Abstract：
This review aims to provide a comprehensive description of surgical approaches for the management of uterine sarcomas. Uterine sarcomas are rare uterine neoplasms. Frequently, diagnosis is made after hysterectomy or myomectomy scheduled for presumed benign leiomyomas. The gold standard for surgical treatment of uterine sarcomas is hysterectomy with bilateral salpingo-oophorectomy. It is possible to adopt a fertility-sparing approach for those patients who wish to maintain their fertility. The role of pelvic lymphadenectomy is controversial; in fact, removal of lymph nodes is only recommended in the case of radiological suspicion of nodal involvement. Use of a morcellator is associated with increased risk of total recurrence, intra-abdominal recurrence and death. Advanced disease management should be customized based on the patient\'s performance status given the uncertain role of adjuvant chemotherapy. Treatment of advanced or recurrent disease remains a subject of debate, but surgery is the best approach in terms of morbidity and mortality. There are few options for management of these uterine tumours, and further studies are needed to clarify the diagnostic and therapeutic pathways of patients with a first diagnosis of uterine sarcoma and patients with relapse of uterine sarcoma. No specific evidence supports the adoption of adjuvant therapy in uterine-confined disease, and molecular/genomic profiling may be useful to identify patients at risk of recurrence.
摘要：
这篇综述旨在全面描述子宫肉瘤的手术方法。子宫肉瘤是罕见的子宫肿瘤。经常,在计划对假定的良性平滑肌瘤进行子宫切除术或子宫肌瘤切除术后进行诊断。子宫肉瘤手术治疗的金标准是子宫切除术和双侧附件卵巢切除术。对于那些希望保持生育能力的患者，可以采取保留生育能力的方法。盆腔淋巴结清扫术的作用是有争议的;事实上,仅在放射学怀疑淋巴结受累的情况下，建议切除淋巴结。使用粉碎器与总复发风险增加有关，腹腔内复发和死亡。鉴于辅助化疗的作用不确定，晚期疾病管理应根据患者的表现状况进行定制。晚期或复发性疾病的治疗仍然是一个争论的话题，但就发病率和死亡率而言，手术是最好的方法。这些子宫肿瘤的治疗方法很少，需要进一步的研究来阐明首次诊断为子宫肉瘤的患者和复发子宫肉瘤的患者的诊断和治疗途径。没有具体证据支持在子宫局限性疾病中采用辅助治疗，和分子/基因组谱分析可能有助于识别有复发风险的患者.
