寄生性平滑肌瘤22例临床分析

Clinical Analysis of 22 Cases of Parasitic Leiomyoma

目的:提高对寄生性平滑肌瘤的认识及治疗水平。方法:回顾性分析2010年9月—2021年8月首都医科大学附属北京妇产医院收治的22例经手术、病理确诊的寄生性平滑肌瘤患者的病例资料,分析其发病机制、临床特点、诊治及预防。结果:22例患者平均发病年龄为(42.9±6.9)岁(31~54岁),其中17例(77.3%)考虑为医源性寄生性平滑肌瘤,5例(22.7%)为无手术史的自发性寄生性平滑肌瘤。18例(81.8%)患者无明显临床症状,尿频3例(13.6%),左下腹腹腔镜Trocar瘢痕处无痛性包块进行性增大1例(4.5%)。22例患者均行手术切除寄生肿物,术中见寄生性平滑肌瘤结节大小0.5~10.0 cm不等,种植于肠系膜、肠表面、盆腹腔腹膜、输卵管系膜、大网膜、直肠子宫陷凹、卵巢及腹腔镜Trocar口,术后均经石蜡切片病理或免疫组织化学证实为平滑肌瘤。术后随访2~132个月,均无寄生性平滑肌瘤复发。结论:寄生性平滑肌瘤好发于育龄期女性,多数患者为子宫肌瘤剔除术后医源性寄生性平滑肌瘤,缺乏特异性临床症状和影像学表现,诊断主要依靠手术探查、术后病理,首选治疗方法为手术治疗。临床在手术治疗子宫肌瘤时应采取相应措施预防该病发生。

Objective:To improve the diagnosis and treatment of parasitic leiomyoma.Methods:22 cases of parasitic leiomyoma admitted between September 2010 and August 2021 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University were analyzed retrospectively,including their pathogenesis,clinical characteristics,diagnosis,treatment and prevention.Results:The average age of onset of the 22 patients was(42.9±6.9)years(31-54 years).17 patients(77.3%)were considered iatrogenic parasitic leiomyoma and 5 patients(22.7%)were spontaneous parasitic leiomyoma with no surgical history.18 patients(81.8%)had no obvious clinical symptoms,3 patients(13.6%)had urinary frequency and 1 patient(4.5%)had a painless mass with progressive enlargement at the original laparoscopic Trocar scar in the left lower abdomen.All 22 patients underwent surgical resection of parasitic tumors.Parasitic leiomyoma nodules ranging in size from 0.5 to 10.0 cm,implanted in the mesentery,intestinal surface,pelvic peritoneum,fallopian tube mesentery,omentum,Douglas pouch,ovary,and laparoscopic Trocar port.All patients were confirmed as leiomyomas by paraffin section pathology or immunohistochemistry.All patients had no recurrence of parasitic leiomyoma at 2-132 months postoperative follow-up.Conclusions:Parasitic leiomyoma is usually found in women of childbearing age,and most of them are considered iatrogenic parasitic leiomyoma after myomectomy.This disease lacks specific clinical symptoms and imaging,and the diagnosis mainly depends on surgical exploration and postoperative pathology.Surgery is the main treatment.Measures should be taken to prevent the parasitic leiomyoma at the time of uterine leiomyoma surgery.