不同部位子宫脂肪平滑肌瘤的临床表现及超声特征

Clinical manifestations and ultrasonic characteristics of uterine lipoleiomyomas at different sites

目的分析不同部位子宫脂肪平滑肌瘤(LL)的临床表现、超声特征。方法回顾性分析2019年9月~2022年9月在我院经手术病理证实为LL的60例患者的临床信息、实验室检查、超声图像特征、病理结果等临床资料。结果60例LL患者,无临床表现41例,下腹胀痛7例,月经量增多6例,绝经后阴道流血3例,同房痛1例,肛门坠胀感1例,尿频尿急1例,不同部位LL临床表现差异无统计学意义(P>0.05)。41例病灶位于子宫体肌壁间或浆膜下,其中5例发生在阔韧带;13例位于子宫颈,其中1例位于宫颈管粘膜下;6例位于宫腔粘膜下。LL在超声多为圆形或类圆形,有假包膜样回声,多边界清楚,均表现为实性稍高回声团块,内部回声较均质,肿物周边均可探及血流信号。术前超声误诊30例,误诊率50%,不同部位LL误诊率差异无统计学意义(P>0.05)。结论LL超声表现具有一定特征,以圆形或类圆形为主,均表现为实性稍高回声团块,能够通过术前超声进行初步诊断,但误诊率较高。

Objective To analyze the clinical manifestations and ultrasonic characteristics of uterine lipoleiomyomas(LL)at different sites.Methods A retrospective analysis was performed on the clinical data of 60 patients with LL confirmed by surgical pathology in the hospital from September 2019 to September 2022.The clinical information,laboratory examinations,characteristics of ultrasonic images and pathological results were analyzed.Results In the 60 patients with LL,there were 41 cases without clinical manifestations,7 cases with abdominal distension,6 cases with increased menstruation,3 cases with postmenopausal vaginal bleeding,1 case with dyspareunia,1 case with anal distension and 1 case with frequent and urgent urination.There was no significant difference in clinical manifestations among patients with LL at different sites(P>0.05).There were 41 cases with lesions located in the intermuscular wall of uterine body or subserous membrane(5 cases in broad ligament),13 cases in the cervix(1 case in submucosa of cervical canal)and 6 cases in uterine submucosa.In ultrasound detection,LL were mostly round or quasi-round,there were false envelope-like echoes,most boundaries were clear.There were solid and slightly hyperechoic lumps,relatively homogeneous internal echoes and blood flow signals around tumors.Preoperative ultrasound showed that there were 30 misdiagnosed cases,with misdiagnosis rate of 50%.There was no significant difference in misdiagnosis rate among patients with LL at different sites(P>0.05).Conclusion There are certain characteristics of ultrasonic manifestations in LL.Most of them are round or quasi-round,with solid and slightly hyperechoic lumps.Preoperative ultrasound can preliminarily determine LL,but the misdiagnosis rate is high.