation, lumbosacral pain and so on), and other clinical manifestations such as lower abdominal pain, original myoma, dysmenorrhea and so on. In addition, some of the patients with malignant potential undefined uterine leiomyoma (SMTUMP) and cell type uterine myoma (CUL) have no clinical symptoms. Only in health examination, the color Doppler sonography before.4. was found: malignant potential unshaped uterine leiomyoma (SMTUMP) and rich. Cell type uterine fibroids (CUL) were characterized by heterogeneous echoes or hypoechoic masses, with abundant blood flow signals in the masses, and most of the boundaries were clear. Uterine leiomyosarcoma (LMS) was characterized by hypoechoic masses, indistinct demarcation with the myometrium, rich blood flow signals and occasional tumors with envelopes. There was no specific manifestation of.5. or swelling in ultrasound. The size of the tumor, the age of the patient, the age of childbirth, the nutritional status of the whole body and the rapid pathological results in the operation are the important basis for the surgical treatment, and 34 cases of the patients with malignant latent uterine leiomyoma (SMTUMP), 17 cases of hysterectomy, uterus plus double appendix excision. In 6 cases, 69 cases of uterine leiomyoma (CUL), 41 cases of hysterectomy, 6 cases of uterine plus unilateral adnexectomy, 4 cases of uterine + bilateral adnexectomy, 4 cases of uterine leiomyosarcoma (LMS) and 2 cases of uterus + unilateral adnexectomy, and 2 cases of unilateral adnexectomy, were performed in the group of uterine leiomyosarcoma (LMS). 1 cases of extensive hysterectomy plus bilateral ovarian wedge biopsy, 3 cases of uterine + double appendage resection, 4 cases of double appendage resection plus pelvic lymphadenectomy, 1 cases of double appendix resection plus pelvic tumor resection in August, and two operation for retroperitoneal swelling of the peritoneum in all patients after the operation of the two operation. Follow up: the shortest 3.5 months of follow-up, the longest 8.5 years, 2 cases of malignant potential unshaped uterine leiomyoma (SMTUMP) patients were 6.5 months after the operation, and 11.5 months of recurrence. In the two group of cases, no malignant change and metastasis were found; 3 cases of cell type uterine leiomyoma (CUL), the remaining patients were all alive; uterine leiomyosarcoma (LMS). 2 patients died in June and December after operation, 1 cases recurred, 3 cases of regular chemotherapy after operation, no recurrence, loss of union 2 cases, and 7 patients in the three group of the study, malignant potential unshaped uterine leiomyoma (SMTUMP) group underwent laparoscopic hysteromyoma dug and 9 cases of hysteromyoma comminator, and the follow-up time was 6-39. There was no recurrence and local implantation in the month, and 28 cases of uterine myoma (CUL) were performed laparoscopic hysteromyoma removal and uterine myoma comminution. The follow-up time was 6-48 months, no recurrence and local implantation were observed. The uterine leiomyosarcoma (LMS) group was operated by laparotomy. Conclusion: malignant potential unshaped uterus No specific clinical manifestations of leiomyoma (SMTUMP) and cell type uterine myoma (CUL) are similar to ordinary uterine leiomyoma. Preoperative ultrasound has no specific performance, preoperative diagnosis is difficult, and the diagnosis still depends on pathological methods. The prognosis of the two types of uterine tumors is better, but the surgical treatment is due to the recurrence rate and malignant tendency. The indications of hysterectomy can be relaxed and follow-up is strengthened. Short term follow-up after the operation shows that the use of laparoscopic myomarcoma can benefit the patients with malignant potential unshaped uterine leiomyoma (SMTUMP) and cell type uterine myoma (CUL). It still needs long-term observation, and the uterine leiomyosarcoma (LMS) is highly malignant and early in the early stage. The probability of recurrence and metastasis is relatively high. Therefore, preoperative examination should be perfected to avoid the use of uterine fibroid smashing device.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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