摘要
目的探讨子宫静脉内平滑肌瘤病(intravenous leiomyomatosis,IVL)的临床特点及诊治情况,以提高对该病的认识。方法回顾性分析2009年12月至2019年12月在柳州市人民医院诊治的6例IVL患者的临床特点、治疗及愈后情况。结果6例患者平均年龄46.7岁,2例主诉为发现盆腔包块,2例体检发现子宫增大,1例腹痛原因待查,1例月经过多。妇科检查:4例子宫增大超过孕12周大小子宫,2例子宫旁触及包块。辅助检查:6例患者中超声提示子宫肌瘤4例,盆腔实质性包块2例,肿瘤内及周边血流信号丰富3例,无明显血流信号1例,余2例未描述。6例中无1例术前诊断提示IVL。6例患者均接受手术治疗,其中行全子宫及双附件切除术4例,全子宫及双侧输卵管切除术2例。术中3例见子宫肌壁间肿瘤如蠕虫状延伸至宫旁静脉内,另外,各有1例患者分别在子宫静脉、髂内静脉及卵巢静脉内取出光滑条状肉样组织。术后平均随访38个月,无1例复发。结论IVL是具有恶性生物学行为的良性疾病,早期缺乏特异性临床表现。提高术前认识,重视术中探查,可改善预后。
Objective To explore the clinical characteristics,diagnosis and treatment of intravenous leiomyomatosis(IVL)in order to improve the understanding of the disease.Methods A retrospective analysis of the clinical characteristics,treatment and post-conditions of 6 patients with IVL who were diagnosed and treated in Liuzhou People's Hospital from December 2009 to December 2019.Results The average age of the 6 patients was 46.7 years.The main complaint was the discovery of pelvic mass in 2 cases,the enlarged uterus in 2 cases,the cause of abdominal pain in 1 case,and menorrhagia in 1 case.Gynecological examination:4 cases of uterine enlargement exceeded the size of 12 weeks gestation,and 2 cases of uterine masses were touched.Auxiliary examination:Among the 6 patients,ultrasound revealed 4 cases of uterine fibroids,2 cases of pelvic masses,3 cases of abundant blood flow signals in and around the tumor,1 case of no obvious blood flow signals,and the remaining 2 cases were not described.None of the 6 cases had preoperative diagnosis suggesting IVL.All 6 patients underwent surgical treatment,including 4 cases of total hysterectomy and double appendectomy,and 2 cases of total hysterectomy and bilateral salpingectomy.During the operation,3 cases of intramuscular tumors of the uterus were seen to extend into the parauterine veins like worms.In addition,1 patient in each case took out smooth strips of fleshy tissue from the uterine vein,internal iliac vein and ovarian vein.After an average follow-up of 38 months,there was no recurrence.Conclusion IVL is a benign disease with malignant biological behavior and lacks specific clinical manifestations in its early stage.Improving preoperative awareness and paying attention to intraoperative exploration can improve the prognosis.
作者
弋文娟
陈煜岊
高彩云
吴琨
YI Wenjuan;CHEN Yujie;GAO Caiyun;WU Kun(Department of Gynecology,Liuzhou People's Hospital,Liuzhou Guangxi 545000,P.R.China)
出处
《中国计划生育和妇产科》
2020年第11期45-47,51,共4页
Chinese Journal of Family Planning & Gynecotokology
关键词
子宫肿瘤
子宫静脉内平滑肌瘤
临床特点
uterine neoplasms
intravenous leiomyoma of uterus
clinical features