子宫肌瘤恶变及腹腔镜下播散的预防

doi:10.7504/fk2016010111

摘要/Abstract

摘要：

子宫肌瘤临床常见，但子宫肌瘤发生肉瘤变则少见。子宫一旦发生肉瘤，其恶性程度高，易局部复发及远处转移，预后不佳。在早期常无有效的检查手段来进行筛查和鉴别。若将肉瘤当作肌瘤进行腹腔镜下直接旋切，必然导致肿瘤碎屑及细胞播散，引起盆腹腔的广泛转移。因此，如何早期进行鉴别诊断，术中如何避免旋切带来的播散成为治疗的关键。文章就子宫肌瘤，子宫肉瘤鉴别诊断、腹腔镜下肌瘤旋切手术播散的预防研究进行综述。

关键词: 子宫肌瘤, 子宫肉瘤, 腹腔镜, 腹腔镜旋切器

Abstract:

Abstact：Uterine fibroids are clinical common, but uterine sarcoma and uterine fibroids sarcomatous change are rare, malignant mesenchymal tumors of the uterus. Uterine sarcomas is considered an aggressive tumor associated with poor prognosis, with a low five-year survival rate. there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma. Patient where morcellation is considered that their fibroid(s) may contain unexpected cancerous tissue and that laparoscopic power morcellation may spread the cancer, significantly worsening their prognosis. So how to identify early diagnosis and intraoperative how to avoid the spread of rotary cutting bring becomes the key to treatment.This pictorial review aims to discuss the clinical features of uterine fibroid and uterine sarcomas, as well as their most common appearances and distinct characteristics. Prospective data collection may clarify the issue on sarcoma risk in presumed fibroids and technology to extract tissue laparoscopically from the abdominal cavity should be perfected.

Key words: uterine fibroids, uterine sarcoma, laparoscopic, laparoscopic power morcellation

中图分类号:

R737.3

赵卫东，周虎. 子宫肌瘤恶变及腹腔镜下播散的预防[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2016010111.

ZHAO Wei-dong, ZHOU Hu.. Uterine fibroids sarcomatous change and prevention of its spreading in laparoscopic morcellation.[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2016010111.

参考文献

[1]     刘丽，许艳瑾，尹伶.我国子宫肌瘤的流行病学特征[J].现代预防医学，2014，41(2)：112-115.

[2]     D?Angelo E，Prat J.Uterine sarcomas：a review[J].Gynecol Oncol，2010，116：131-139

[3]     张果，祝洪澜，魏丽惠.子宫肉瘤分类、分期及治疗进展[J].中国妇产科临床杂志，2010，15（5）：397-400.

[4]     FDA. FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids[R].Food Drug Adm, 2014,17：4.

[5]     García-Martínez E，Prefasi LE，García-Donas J，et al.Current management of uterine sarcomas[J].Clin Transl Oncol，2011，13(5)：307-314.

[6]    Wu TI，Yen TC，Lay CH.Clinical presentation and diagnosis of uterine sarcoma，including imaging[J].Best Pract Res Clin Obstet Gynaecol, 2011, 25(6)：681-689.

[7]     Tropé CG，Abeler VM，Kristensen GB.Diagnosis and treatment of sarcoma of the uterus: a review[J].Acta Oncol, 2012, 51(6)：694-705.

[8]     Bansal N，Herzog TJ，Burke W，et al.The utility of preoperative endometrial sampling for the detection of uterine sarcomas[J].Gynecol Oncol, 2008, 110(1)：43-48.

[9]     Kawamura N，Ichimura T，Ito F，et al.Transcervical needle biopsy for the differential diagnosis between uterine sarcoma and leiomyoma[J].Cancer, 2002, 94(6)：1713-1720.

[10]     Goto A，Takeuchi S，Sugimura K，et al.Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus[J].Int J Gynecol Cancer,2002, 12(4)：354-361.

[11]     Juang CM，Yen MS，Horng HC，et al.Potential role of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma[J].Eur J Gynaecol Oncol, 2006, 27(4)：370-374.

[12]     Exacoustos C，Romanini ME，Amadio A，et al.Can gray-scale and color Doppler sonography differentiate between uterine leiomyosarcoma and leiomyoma?[J]. Clin Ultrasound, 2007,35(8)：449-457.

[13]     Aviram R，Ochshorn Y，Markovitch O，et al.Uterine sarcomas versus leiomyomas：gray-scale and Doppler sonographic findings[J].J Clin Ultrasound, 2005, 33(1)：10-13.

[14]     Santos P，Cunha TM. Uterine sarcomas：clinical presentation and MRI features[J].Diagn Interv Radiol，2015,21(1):4-9.

[15]    Yoshida Y，Kiyono Y，Tsujikawa T，et al. Additional value of 16α-[18F]fluoro-17β-oestradiol PET for differential diagnosis between uterine sarcoma and leiomyoma in patients with positive or equivocal findings on[18F]fluorodeoxyglucose PET[J]. Eur J Nucl Med Molec Imag，2011，38(10)：1824-1831.

[16]     Park JY，Park SK，Kim DY，et al.The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma[J].Gynecol Oncol, 2011, 122(2)：255-259.

[17]     Cohen SL，Einarsson JI，Wang KC，et al.Morcellation within contained pneumoperitoneum：technical report and case series[J].J Minim Invas Gynec，2014，21(6)：S43-S49.

（2015-11-23收稿）