摘要
目的探讨静脉内平滑肌瘤病的临床病理特点和治疗策略。方法回顾性分析北京大学人民医院收治的18例静脉内平滑肌瘤病患者临床病理资料。结果 18例患者中,12例就诊于妇科,6例就诊于血管外科;中位数年龄为45岁,主诉以月经改变、腹痛及运动后黑朦为主。术前影像学检查如彩色超声、MRI、CT、血管造影等检查可初步提示该疾病,8例术前提示此诊断。18例患者均接受手术治疗,在血管外科就诊的患者中2例行盆腔肿物切除术,4例行下腔静脉(心房)病变切除术,妇科手术范围包括7例行全子宫双侧输卵管卵巢切除术,7例行全子宫切除术,2例既往曾行全子宫切除术的患者,术中切除子宫外病灶后切除双侧输卵管卵巢,1例行子宫肌瘤切除术。术中均尽可能切除肿瘤组织,术后经病理明确诊断。术后均未药物治疗,平均随访34.7个月,一例患者术后1年复发,再次手术切除复发病灶并切除双侧输卵管卵巢后随访无复发。结论静脉内平滑肌瘤病术前诊断较困难,影像学检查有辅助诊断价值。手术为主要治疗方式,无生育要求者建议切除全子宫及双侧附件。
Objective To investigate the clinical pathological characteristics and treatment strategy of intravenous leiomyomatosis（IVL）.Methods The clinical and pathological data of 18 patients who were diagnosed as intravenous leiomyomatosis and treated in People’s hospital,Peking University from December 2007 to January 2016 were retrospectively analyzed.Results Of these 18 cases,12 cases were treated in the department of gynecology,6 cases were treated in the department of vascular surgery.The average age was 43.5 years old,the complains included menstrual change,abdominal pain and dreadful dizzy after exercise.Preoperative imaging examinations such as color doppler,MRI,CT,angiography and other tests which can be initially suggested this disease.8 cases were diagnosed as IVL before operation.All of these patients received surgical treatment,among the 6 patients who were treated in the department of vascular surgery,2 patients had their pelvic tumor resected,4 patients had inferior vena cava/atrial lesion resected.The gynecological operations were as following：7 cases underwent hysterectomy and bilateral salpingo-oophorectomy; 8 cases underwent hysterectomy; of the 2 cases who had previous hysterectomy,one had her extra uterine lesions resected as well as bilateral salpingo-oophorectomy,the other only her extra uterine lesions resected; 1 case underwent myomectomy.During the operations,all the tumors were resected and all cases were diagnosed by pathology after surgery.No medical treatment were administered after operation,the mean follow-up period was 34.7 months.One patient recurred 1 year after operation,resection of recurrent lesions and bilateral salpingo-oophorectomy were performed.After the second operation,she had no recurrence during the follow up.Conclusions The preoperative diagnosis of intravenous leiomyomatosis is relatively difficult.Imaging examinations may have the auxiliary value for diagnosis.Operation is the main treatment method,hysterectomy and bilateral salpingo-oophorectomy is recommended if the patient has no fertility desire.
作者
祝洪澜
李佳
李艺
王悦
鲍冬梅
沈丹华
崔恒
ZHU Honglan LI Jia LI Yi WANG Yue BAO Dongmei SHEN Danhua CUI Heng(Department of Obstetrics Gynecology, Peking University People＇s Hospital, Beijing 100044, China)
出处
《中国妇产科临床杂志》
CSCD
北大核心
2017年第2期137-140,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
静脉内平滑肌瘤病
平滑肌瘤
治疗
预后
intravenous leiomyomatosis
leiomyoma
treatment
prognosis
