4例医源性寄生子宫肌瘤病例分析及文献回顾

Retrospectively analyzing 4 cases of iatrogenic parasitic myomas and literature review

目的:探讨医源性寄生子宫肌瘤的临床特点、预防和治疗。方法:回顾分析2012年9月至2014年12月北京大学第一医院收治的4例医源性寄生子宫肌瘤病例,总结其临床特点,结合国内外相关文献,分析其病因及防治。结果:4例患者有腹腔镜子宫肌瘤剔除术史或腹腔镜子宫次全切除术史,术中均应用粉碎器,病理均为子宫平滑肌瘤,术后42~69个月复发。1例表现为腹痛、腹胀,1例表现为腹部包块,2例无症状为常规体检发现。再次手术方式为开腹探查术或腹腔镜探查术,切除病灶,其中1例行乙状结肠切除术,术后病理回报为平滑肌瘤及腺肌瘤,结局良好。结论:应用粉碎器的腹腔镜子宫肌瘤剔除手术或子宫切除手术会增加寄生性子宫肌瘤的发病风险。操作中避免组织残留,术后结合其他相关治疗,将最大限度地减少寄生性子宫肌瘤发生。

Objective: To discuss the clinical characteristics of iatrogenic parasitic myomas,and how to prevent and treat iatrogenic parasitic myomas. Methods: Analyzing 4 cases of iatrogenic parasitic myomas in Peking University First Hospital from Sep. 2012 to Dec. 2014,to summarize the clinical characteristics of this disease. Combining reports about this disease in international and domestic,retrospectively analyzing the pathogenesis of parasitic myomas. Finding the way to prevent and treat this disease. Results: All of four cases ever underwent laparoscopic myomectomy or laparoscopic subtotal hysterectomy. Meanwhile,all four surgeries used power morcellation. The interval of recurrence range 42 to 69 months. 1 case was characterized by abdominal pain,abdominal distention; 1 case was characterized by abdominal mass; 2 cases found lesions in routine physical examination. Reoperation way of the 4 cases was exploratory laparotomy or laparoscopic exploration,resection of lesions. One of the 4 cases underwent sigmoidectomy simultaneously. Postoperative histopathology confirmed the masses to be leiomyomas and adenomyoma. Follow-up for the 4 cases had good ending. Conclusions: Although pathogenesis of this disease is not clear,undergoing laparoscopic myomectomy or laparoscopic hysterectomy with application of power morcellation may increase the risk of parasitic myomas. Avoid tissue residues in operation and combining with other treatment postoperation will minimize the morbidity of iatrogenic parasitic myomas.