子宫静脉内平滑肌瘤临床病理分析

Clinical and pathological analyses of intravenous leiomyomatosis

目的 探讨子宫静脉内平滑肌瘤的临床生物学特征及治疗手段对预后的影响。方法对北京协和医院和江西省妇幼保健院 1992年 6月至 2 0 0 3年 6月间收治并经手术及病理检查证实的子宫静脉内平滑肌瘤 7例患者的临床和病理资料进行回顾性分析 ,全部病例均随访。结果 临床表现 :7例患者均以盆腔包块为主诉 ,其中 3例盆腔包块超过妊娠 12周子宫大小 ,最大者妊娠 16周大小 ;2例表现为经期延长、经量增多 ,1例表现为绝经后出血。超声检查 :4例提示子宫肌瘤 ,1例提示子宫肉瘤 ,2例提示卵巢肿瘤 ,术前确诊率为 0。术中冰冻检查 :2例中 1例确诊。手术治疗 :4例行全子宫及双侧附件切除术 ,2例行全子宫及一侧附件切除术 ,1例仅行肌瘤剔除术 ;1例行子宫及一侧附件切除术患者术后 2年复发 ,瘤栓沿下腔静脉转移至右心房及右心室再次手术治疗。结论 子宫静脉内平滑肌瘤具有特殊的不良生物学行为 ,提高术中确诊率与正确选择手术方式及术后密切随诊可以改善其预后。

Objective To investigate the clinical and biological characteristics of intravenous leiomyomatosis and the treatment methods, as well as their effect on prognosis Methods The clinical and pathologic data of 7 patients with intravenous leiomyomatosis of the uterus admitted to our hospital from June 1992 to June 2003 were analyzed retrospectively All the cases were followed up Results All the patients complained of pelvic mass Three of them had enlarged uterus which was over 12 gestational week, 2 of them had prolonged menstruation and hypermenorrhea, 1 of them presented with postmenopausal bleeding B ultrasound examination showed 4 leiomyomas, 1 sarcoma of uterus, and 3 ovarian tumors No intravenous leiomyomatosis within uterus was diagnosed preoperatively A resection of the mass and a total abdominal hysterectomy with bilateral salpingo oophorectomy were performed in 4 cases Conclusions Intravenous leiomyomatosis has special and quasi malignant biological behavior The prognosis can be improved if the disease could be correctly diagnosed during the operation and treated with combined modality therapy and intensively followed up after operation