【摘要】 目的 探讨影响低级别子宫内膜间质肉瘤(LGESS)术前诊断准确性的临床特征。方法 回顾性分析2013年1月至2022年12月于浙江大学医学院附属妇产科医院诊治的52例LGESS患者。根据是否术前诊断为子宫内膜间质肉瘤或子宫恶性肿瘤分为术前确诊组和术前未确诊组。比较两组的一般情况、临床症状、实验室检查、影像学检查、病理检查及手术情况等,分析其与术前确诊及误诊的相关性,随访患者术后的生存及复发情况。结果 52例LGESS患者中,23例术前确诊(44.2%,术前确诊组),29例术前未确诊(55.8%,术前未确诊组)。年龄较小、有异常阴道流血、肿瘤最大径线小、病灶突入宫腔、术前行组织病理检查的患者更易在术前被确诊,与术前未确诊组比较差异有统计学意义(P值分别为0.009,0.027,<0.001,<0.001,<0.001)。宫腔镜+病理检查对LGESS诊断的敏感度为94.4%。术前未确诊组中有41.4%患者术中行无保护性病灶分碎,51.7%患者因第1次手术范围不足而施行二次手术。结论 LGESS术前未确诊率高。对有异常阴道流血、病灶突入宫腔内的患者术前可行宫腔镜+病理检查,以降低术前未确诊率。无异常阴道流血、肿瘤径线较大、病灶未突入宫腔的LGESS患者,术前更难被确诊,可结合超声及磁共振检查进一步诊断。尽量避免无保护性的腹腔镜下病灶分碎,术中冰冻病理检查可防止手术范围不当。更多还原

【Abstract】 Objective To investigate the clinical features of low-grade endometrial stromal sarcoma(LGESS) which affect its preoperative diagnostic accuracy.Methods Data of 52 patients with LGESS diagnosed and treated in the Gynecology and Obstetrics Hospital Affiliated to Zhejiang University School of Medicine from January 2013 to December 2022 was studied retrospectively.These patients were divided into the diagnosis group and the misdiagnosis group according to whether they were diagnosed with endometrial stromal sarcoma or uterine malignancy before surgery.We compared their general status,clinical symptoms,laboratory examination,imaging examination,pathological examination and surgical situation,analyzed their correlation with preoperative diagnosis and misdiagnosis,and followed up the survival and recurrence of these patients.Results Of 52 cases(44.2%),23 were diagnosed and 29 cases(55.8%) were not diagnosed before surgery. Patients with younger age,abnormal vaginal bleeding,smaller maximum diameter of tumor,protrusion of the lesion into the uterine cavity and preoperative histopathological examination were more likely to be diagnosed before surgery,the difference was statistically significant compared with the no-diagnosis group(P=0.009,0.027,<0.001,<0.001,<0.001,respectively). The diagnostic sensitivity of hysteroscopy plus pathology for LGESS was 94.4%. In the no-diagnosis group,41.4% of the patients underwent unprotected lesion fragmentation,and 51.7% of the patients underwent a second operation due to the improper scope of the first operation.Conclusions LGESS has a high rate of preoperative misseddiagnosis. For patients with abnormal vaginal bleeding or protrusion of the lesion into the uterine cavity,hysteroscopy with pathological examination is feasible before surgery,which can reduce the misseddiagnosis rate. Patients without abnormal vaginal bleeding, larger tumor diameter and no protrusion of the lesion into the uterine cavity are likely to be misdiagnosed before operation. Ultrasound and magnetic resonance imaging can be used for further diagnosis. Non-protective laparoscopic lesion fragmentation should be avoided as far as possible,and intraoperative frozen pathological examination can prevent improper surgical scope.更多还原