Treatment of uterine sarcoma

With chemotherapy in the treatment of uterine sarcoma, cyclophosphamide, vincristine, adriamycin and triazene microphone amine CYVADIC programme reported that more efficient up to 15% to 55%. 1997, Jelic, such as the use of cisplatin, epirubicin PE programme that is forward-looking, were treated 106 cases of soft tissue sarcoma patients, the CR for 13%, PR for 41 percent of the total effective rate of 54 percent, significantly higher than the effect of Adriamycin chemotherapy alone group.

Uterine sarcoma is the early transfer of blood characteristics. It was reported in the literature, even clinical I, II period of uterine sarcoma, after three years also have higher rates of lung metastases, which uterine leiomyosarcoma up 40.7 percent. Therefore, after the main support to the systemic chemotherapy treatment to delay tumor recurrence, has received increasing attention.

1. Chemotherapy drugs alone

At present, the effect of chemotherapy is relatively sure of the embryo in the womb of malignant mixed tumor. U.S. GOG done a two prospective, random study.

(1) alone ifosfamide embryo in the treatment of malignant tumors in 29 cases of mixed daily 1.5 mg/m2, intravenous infusion for 5 days. The total efficiency of 32.2 percent, the rate of complete remission (CR) of 17.9%, partial response rate (PR) was 14.3%.

(2) single-agent cisplatin in the treatment of malignant tumor hybrid embryo of the 63 cases, each for 50 mg/m2, to 1 mg per minute rate of intravenous infusion every three weeks 1. The total effective rate of 19 per cent, of which CR to 8%, PR 11%. Therefore, the United States Gynecologic Oncology Association of Jurists under the two research findings, recommend the use of ifosfamide or Ifosfamide + cisplatin in the treatment of malignant uterine tumors in the embryo of mixed.

Adriamycin chemotherapy uterine sarcoma is worthy of attention in the drug activity. GOG the United States had observed the time-consuming 11 to 60 mg/m2 per Adriamycin treatment of I, II of the 156 cases of uterine sarcoma patients, although the results showed that doxorubicin is the trend of delaying tumor recurrence, but the difference was not significant . 1988, Piver forward-looking, such as the treatment of 19 patients with stage I uterine sarcoma patients were randomly divided into simple operation group, surgery Jiae Adriamycin chemotherapy, doxorubicin dosage for each of the 75 mg/m2 or 60 mg/m2, Intravenous injection every four weeks a course of treatment, for six courses. The results, the operation group of 5-year survival rate was 36 percent, surgery Jiae Adriamycin chemotherapy group of 5-year survival rate was 63 percent. Another report, adriamycin treatment of advanced and recurrent uterine leiomyosarcoma efficiency of 25%.

2. Chemotherapy

With chemotherapy in the treatment of uterine sarcoma, cyclophosphamide, vincristine, adriamycin and triazene microphone amine CYVADIC programme reported that more efficient up to 15% to 55%. 1997, Jelic, such as the use of cisplatin, epirubicin PE programme that is forward-looking, were treated 106 cases of soft tissue sarcoma patients, the CR for 13%, PR for 41 percent of the total effective rate of 54 percent, significantly higher than the effect of Adriamycin chemotherapy alone group. PE programme than CYVADIC simple clinical application of the programme, randomized studies show that the effect is also better.

3. Progesterone treatment

1990, Wade and other detected 60 cases of different types of organizations of uterine sarcoma expression of estrogen and progesterone receptors, found that the patients in the uterine sarcoma, endometrial stromal sarcoma and malignant uterine in the embryo of mixed Of estrogen receptor-positive rate of 60%, 78% and 42%. Progesterone receptor-positive rate of 60%, 22% and 19%. Therefore, the auxiliary progesterone treatment of uterine sarcoma should have a certain effect. The current clinical observation showed that progesterone to endometrial stromal sarcoma and malignant uterine tumors in the embryo of the mixed effect to a certain extent, endometrial stromal sarcoma efficiency as high as 50 percent. Sun love of progesterone treatment, such as the use of low-grade endometrial stromal sarcoma has also made good effect. Therefore, some scholars have suggested that endometrial stromal sarcoma and progesterone not only to be used for the treatment of recurrence or metastasis, but also as adjuvant treatment after one of the basic.

Minimally invasive treatment of uterine fibroids

Indications from the surgery, the choice of open surgery patients should be the condition of most, if fibroids too much, you can use medication from January to March, so that the tumor shrinking, reducing operation difficult. Of fibroids in the open before local injection of oxytocin, to promote uterine contraction and reduce bleeding. Carefully designed uterine incision in the position, at least as far as possible with the incision, stripping out most of the fibroids. Vascular encountered in the operation, the condensate after the first cut, carefully distinguish between anatomical level, layered closure of cavity. As long as there are minimally invasive medical awareness of the details carefully designed, can in large incision minimally invasive surgery to achieve the objective.

A surgeon has said that surgery is the doctor to withdraw his name engraved on patients process. We want to stay on patients is not filled with pain and regret the injuries, but full of love and breadth of our skills superb works of art. Minimally invasive treatment of patients on the maximum psychological and physical rehabilitation for the ultimate goal. Here the physical covers the treatment of patients suffering of the extent and consequences, and the psychological covers the patient's fear and sense of beauty after, minimally invasive is an art.

uterus is not only the cradle of life, is also involved in formation of menstruation, the role of endocrine regulation. Hysterectomy after ovarian blood supply affected, decreased ovarian function, endocrine disorders, vaginal dryness, sexual dysfunction, depression, aging, one against one after another, emerging from the physical pain of torture, mental and crashed into the suffering of the Abyss, in ensuring the quality of medical care under the premise, with the superb skills of medicine with cancer, preservation of the uterus, is not only a woman returned to the organs, but health, happiness, charm and dignity. Uterine fibroids are the most common gynecological benign one, its treatment of the complex and volatile, as long as conditions allow, to retain the uterus.

Under what circumstances the choice of minimally invasive surgical treatment »

When small fibroids, there is no discomfort, or close to menopause, can choose to observe the dynamic, every 3-6 months to do a B-, monitoring fibroids change. Drug treatment for fibroids little less serious symptoms, close to menopause or poor physical condition of patients can not tolerate surgery because of drug treatment can not cure, long-term medication side effects, and very easy to relapse after treatment, and other defects, the clinical Application to be careful. When in the following situations will require surgical treatment:

1, Changde Tai uterine fibroids, more than three months of pregnancy size.

2, fibroids oppression bladder, rectum, a urine abnormalities.

3, fibroids cause serious irregular bleeding, menorrhagia, has caused anemia.

4, fibroids grow too fast, worried about the possibility of a malignant change.

5, the location of fibroids long bad, such as cervical fibroids, fibroids should be broad ligament surgery as soon as possible, otherwise, as the fibroids grow up, will lead to changes in local anatomical structure, operation, greatly increased ureteral injury, and other serious complications The incidence rate.

Accurately identify symptoms, a reasonable choice preservation of uterine surgery

Symptoms 1: submucous fibroids

When we decided to do with fibroids removed, if the submucosal fibroids, less than 5 cm in diameter, should choose hysteroscopy; hysteroscopy the vagina, without any abdominal wound, injury, but not the muscle Complete removal of only the fibroids 1.1 points, "dug up" operation a long time, the need for effective monitoring tools. Choose this operation, full consideration must be given to the patient's condition, physical condition and doctors have the technical proficiency and to prevent perforation of the uterus or near organs (ureter, the tube), vice injury.

2 symptoms: a small number of subserosal fibroids

If it is subserosal fibroids or muscle intramural fibroids, the number of fibroids are not too many (less than 10), the modest size (more than 4 centimeters less than 10 cm), ruled out the possibility of fibroids malignant peritoneal Endoscopic surgery should be the best option, but laparoscopic surgery, the doctor's hands can not touch directly into the abdominal hysterectomy, may be missing hidden small fibroids, very easily lead to surgery did not completely, after doing that have fibroids B - , Or shortly after fibroid recurrence. In addition, the laparoscopic operation bleeding fibroids removed, suture cavity of difficulties, surgery a long time, patients receiving prolonged anesthesia, causing unnecessary harm. Therefore, doctors in the operation before, during the operation more difficult to make timely and accurate estimates, the development and decisive adjustments surgery, to minimize surgical trauma.

3 symptoms: multiple fibroids or a large number of subserosal fibroids

If too many fibroids number (more than 10), are far too large (more than 10 cm), the volume is too small (less than 4 cm), could not rule out the malignant the best choice laparotomy. Indications from the surgery, the choice of open surgery patients should be the condition of most, if fibroids too much, you can use medication from January to March, so that the tumor shrinking, reducing operation difficult. Of fibroids in the open before local injection of oxytocin, to promote uterine contraction and reduce bleeding. Carefully designed uterine incision in the position, at least as far as possible with the incision, stripping out most of the fibroids. Vascular encountered in the operation, the condensate after the first cut, carefully distinguish between anatomical level, layered closure of cavity. As long as there are minimally invasive medical awareness of the details carefully designed, can in large incision minimally invasive surgery to achieve the objective.