子宫肿瘤表面浆膜层破裂3例临床分析

Clinical analysis of the rupture of surface serous membrane in 3 cases of uterine neoplasm

目的探讨子宫肿瘤表面浆膜层破裂的病因、临床特点,以提高本病的诊断水平,并为临床治疗提供依据。方法收集2017年8月至2020年8月3例子宫肿瘤表面浆膜层破裂患者的临床及影像资料,其中子宫癌肉瘤1例,子宫肌瘤2例。观察并分析临床表现、影像学资料、手术方法、术后住院时间、病理特征、术中术后并发症以及手术效果。结果绝经后子宫癌肉瘤自发破裂导致腹痛1例,超声见子宫中等回声肿物,边界前欠清,MRI见子宫等信号结节及不均匀T2WI高信号斑片影,DWI呈高信号,增强扫描呈不均匀明显强化,子宫周围见渗出影。引产后子宫肌瘤表面浆膜层破裂导致腹痛1例,超声见子宫凸向浆膜下肌瘤,腹腔穿刺见不凝血。同房后子宫肌瘤表面浆膜层破裂并发失血性休克1例,超声检查提示子宫肌瘤并腹腔积液,超声见偏向右附件区低回声肿物,盆腹腔积液。子宫癌肉瘤患者行全子宫双附件及阑尾切除术,2例子宫肌瘤患者均行子宫肌瘤剥除术,手术均顺利完成。结论子宫浆膜下肌瘤较大或形态异常、分娩期或月经期子宫收缩、子宫肌瘤恶变导致或原发性的子宫肉瘤/癌肉瘤、外力或腹压增加等因素均可增加子宫肿瘤表面浆膜层破裂风险;以上高危因素基础上出现腹痛和或腹腔内出血、超声检查见子宫肿瘤并且排除其他急腹症时,可诊断子宫肿瘤破裂;根据肿瘤良恶性以及患者年龄、生育要求选择手术方式。

Objective To investigate the etiology,clinical characteristics of serosal rupture of uterine neoplasms,so as to improve the diagnosis of the disease and provide a basis for clinical treatment.Methods The clinical and imaging data of 3 patients with serosal rupture of uterine neoplasms from August 2017 to August 2020 were collected,including 1 case of uterine carcinosarcoma and 2 cases of uterine myoma.The clinical manifestations,imaging data,surgical methods,postoperative hospital stay,pathological features,intraoperative and postoperative complications and surgical effects were reviewed.Results One case had spontaneous rupture of the uterine carcinosarcoma in a postmenopausal woman,resulting in abdominal pain.Ultrasonography showed a moderately echogenic mass in the uterus with an unclear anterior boundary.MRI revealed isointense nodules and inhomogeneous hyperintense patches on T2WI,and hyperintense patches on DWI.One case of abdominal pain was caused by rupture of the serous layer on the surface of uterine myoma after induced labor.Ultrasound showed a protruding uterine subserosal myoma,and abdominal puncture revealed hemorrhage.One case of uterine myoma had surface serous layer rupture,complicated by hemorrhagic shock after sexual intercourse.Ultrasound examination indicated uterine myoma and ascites.Ultrasound revealed a hypoechoic mass in the right adnexa area,pelvic fluid,and ascites.The patient with uterine carcinosarcoma underwent total hysterectomy,bilateral adnexectomy and appendectomy,and the 2 patients with uterine myoma underwent myomectomy.The operations were successfully completed.Conclusion Factors such as large size or abnormal shape of subserosal myoma,uterine contraction during delivery or menstruation,malignant transformation of myoma or primary uterine sarcoma/carcinosarcoma,external force or increased abdominal pressure,all increase the risk of serosal rupture of uterine tumors.When abdominal pain and/or intra-abdominal hemorrhage occur in patients with the above risk factors,and uterine tumors are found on ultrasonography and other acute abdominal diseases are excluded,a uterine tumor rupture can be diagnosed.A surgical method shall be selected according to benign or malignant nature of the tumor,age of the patient and the fertility requirements.