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中国2003—2013年女性间质瘤误诊妇科肿瘤的诊治现状与思考 预览 被引量:5

Reflection and Current Situation in Diagnosis and Treatment Upon Female Stromal Tumors Misdiagnosed as Gynecologic Tumors of China from 2003 to 2013
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摘要 目的:了解中国2003—2013年女性间质瘤误诊妇科肿瘤的治疗现状。方法:复习中国人民解放军第四五四医院"间质瘤"误诊"妇科肿瘤"2例临床资料和33篇文献资料,合计63例。结果:1诊断及治疗。胃肠道间质瘤(GIST)51例,胃肠道外间质瘤(EGIST)12例,术前均误诊为妇科肿瘤,全部手术、病理确诊。63例患者中,1例术前活检,18例术中冰冻,均未确诊。4例术后口服甲磺酸伊马替尼,1例术后环磷酰氨+顺铂联合静脉化疗1个疗程。2间质瘤来源。51例GIST中,小肠36例,小肠系膜、回肠各3例,胃2例,空肠、乙状结肠、右半结肠、回盲部、阑尾各1例,肠道(未记部位)2例;12例EGIST中,腹腔内4例,卵巢3例,阔韧带2例,子宫膀胱腹膜返折处1例,阴道后壁2例。311例记录随访。4例死亡,2例中途失访,5例正常。结论:早期间质瘤可能的治愈方法是完整手术切除肿瘤,不适当的活检可能引起肿瘤破溃、出血和增加肿瘤播散种植危险;疑有肿瘤周围淋巴结转移或不能排除其他恶性肿瘤,可考虑冰冻活检,不必常规清扫盆腔淋巴结;放化疗对其不敏感,可辅助分子靶向药物治疗,预防、减少和推迟肿瘤的复发及转移。 Objective:Investigating the current situation in treatment on female stromal tumors misdiagnosed as gynecologic tumors of China from 2003 to 2013. Methods: 2 misdiagnosed cases as gynecologic tumors in the 454 hospital of PLA and 33 relative literatures were reviewed,in a total of 63 cases. Results: 1Diagnosis and treatment. There were 51 cases of GIST and 12 cases of EGIST. All were diagnosed accurately only by routine postoperative pathological diagnosis. One case was performed biopsy prior to operation and 18 were given intraoperative frozen section, which failed to confirm the diagnosis. After operation,4 cases took oral administration of imatinib mesylate,one case was given intravenous chemotherapy with cyclophosphamide and cisplatin for a course of treatment. 2The stromal tumor origin. In 51 cases GIST, 36 cases from small intestine;each 3 from small bowel mesentery and ileum;and 2 from stomach;1 from jejunum,colon,right colon,cecum,appendix each; 2 from intestinal(unrecorded parts). 12 cases EGIST:4 cases were from intraperitoneal; 3 from ovarian,2 from broad ligament,and 1 from uterine bladder peritonea; 2 from vaginal wall. 3 11 cases were recorded of follow-up,4 have been dead,2 were halfway lost,5 cases were normal. Conclusions:The main methods to completely cure early-stage stromal tumor is tumor removal operation. Inappropriate biopsy may cause tumor rupture,hemorrhage and increased a danger of tumor dissemination. The cases suspected of tumor metastasis in lymph node or other malignant tumors,may be considered to be treated with the frozen biopsy,without routine pelvic lymph node resction. The cases which are not sensitive to chemotherapy and radiotherapy can assist with the molecular targeted drug therapy to prevent,reduce and delay the recurrence and metastasis of tumor.
作者 骆文香 张鸿慧 崔向华 石丽芳 刘婕娜 王露 杨秀兰 张坚 LUO We n-xiang, ZHA NG Hong-hui, CUI Xiang-hua,SHl Li-fang ,LIU Jie -na, WANG Lu , YA NG X iu-lan ,ZHA NG Jian.( Department of Obstetrics and Gynecology, The 454 Hospital of PLA , Nanjing 210002, China)
出处 《国际妇产科学杂志》 2015年第3期281-285,共5页 Foreign Medical Sciences(Obstet Gynecol Fascicle)
关键词 胃肠道间质肿瘤 误诊 生殖器肿瘤 女(雌)性 治疗 Gastrointestinal stromal tumors Diagnostic errors Genital neoplasms females Therapy
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