国际生殖健康/计划生育 ›› 2019, Vol. 38 ›› Issue (3): 257-260.

• 综述 • 上一篇    下一篇

子宫肉瘤的术前诊断

陈思蕾,王光伟,赵万成,杨清   

  1. 110004 沈阳,中国医科大学附属盛京医院妇产科
  • 收稿日期:2018-12-06 修回日期:2019-02-01 出版日期:2019-05-15 发布日期:2019-05-16
  • 通讯作者: 杨清,E-mail:yangq@sj-hospital.org E-mail:yangq@sj-hospital.org

Preoperative Diagnosis of Uterine Sarcoma

CHEN Si-lei,WANG Guang-wei,ZHAO Wan-cheng,YANG Qing   

  1. Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110004,China
  • Received:2018-12-06 Revised:2019-02-01 Published:2019-05-15 Online:2019-05-16
  • Contact: YANG Qing,E-mail:yangq@sj-hospital.org E-mail:yangq@sj-hospital.org

摘要: 子宫肉瘤(uterine sarcoma,US)是一种罕见的恶性肿瘤,具有早期诊断困难、恶性程度高、易远处转移、易复发、预后差等特点。早期诊断和手术治疗是改善预后的关键因素,因此术前对子宫肉瘤的诊断和分期有重大的临床意义。子宫肉瘤无特异的临床表现,单一的术前检查,如血清CA125或乳酸脱氢酶(LDH)值升高,对子宫肉瘤有提示意义,但无法明确诊断。当子宫肉瘤凸向宫腔时,子宫内膜细胞学检查可有阳性发现。影像学检查如磁共振成像与弥散加权成像相结合有助于区分子宫肉瘤与子宫良性肿瘤,但仍需大样本研究进一步验证。超声引导下穿刺活检可以获得较为可靠的病理结果,但由于相关风险及并发症并不作为常规术前检查手段。通过将临床体征、生物学标记物及影像学检查相结合构建的综合术前预测系统可以显著提高子宫肉瘤诊断的准确性。

关键词: 子宫肉瘤, 子宫肿瘤, 肉瘤, 诊断, 磁共振成像

Abstract: Uterine sarcoma (US) is a rare malignant tumor with the characteristics of difficulty in diagnosis, high malignant degree, early metastasis, early recurrence and poor prognosis. Early diagnosis and surgical treatment are two key factors in improving prognosis, the preoperative diagnosis of uterine sarcoma, and staging, is of great clinical significance. There is no specific clinical manifestation of uterine sarcoma. Preoperative examinations such as the elevated levels of serum CA125 and lactate dehydrogenase (LDH) are suggestive, however they cannot be used as diagnostic indicators. When uterine sarcoma protruded into the uterine cavity, the cytological examination of endometrium could make a positive diagnosis. Imaging studies such as the magnetic resonance imaging (MRI) combined with diffusion-weighted imaging (DWI) can be helpful to distinguish uterine sarcoma and benign uterine tumors. However, the clinical value of this combined imaging should be furtherly validated. Ultrasound-guided biopsy can obtain reliable pathological results, which cannot be used as a routine preoperative examination due to the related risks and complications. The comprehensive preoperative predictive systems of uterine sarcoma is constructed by the clinical signs, biomarkers and imaging.

Key words: Uterine sarcoma, Uterine Neoplasms, Sarcoma, Diagnosis, Magnetic Resonance Imaging

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