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目的探索早期子宫肉瘤年轻未育患者采用保留生育功能手术治疗的可行性。方法回顾分析中山大学附属第一医院2002年1月至2009年12月期间住院的采用保留子宫手术治疗的Ⅰ期子宫肉瘤35岁以下未生育患者的病历及病理检查资料,搜集年龄、手术方式、病理类型、术后生育情况、病情转归等信息,探讨早期子宫肉瘤年轻未育患者采用保留生育功能手术的适用范围及安全性。结果符合条件的患者有6例,平均年龄26岁(20～34岁);6例均接受子宫肿瘤切除术。病理类型为子宫平滑肌瘤肉瘤变性的有2例,2例病理检查均提示肉瘤病灶局限在子宫平滑肌瘤内未侵及切缘,其中1例术后自然受孕并足月分娩1健康婴儿;另1例术后28个月未生育,因B超提示多发性子宫平滑肌瘤,应患者要求行全子宫切除术,术后病理检查未见肉瘤病灶。病理类型为低度恶性子宫内膜间质肉瘤的有4例,其中3例术后2～6个月复查B超,再次发现子宫肿物并行全子宫切除术,术后病理确诊子宫内膜间质肉瘤;另1例术后2个月应患者要求行全子宫切除术,术后病理检查未发现子宫内膜间质肉瘤病灶。结论子宫平滑肌瘤肉瘤变性的年轻未育患者,若肉瘤组织局限于子宫平滑肌瘤内且未侵及切缘,有可能通过保留子宫的手术治疗保留其生育能力;子宫内膜间质肉瘤患者采取子宫肿瘤切除术不易一次性将子宫内膜间质肉瘤病灶切除干净,难以达到生育目的 。
Objective To explore the feasibility of using fertility-preserving surgery in younger infertile patients with early-stage uterine sarcoma. Methods A retrospective analysis of the first Affiliated Hospital of Sun Yat-sen from January 2002 to December 2009 hospitalized with uterine surgery retained uterine sarcoma of patients under 35 years of age without medical records and pathological examination of patients with age, age, surgical methods, Pathological types, postoperative reproductive status, the prognosis and other information to explore the early age of uterine sarcoma non-infertile patients with fertility preserving function of the scope and safety of surgery. Results Six patients were eligible, the average age was 26 years old (20 to 34 years). All the 6 patients underwent resection of the uterus. Pathological type of uterine leiomyoma sarcoma in 2 cases of degeneration, 2 cases of pathological examination showed sarcoma lesions confined to the uterine leiomyoma did not invade the margin, including 1 case of natural pregnancy and full-term delivery of a healthy baby; Another case of 28 months after childbirth did not give birth, due to B-prompt multiple uterine leiomyoma, patients should be required hysterectomy, postoperative pathological examination showed no sarcoma lesions. Pathological type of low grade endometrial stromal sarcoma in 4 cases, of which 3 cases were 2 to 6 months after the review of B-, once again found that the uterus mass hysterectomy, postoperative pathological diagnosis of endometrial Sarcoma; another case of 2 months after surgery should be required for patients with hysterectomy, postoperative pathological examination found no endometrial stromal sarcoma lesions. Conclusions In young patients with uterine leiomyosarcoma degeneration, if the sarcoma is confined to the uterine leiomyoma without invasion of the margin, it is possible to preserve its fertility by preserving the uterus. The patients with endometrial stromal sarcoma Uterine tumor resection is not easy to remove the endometrial stromal sarcoma lesions clean, it is difficult to achieve reproductive goals.