| ObjectiveThe purpose of this study was to analyze the clinical datas of patients with Uterine Sarcoma(US)and Uterine Carcinosarcoma(UCS)to find the clinical features of improving the preoperative diagnostic rate and provide clinical basis for the standardized diagnosis and treatment of US and UCS.Methods86 patients with US or UCS in the first and the second hospital of Jilin University from February 1st 2007 to February 1st 2018 were studied retrospectively about the clinical features?pathological features?diagnosis methods?and treatment methods,including 51 cases of utrine sarcoma and 35 cases of uterine Carcinosarcoma.The differences in clinical datas between patients with different histological types were compared,and whether the patients were considered or diagnosed as malignant tumors before surgery,the patients were divided into the diagnosis group and the undiagnosed group,and the clinical characteristics of the two groups were compared.Results1.The mean age of 86 cases of uterine malignant tumors was 52.86±10.89 years.Among them the mean age of 51 patients in the US was 49.31±10.22,which was significantly lower than the average age of 58.03±9.83 years in UCS patients(35 patients).The difference was statistically significant(P=0.000).2.Among these 86 cases of uterine malignant tumors,there were 37 cases(43.02%)were non-menopause and 49 cases(59.8%)were postmenopausal.Among them,28 cases(54.90%)were non-menopausal in 51 cases of US patients,and 23 cases(45.10%)were postmenopausal.9 cases(25.71%)were non-menopausal in 35 cases of UCS patients,and 26 cases(74.29%)were postmenopausal.The proportion of non-menopause in US patients was significantly higher than UCS,and the difference was statistically significant(P=0.003).3.The clinical manifestations of 86 cases of uterine malignant tumors are lack of specificity,mainly complained about irregular vaginal bleeding and abdominal pain.The incidence of vaginal bleeding in US(52.94%)was lower than that in UCS(85.71%),the difference was statistically significant(P=0.002).The incidence of abdominal pain in US(41.18%)was higher than that in UCS(31.43%),the difference was not statistically significant(P=0.358).4.Among these 86 cases of uterine malignant tumors,who underwent preoperative ultrasonography,49 cases(56.98%)showed blood flow signals,Of which 15 cases(17.44%)showed abundant blood flow signals.In the US,31(60.78%)cases showed blood flow signals,Of which 9(17.65%)cases showed abundant blood flow signals.In the UCS,18(51.43%)cases showed blood flow signals,of which 6(17.14%)cases showed abundant blood flow signals.There was no significant difference in the ratio of blood flow signal and abundant blood flow signal between US and UCS patients(P values were 0.389 and 0.952,respectively).5.Among these 86 cases of uterine malignant tumors,35 cases underwent pathological examination preoperatively.In the US,15 cases underwent pathological examination preoperatively,11 of them showed "malignancy",and the accuracy rate of the nature was 73.33%.Among them,6 cases were found to be "in accordance with sarcoma",and the accuracy rate of the pathological type was 40.00%.In the UCS,20 cases underwent pathological examinations preoperatively.The pathological findings all indicated "malignancy" and the accuracy rate of thenaturewas 100%.Among them,3 cases showed "in accordance with carcinosarcoma" and the accuracy rate of the pathological type was 15.00%.The accuracy rate of the nature between US and UCS patients was statistically significant(P=0.026),and the difference in the pathological type accuracy was not statistically significant(P=0.129).6.Among these 86 cases of uterine malignant tumors,35 cases underwent rapid frozen pathological examination during surgery.In the US,23 cases underwent rapid frozen pathological examination during surgery,17 cases showed "malignant",and the accuracy rate of the nature was 73.91%.Among them,6 cases showed "in accordance with sarcoma",and the pathological type accuracy rate was 26.09%.In the UCS,12 cases underwent rapid frozen pathological examination.All of them showed "malignancy" and the accuracy rate of thenaturewas 100%.2 of them showed "in accordance with carcinosarcoma",and the pathological type accuracy rate was 16.67%.There was no statistically significant difference in the accuracy rate of the nature between US and UCS patients(P=0.074).The accuracy rate of the pathological types was not statistically significant(P=0.685).7.Among these 86 cases of uterine malignant tumors,the preoperative diagnosis rate was 52.33%,and the undiagnosis rate was 47.67%.In the US,19 were diagnosed,accounting for 32.75%,and 32 were undiagnosed,accounting for 67.25%.In the UCS,26 were diagnosed,accounting for 74.29%,and 9 were undiagnosed,accounting for 25.71%.The preoperative diagnosis rate between US and UCS patients was statistically significant(P=0.001).8.Only 53.66%(22/41)of the undiagnosed preoperative cases complained of vaginal bleeding,which was significantly lower than 77.78%(35/45)of the diagnosed patients.The difference was statistically significant(P=0.018).9.There were 50 cases whose lesions were in the uterine cavity,35 cases in the diagnosis group and 15 cases in the undiagnosis group.There was a statistically significant difference between the two groups(P=0.000).The lesions were located in the 40 cases between the muscle walls.12 cases in the diagnosis group and 28 cases in the undiagnosis group.There was a statistically significant difference between the two groups(P=0.000).10.In the US,19 cases were diagnosed,and 1 underwent laparoscopic hysterectomy and bilateral salpingooophorectomy;32 cases were undiagnosed,and 4 patients underwent laparoscopic surgery,Among them,2 cases were laparoscopically converted to laparotomy.,and 5 cases were reoperated due to the improper range of the first operation.In the UCS,1 patient only had a only had a diagnostic curettage,After diagnosis,she gave up the treatment without further surgery,The remaining 34 cases had undergonelaparotomy.Conclusions1.The most common clinical manifestation of US and UCS is vaginal bleeding.UCS patients have more common than US.2.It is difficult to confirm the diagnosis of uterine malignant tumor before surgery.Preoperative diagnosis of US is more difficult than UCS.When the lesion is located in the muscle walls,it is easily to miss diagnosis,and the lesion is located in the uterine cavity is easily to diagnosis.Preoperative pathological examination is the most important diagnostic method.3.Gynecological clinicians should strengthen the diagnosis and treatment of rare malignant tumors such as uterine sarcoma and uterine carcinosarcoma.Laparoscopic surgery should avoid tumor dissemination or secondary surgery.The best choice for surgery is laparotomy. |
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