弥漫性子宫平滑肌瘤病18例临床特点及诊治对策探讨

Diagnosis and treatment countermeasure for eighteen patients with diffuse uterine leiomyomatosis

目的:分析弥漫性子宫平滑肌瘤病的临床特点和诊治情况,探讨治疗对策。方法:收集2012年1月至2017年1月北京大学第三医院诊治的弥漫性子宫平滑肌瘤病患者18例,分析其疾病特点及诊治情况。结果:患者平均年龄33.5岁(25~40岁),临床症状以月经增多(12/18)及不孕(17/18)为主;查体子宫均匀性增大,如孕2~3月;超声及核磁共振是术前主要诊断依据。手术为主要治疗方法,术式有宫腔镜黏膜下肌瘤切除术,腹腔镜或开腹子宫肌瘤剔除术等。治疗后患者症状好转。16例有生育要求者,2例妊娠,足月剖宫产1例,晚期流产1例,2例均发生大出血。结论:弥漫性子宫平滑肌瘤病的治疗较为棘手,对于有生育要求者,行宫腔镜黏膜下肌瘤切除术,术后尽快妊娠不失为一种可选择的方案。

Objective：To analyze the characteristic, diagonosis and treatment of diffuse uterine leiomyomatosis（DUL）. Methods： The clinical recordings of 18 patients suffered from DUL in Peking University Third Hospital from Jan. 2012 to Jan. 2017 were analyzed retrospec- tively, and the clinical feature of this disease was summarized. Results： The average age of these patients was 33.5 （25 - 40 ） years old. The most common clinical symptoms were menorrhagia （12/18） and infertility（17/18）. Gynecologic examination showed uterus enlarged as two or three months pregnancy. Ultrasound and MRI were the main diagnostic criteria preoperatively. Main therapeutic choice including hysteroscopic myomectomy or laparoscopic or lararotomic myomectomy. Most patients＂ symptoms were relieved post-operatively. Two patients got preg- nant, including one full-term deliverey. Both of them suffered from prepartum and postpartum hemorrhage. Conclusion：There is still no effective treatment for DUL currently. For those who have fertility requirements, hysteroscopic submueosal fibroids resection and persuing pregnancy as soon as possible postoperatively is an feasible selection.