富细胞性子宫平滑肌瘤术前临床与影像学特征分析

Analysis of preoperative clinical and imaging signs of the cellular leiomyoma

目的探讨提高富细胞性平滑肌瘤患者术前评估能力的方法。方法回顾性分析2016年1月至2019年12月因子宫肌瘤于中国医学科学院北京协和医学院北京协和医院妇产科手术治疗,术后病理诊断为富细胞性子宫平滑肌瘤的患者(观察组)100例及同期术后病理诊断为普通子宫平滑肌瘤的患者(对照组)100例的临床资料,比较其一般资料、临床、超声、MRI表现及手术方式差异性。结果观察组与对照组发病年龄、孕产次、肌瘤大小、贫血、腹胀、尿频压迫症状差异无统计学意义(P>0.05)。但两组20~35岁年龄段所占比例观察组高于对照组(32%vs.19%;P=0.035);观察组月经改变例数多于对照组(53例vs.33例;P=0.004);超声表现两组肌瘤均以低回声为主,观察组丰富血流率高于对照组[62.1%(41/66)vs.31.4%(27/86),P=0.000]。MRI表现观察组DWI表达高信号率高于对照组[61.9%(13/21)vs.12.0%(3/25),P=0.002]。手术方式上两组均以腹腔镜子宫肌瘤剔除术为主,观察组开腹子宫肌瘤剔除术例数多于对照组(36/46 vs.20/38;P=0.013)。结论富细胞性平滑肌瘤与普通平滑肌瘤临床表现及影像学特征有一定区别,术前应重视影像学特征,特别是MRI检查的不同。

Objective To improve preoperative evaluation accuracy of cellular leiomyoma.MethodsThe retrospectiveanalysis was conducted in 100 patients with cellular leiomyoma(test group)and 100 patients with uterine leiomyoma(control group)who was proved by operation and pathology from January 2016 to December 2019 in Peking UnionMedical College Hospital,and the differences in basic data,clinical manifestations,ultrasonic manifestations,themagnetic resonance imaning(MRI)findings and operations between cellular leiomyoma and uterine leiomyoma wereanalyzed.ResultsThere was no statistical difference in onset age,times of pregnancy and delivery,size of myoma,anemia,abdominal distention,frequent urination or oppression.The proportion of 20-35 years old in test group washigher than that in control group(32%vs.19%;P=0.035).The incidence of menstrual changes in test group was higherthan that in control group(n=53 vs.n=33;P=0.004).The rich blood flow rate in test group was higher than that incontrol group[62.1%(41/66)vs.31.4%(27/86),P=0.000].Ultrasonography showed hypoecho was the mainmanifestation of myoma in both groups.There was significant difference in the expression of high signal on DWI betweentest group and control group[61.9%(13/21)vs.12.0%(3/25),P=0.002].Laparoscopic myomectomy was the mainsurgical method in both groups,and the number of open myomectomy cases in test group was more than that incontrol group(36/46 vs.20/38;P=0.013).ConclusionThere are some differences in the clinical manifestations andimaging features between cellular leiomyoma and leiomyoma.The imaging features,especially MRI examination,shouldbe paid attention to before operation.