【摘要】：目的:探討子宮肉瘤的發(fā)生率、常見(jiàn)臨床表現(xiàn)、影像學(xué)表現(xiàn)、治療方法及預(yù)后,為更好的診治子宮肉瘤提供臨床依據(jù);分析未預(yù)料子宮肉瘤的發(fā)生率,臨床特點(diǎn),探討如何盡量避免未預(yù)料子宮肉瘤的發(fā)生及如何避免遇到未預(yù)料子宮肉瘤造成的不良后果。方法:1.收集2011年3月-2016年7月于天津中心婦產(chǎn)科醫(yī)院住院的66例子宮肉瘤患者的臨床資料,應(yīng)用SPSS19.0統(tǒng)計(jì)學(xué)軟件,對(duì)各組織學(xué)類(lèi)型患者的臨床特點(diǎn)(年齡、絕經(jīng)情況、生育史、腫物大小、臨床分期、臨床表現(xiàn)、腫瘤標(biāo)志物、術(shù)前診刮、ER、PR及Ki-67的表達(dá)等)、影像學(xué)表現(xiàn)、治療以及患者的預(yù)后進(jìn)行分析比較,所有計(jì)數(shù)資料采用卡方檢驗(yàn),當(dāng)單元格資料計(jì)數(shù)較小時(shí),采用Fisher精確檢驗(yàn),Log-rank檢驗(yàn)法單因素分析影響患者預(yù)后的相關(guān)因素,COX回歸模型法對(duì)患者預(yù)后進(jìn)行多因素分析,采用Kaplan-Meier乘積極限法繪制生存曲線圖。2.收集在2011年3月-2016年7月因子宮肌瘤于天津中心婦產(chǎn)科醫(yī)院住院的病人總數(shù),術(shù)后病理診斷為子宮肉瘤患者45例,隨機(jī)抽取同期住院的子宮肌瘤患者45例,分析未預(yù)料子宮肉瘤的發(fā)生率,以及未預(yù)料子宮肉瘤的臨床特點(diǎn),所有計(jì)數(shù)資料采用卡方檢驗(yàn)。閱讀文獻(xiàn),探討粉碎器使用對(duì)子宮肉瘤預(yù)后造成的影響,如何盡量避免未預(yù)料子宮肉瘤的發(fā)生及未預(yù)料發(fā)生后如何避免造成不良影響。結(jié)果:1.構(gòu)成比:子宮肉瘤占子宮體惡性腫瘤的4.7%,66例子宮肉瘤患者中:LMS:28例,ESS:25例,AS:13例。各組織類(lèi)型中以子宮平滑肌肉瘤、子宮內(nèi)膜間質(zhì)肉瘤為主。2.年齡:66例子宮肉瘤患者中年齡最小的24歲,年齡最大68歲,平均年齡為:47.83±8.42歲,中位年齡49歲,子宮平滑肌肉瘤患者發(fā)病年齡較子宮內(nèi)膜間質(zhì)肉瘤高(P=0.008)。發(fā)病平均年齡:LMS:50.61±7.85歲,ESS:45.36±7.85。3.絕經(jīng)狀態(tài)及生育史:一半以上的患者于絕經(jīng)前發(fā)病,絕大多數(shù)患者發(fā)病時(shí)已生育,各組織類(lèi)型間的絕經(jīng)狀態(tài)、生育史無(wú)統(tǒng)計(jì)學(xué)差異。4.臨床表現(xiàn)及分期:臨床分期以I期為主,最常見(jiàn)的首發(fā)臨床表現(xiàn)為陰道不規(guī)則出血,不同組織類(lèi)型患者的臨床表現(xiàn)及臨床分期無(wú)統(tǒng)計(jì)學(xué)差異。5.腫物大小、病史:66例子宮肉瘤患者中,最長(zhǎng)病史20年,最短的1月,腫物的大小2.5-25cm,各組織類(lèi)型間腫物大小、病史有統(tǒng)計(jì)學(xué)差異(P=0.033)。6.術(shù)前檢查:各組織類(lèi)型間CA125陽(yáng)性的差異無(wú)統(tǒng)計(jì)學(xué)意義。各組織類(lèi)型間術(shù)前診刮陽(yáng)性率差異有統(tǒng)計(jì)學(xué)意義(P=0.001),子宮腺肉瘤術(shù)前診刮陽(yáng)性率較高(72.4%)。盆腔核磁診斷子宮肉瘤陽(yáng)性率優(yōu)于婦科超聲(P=0.000)。7.雌孕激素ER/PR受體及Ki-67的表達(dá):各組織類(lèi)型中ER/PR受體的表達(dá)差異有統(tǒng)計(jì)學(xué)意義(P=0.042),雌孕激素受體在子宮內(nèi)膜間質(zhì)肉瘤中有較高的表達(dá)。各組織類(lèi)型中Ki-67表達(dá)無(wú)統(tǒng)計(jì)學(xué)差異。8.預(yù)后:單因素分析中患者的發(fā)病年齡、臨床分期、有無(wú)脈管癌栓是影響患者預(yù)后的相關(guān)因素(P=0.042 P=0.002 P=0.003),多因素分析中臨床分期、脈管癌栓是影響患者預(yù)后的獨(dú)立因素(P=0.014 P=0..008),ER/PR陽(yáng)性表達(dá)、病理類(lèi)型、治療方式對(duì)患者預(yù)后的差異無(wú)統(tǒng)計(jì)學(xué)意義。9.未預(yù)料子宮肉瘤發(fā)生率為6.7‰,I期患者為主,主要是子宮平滑肌肉瘤,其次是子宮內(nèi)膜間質(zhì)肉瘤,腺肉瘤少見(jiàn)。10.未預(yù)料子宮肉瘤患者,發(fā)病年齡46.51±8.14歲,肌瘤平均病史2.89±1.79年,肌瘤個(gè)數(shù)≤3個(gè);子宮肌瘤組發(fā)病年齡41.98±0.34歲,肌瘤病史4.32±2.28年,肌瘤個(gè)數(shù)3個(gè),發(fā)病年齡、肌瘤病史、肌瘤個(gè)數(shù)有統(tǒng)計(jì)學(xué)差異(P=0.039 P=0.033P=0.003),兩組患者間臨床表現(xiàn)、絕經(jīng)狀態(tài)無(wú)統(tǒng)計(jì)學(xué)差異。11.子宮肉瘤與子宮肌瘤之間超聲征象差異有統(tǒng)計(jì)學(xué)意義(P0.05),子宮肌瘤超聲表現(xiàn)邊界清晰、回聲以低回聲為主,瘤體內(nèi)部血流分布規(guī)則,而未預(yù)料子宮肉瘤患者邊界欠清、回聲以蜂窩狀或中高回聲為主、血流分布不均。結(jié)論:1.子宮肉瘤發(fā)病率占子宮體惡性腫瘤的4.7%,多發(fā)生在絕經(jīng)前女性患者中,無(wú)特異性臨床表現(xiàn),最常見(jiàn)的臨床表現(xiàn)為陰道不規(guī)則出血。2.子宮肉瘤術(shù)前診斷困難。盆腔核磁在子宮肉瘤診斷中優(yōu)于婦科超聲,術(shù)前診斷性刮宮或?qū)m腔鏡檢查能提高子宮腺肉瘤術(shù)前診斷率,雌孕激素受體在子宮內(nèi)膜間質(zhì)肉瘤中有較高的表達(dá)。3.單因素分析中患者的發(fā)病年齡、臨床分期、有無(wú)脈管癌栓是影響患者預(yù)后的相關(guān)因素,多因素分析中臨床分期、脈管癌栓是影響患者預(yù)后的獨(dú)立因素,ER/PR陽(yáng)性表達(dá)、病理類(lèi)型、治療方式對(duì)患者預(yù)后的差異無(wú)統(tǒng)計(jì)學(xué)意義。4.未預(yù)料子宮肉瘤發(fā)生率為6.7‰,早期患者為主,主要是子宮平滑肌肉瘤,其次是子宮內(nèi)膜間質(zhì)肉瘤,腺肉瘤少見(jiàn)。5.未預(yù)料子宮肉瘤與子宮肌瘤患者相比比較,具有發(fā)病年齡大、肌瘤病史短、肌瘤個(gè)數(shù)少的特點(diǎn)。兩組患者絕經(jīng)狀態(tài)、臨床表現(xiàn)無(wú)統(tǒng)計(jì)學(xué)差異。6.子宮肌瘤超聲表現(xiàn)邊界清晰、回聲以低回聲為主,瘤體血流分布規(guī)則,而未預(yù)料子宮肉瘤患者邊界欠清、回聲以蜂窩狀或中高回聲為主、血流分布不均。
[Abstract]:Objective: To investigate the incidence, common clinical manifestations, imaging manifestations, treatment methods and prognosis of uterine sarcoma, and to provide clinical evidence for better diagnosis and treatment of uterine sarcoma. Methods: 1. The clinical data of 66 cases of uterine sarcoma hospitalized in Tianjin Central Obstetrics and Gynecology Hospital from March 2011 to July 2016 were collected. The clinical characteristics (age, menopause, birth history, tumor size, clinical stage, clinical manifestations, tumor markers, preoperative diagnosis) of each histological type of uterine sarcoma were analyzed by SPSS 19.0 statistical software. Scraping, ER, PR and Ki-67 expression, imaging findings, treatment and prognosis of patients were analyzed and compared. Chi-square test was used for all counting data. Fisher exact test was used for small cell data. Log-rank test was used for univariate analysis of related factors affecting the prognosis of patients. COX regression model was used for multiple prognosis of patients. Factor analysis, Kaplan-Meier multiplying positive limit method was used to draw survival curve. 2. The total number of patients admitted to Tianjin Central Obstetrics and Gynecology Hospital from March 2011 to July 2016 were collected. 45 patients with uterine sarcoma were pathologically diagnosed. 45 patients with uterine sarcoma were randomly selected from the same period of hospitalization. The incidence of unexpected uterine sarcoma was analyzed. Chi-square test was used to determine the incidence of unexpected uterine sarcoma and the clinical characteristics of unexpected uterine sarcoma. Of the 66 patients with uterine sarcoma, 28 were LMS, 25 ESS, and 13 AS. Most of them were leiomyosarcoma and endometrial stromal sarcoma. The average age of onset was LMS: 50.61 [7.85], ESS: 45.36 [7.85.3]. Menopausal status and fertility history: more than half of the patients had premenopausal onset, the vast majority of patients had fertility at the time of onset, and there was no statistical difference in the state of menopause and fertility history between different tissue types. Stage I: The most common clinical manifestation was irregular vaginal bleeding. There was no significant difference in clinical manifestation and staging between different tissue types. 5. Tumor size, medical history: 66 cases of uterine sarcoma patients, the longest history of 20 years, the shortest 1 month, the size of the tumor 2.5-25 cm, the size of the tumor between tissue types, disease. Preoperative examination: There was no significant difference in the positive rate of CA125 among different tissue types. The positive rate of preoperative curettage was statistically significant (P = 0.001). The positive rate of preoperative curettage for uterine adenosarcoma was higher (72.4%). Progesterone ER/PR receptor and Ki-67 expression: There was significant difference in ER/PR receptor expression among different tissue types (P = 0.042), estrogen and progesterone receptor expression was high in endometrial stromal sarcoma. There was no significant difference in Ki-67 expression among different tissue types. 8. Prognosis: Univariate analysis of the patient's age, clinical stage, presence or absence of vascular vessels. Tumor thrombus is a related factor affecting the prognosis of patients (P = 0.042 P = 0.002 P = 0.003). In multivariate analysis, vascular tumor thrombus is an independent factor affecting the prognosis of patients (P = 0.014 P = 0.008), positive expression of ER / PR, pathological types, treatment methods have no significant difference on the prognosis of patients. 9. Unexpected incidence of uterine sarcoma is 6.7, stage I. The patients were mainly leiomyosarcoma of uterus, followed by endometrial stromal sarcoma and adenosarcoma. 10. Unexpected patients with uterine sarcoma were 46.51 (+ 8.14) years old, with an average history of 2.89 (+ 1.79) years, and the number of leiomyomas (< 3); 41.98 (+ 0.34) years old, 4.32 (+ 2.28) years old, and 3 years old. Age, history of leiomyoma, the number of leiomyomas were statistically significant (P = 0.039 P = 0.033 P = 0.003), clinical manifestations between the two groups, no statistical difference in menopausal status. Conclusion: 1. The incidence of uterine sarcoma accounted for 4.7% of uterine malignancies, mostly occurred in premenopausal women, without specific clinical manifestations, the most common clinical manifestation was vaginal irregular bleeding. 2. Uterine sarcoma surgery. Pelvic MRI is superior to gynecological ultrasound in the diagnosis of uterine sarcoma. Preoperative diagnostic curettage or hysteroscopy can improve the preoperative diagnosis rate of uterine adenosarcoma. Estrogen and progesterone receptors are highly expressed in endometrial stromal sarcoma. 3. Univariate analysis of the patient's age of onset, clinical stage, presence or absence of vascular tumor thrombus is an influence. Multivariate analysis of the clinical stage, vascular tumor thrombus is an independent factor affecting the prognosis of patients, ER/PR positive expression, pathological types, treatment methods of patients with prognosis of the difference was not statistically significant. 4. Unexpected incidence of uterine sarcoma was 6.7, early patients mainly uterine leiomyosarcoma, followed by son. Endometrial stromal sarcoma, adenosarcoma is rare. 5. Unexpected uterine sarcoma compared with myoma patients, with the onset of age, myomatosis history is short, the number of myomas is small. Two groups of patients with menopausal status, clinical manifestations are not statistically significant. 6. Myoma ultrasound manifestations of clear borders, echo mainly hypoechoic, tumor blood flow distribution rules. In the case of unexpected uterine sarcoma, the margin was poorly defined, the echoes were mainly honeycomb-like or medium-high echoes, and the blood flow was uneven.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.33

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