腹壁子宫内膜异位症相关性透明细胞癌一例及文献回顾

doi:10.3877/cma.j.issn.1674-392X.2022.05.023

目的

探讨剖宫产术后腹壁子宫内膜异位症（AWE）相关性透明细胞癌（CCC）的临床特点、治疗方法和预防措施。

方法

搜集近10年AWE后恶性病变的相关资料结合1例相关患者的诊疗过程，对资料进行系统回顾分析。

结果

共检索出410篇文献，最终25篇（其中英文20篇，中文5篇）文献符合纳入标准，纳入31例剖宫产后AWE发生CCC患者。其中12例行单纯肿瘤切除，17例同时行肿瘤切除和附加手术，2例未行手术治疗。接受化疗的患者为21例，放疗者6例，同时接受放化疗者5例。2例接受了术前新辅助化疗。12例患者出现肿瘤的扩散或转移。23例有随访信息，随访期间死于疾病者4例，带病存活者8例，无疾病迹象者11例。本文报道1例AWE后发生CCC的患者，行病灶及部分腹壁切除后使用补片进行腹壁重建治疗，术后恢复良好。

结论

AWE后发生CCC恶变的情况近几年有增加的趋势。目前对此类恶变过程缺乏有效的预防与观察手段，对AWE者应早期行病变切除手术。对发生恶变者，应行包括病灶在内的腹壁整块切除手术，形成的缺损可行包括应用补片的腹壁重建手术治疗。

关键词: 子宫内膜异位症, 剖宫产, 透明细胞癌, 腹壁重建术, 补片

Objective

To investigate the clinical features, treatment and prevention of clear cell carcinoma (CCC) associated with abdominal wall endometriosis (AWE) after cesarean section.

Methods

The data of malignant degeneration after AWE in the past 10 years were collected and analyzed systematically, combined with the diagnosis and treatment process of one patient.

Results

A total of 410 articles were retrieved, and finally 25 articles (including 20 English articles and 5 Chinese articles) met the inclusion criteria, of which 31 patients with AWE after cesarean section were diagnosed with CCC. Among them, 12 cases underwent simple tumor resection, 17 cases underwent tumor resection and additional surgery, and 2 cases did not undergo surgery. Twenty-one patients received chemotherapy, 6 patients received radiotherapy, 5 patients received both radiotherapy and chemotherapy, and 2 patients received preoperative neoadjuvant chemotherapy. Twelve patients had tumor spread or metastasis. Twenty-three patients had follow-up information. During the follow-up period, 4 patients died of the disease, 8 patients survived with the disease, and 11 patients had no signs of the disease. This paper reports a case of CCC after AWE. After resection of the lesion and part of the abdominal wall, the abdominal wall reconstruction with mesh was performed, and the postoperative recovery was good.

Conclusion

The incidence of CCC malignant transformation after AWE has increased in recent years. At present, there is a lack of effective prevention and observation methods for this malignant transformation process. Early lesion resection should be performed for patients with AWE. For those with malignant transformation, en bloc resection of the abdominal wall including the lesion should be performed, and the formed defect can be treated by abdominal wall reconstruction with mesh.

Key words: Endometriosis, Cesarean section, Clear cell Carcinoma, Abdominal wall reconstruction, Mesh

表1 检索文献纳入31例腹壁子宫内膜异位症相关性透明细胞癌患者资料

病例	年龄(岁)	是否转移/扩散	手术方式	大体病理性质	化疗/放疗	随访时间(月)	随访时情况	作者
1	41	否	LR	囊性	是/否	24	无疾病迹象	Yan等^[1]
2	42	否	LR，TAH，BSO，OMT	—	卡铂+紫杉醇/否	26	无疾病迹象	Mert等^[2]
3	51	否	LR，BSO，OMT	—	否/是	49	无疾病迹象	Mert等^[2]
4	47	是	LR	纤维性	顺铂/是	7	无疾病迹象	Shalin等^[3]
5	41	—	LR	囊性	卡铂+紫杉醇/—	—	—	Sawazaki等^[4]
6	49	否	LR	囊实混合	卡铂+紫杉醇/否	8	无疾病迹象	Li等^[5]
7	39	是	LR，TAH，BSO，OMT	—	卡铂+紫杉醇/否	12	因病死亡	Liu等^[6]
8	37	否	LR	—	—/—	5	带病生存	Heller等^[7]
9	42	否	LR	—	—/—		无疾病迹象	Dobrosz等^[8]
10	60	否	LR	囊实混合	否/否	8	带病生存	Ijichi等^[9]
11	47	是	LR，TAH，BSO，OMT	—	卡铂+紫杉醇/否	10	无疾病迹象	Aust等^[10]
12	41	否	LR	囊性	卡铂+紫杉醇/是	6	带病生存	Ruiz等^[11]
13	57	是	LR，TAH，BSO	—	卡铂+紫杉醇/是	—	—	Ruiz等^[11]
14	44	是	NACT, LR，TAH，BSO	囊实混合	否/否	6	因病死亡	Ferrandina等^[12]
15	46	—	LR	囊实混合	否/否	—	—	Wei等^[13]
16	58	否	LR，TAH	—	否/否	6	带病生存	Ewa等^[14]
17	47	否	LR，BSO	囊性	卡铂+紫杉醇/否	9	带病生存	Marques等^[15]
18	42	是	LR，TAH，BSO	囊性	是/否	2	无疾病迹象	Gentile等^[16]
19	40	否	LR，TAH，BSO，OMT，BPLND	囊性	铂类+紫杉醇/—	12	带病生存	张承等^[17]
20	52	否	LR，TAH，BSO	囊性	否/否	14	带病生存	Lai等^[18]
21	56	是	LR，TAH，BSO，OMT，BPLND	囊性	卡铂+紫杉醇/否	11	无疾病迹象	Lai等^[18]
22	56	是	LR，TAH，BSO，BPLND	囊性	卡铂+紫杉醇/否	5	无疾病迹象	Lai等^[18]
23	55	否	TAH，BSO, NACT，OMT	囊性	吉西他滨+卡铂+贝伐单抗/否	23	因病死亡	Lai等^[18]
24	45	否	未手术	囊性	卡铂+紫杉醇；脂质体阿霉素+卡铂/是	7	带病生存	Lai等^[18]
25	48	是	LR，TAH，BSO，OMT	囊实混合	卡铂+紫杉醇/否	4	无疾病迹象	Lopes等^[19]
26	48	否	LR	囊实混合	否/否	2	—	Ronlon等^[20]
27	55	是	LR，TAH，BSO	囊实混合	洛铂+紫杉醇/否	—	—	崔莹莹等^[21]
28	54	是	LR，TAH，BSO，OMT	囊性	铂类+紫杉醇/否	—	—	曾美龄等^[22]
29	47	否	LR	囊性	卡铂+紫杉醇/否	—	—	曾昊等^[23]
30	49	是	未手术	实性	卡铂+紫杉醇；吉西他滨；阿霉素/是	7	因病死亡	GIANNELLA等^[24]
31	41	否	LR	囊实混合	—/—	—	—	唐庄艳等^[25]

表1 检索文献纳入31例腹壁子宫内膜异位症相关性透明细胞癌患者资料

病例	年龄(岁)	是否转移/扩散	手术方式	大体病理性质	化疗/放疗	随访时间(月)	随访时情况	作者
1	41	否	LR	囊性	是/否	24	无疾病迹象	Yan等^[1]
2	42	否	LR，TAH，BSO，OMT	—	卡铂+紫杉醇/否	26	无疾病迹象	Mert等^[2]
3	51	否	LR，BSO，OMT	—	否/是	49	无疾病迹象	Mert等^[2]
4	47	是	LR	纤维性	顺铂/是	7	无疾病迹象	Shalin等^[3]
5	41	—	LR	囊性	卡铂+紫杉醇/—	—	—	Sawazaki等^[4]
6	49	否	LR	囊实混合	卡铂+紫杉醇/否	8	无疾病迹象	Li等^[5]
7	39	是	LR，TAH，BSO，OMT	—	卡铂+紫杉醇/否	12	因病死亡	Liu等^[6]
8	37	否	LR	—	—/—	5	带病生存	Heller等^[7]
9	42	否	LR	—	—/—		无疾病迹象	Dobrosz等^[8]
10	60	否	LR	囊实混合	否/否	8	带病生存	Ijichi等^[9]
11	47	是	LR，TAH，BSO，OMT	—	卡铂+紫杉醇/否	10	无疾病迹象	Aust等^[10]
12	41	否	LR	囊性	卡铂+紫杉醇/是	6	带病生存	Ruiz等^[11]
13	57	是	LR，TAH，BSO	—	卡铂+紫杉醇/是	—	—	Ruiz等^[11]
14	44	是	NACT, LR，TAH，BSO	囊实混合	否/否	6	因病死亡	Ferrandina等^[12]
15	46	—	LR	囊实混合	否/否	—	—	Wei等^[13]
16	58	否	LR，TAH	—	否/否	6	带病生存	Ewa等^[14]
17	47	否	LR，BSO	囊性	卡铂+紫杉醇/否	9	带病生存	Marques等^[15]
18	42	是	LR，TAH，BSO	囊性	是/否	2	无疾病迹象	Gentile等^[16]
19	40	否	LR，TAH，BSO，OMT，BPLND	囊性	铂类+紫杉醇/—	12	带病生存	张承等^[17]
20	52	否	LR，TAH，BSO	囊性	否/否	14	带病生存	Lai等^[18]
21	56	是	LR，TAH，BSO，OMT，BPLND	囊性	卡铂+紫杉醇/否	11	无疾病迹象	Lai等^[18]
22	56	是	LR，TAH，BSO，BPLND	囊性	卡铂+紫杉醇/否	5	无疾病迹象	Lai等^[18]
23	55	否	TAH，BSO, NACT，OMT	囊性	吉西他滨+卡铂+贝伐单抗/否	23	因病死亡	Lai等^[18]
24	45	否	未手术	囊性	卡铂+紫杉醇；脂质体阿霉素+卡铂/是	7	带病生存	Lai等^[18]
25	48	是	LR，TAH，BSO，OMT	囊实混合	卡铂+紫杉醇/否	4	无疾病迹象	Lopes等^[19]
26	48	否	LR	囊实混合	否/否	2	—	Ronlon等^[20]
27	55	是	LR，TAH，BSO	囊实混合	洛铂+紫杉醇/否	—	—	崔莹莹等^[21]
28	54	是	LR，TAH，BSO，OMT	囊性	铂类+紫杉醇/否	—	—	曾美龄等^[22]
29	47	否	LR	囊性	卡铂+紫杉醇/否	—	—	曾昊等^[23]
30	49	是	未手术	实性	卡铂+紫杉醇；吉西他滨；阿霉素/是	7	因病死亡	GIANNELLA等^[24]
31	41	否	LR	囊实混合	—/—	—	—	唐庄艳等^[25]

图3 术中应用补片行腹壁重建

图4 术后镜下病理图像

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[15]	杨洋, 闫盛, 陈作观, 吴志远, 刁永鹏, 高擎, 陈跃鑫, 郑月宏, 李拥军. 补片式颈动脉内膜剥脱术与外翻式颈动脉内膜剥脱术长期随访结果比较[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 337-343.

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Endometriosis-associated clear cell carcinoma of the abdominal wall: a case report and review of the literature

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Endometriosis-associated clear cell carcinoma of the abdominal wall: a case report and review of the literature