巨大子宫肌瘤的诊治分析

Diagnosis and treatment analysis of giant uterine fibroids

目的分析巨大子宫肌瘤的临床特点及诊治方法,以寻找合理化治疗方案。方法回顾性分析30例经手术病理证实的巨大子宫肌瘤的临床及术前影像学检查资料。结果患者均以腹盆腔包块就诊,术前所有患者均行经腹和(或)经阴道超声检查,14例行多排螺旋CT检查,17例行MRI检查。以病理结果为诊断金标准,术前综合影像学诊断准确率为93.33%(28/30)。根据患者生育要求以及肌瘤的位置、大小及数目评估患者全身状况,选择较优方案,分别行开腹(n=13)或者腹腔镜(n=8)子宫肌瘤剔除术、开腹(n=5)或者腹腔镜下(n=4)全子宫切除术,同时进行附件手术3例,输卵管切除1例。术中发现巨大肌瘤位于浆膜下22例,肌壁间5例,阔韧带1例。8例术中因盆腹腔粘连而行粘连松解术。术后影像学随访6个月~5年,未见术区肿瘤残余或复发。结论巨大子宫肌瘤术前进行细致地临床及影像学检查,优化手术方案,术后影像学定期随访,对于患者获得良好预后具有重要意义。

Objective To analyze the clinical characteristics,diagnosis and treatment of giant uterine leiomyoma,and to find a reasonable treatment plan.Methods The clinical and preoperative imaging data of 30 cases with giant uterine fibroids confirmed by surgery and pathology were analyzed retrospectively.Results All patients presented with abdominopelvic masses and all patients underwent transabdominal and/or transvaginal ultrasound examination before surgery.A total of 14 cases were examined by multislice spiral CT,17 cases were examined by MRI.Based on pathological results as the gold standard,the accuracy of preoperative comprehensive imaging diagnosis was 93.33%(28/30).According to the patient's fertility requirement,the location,size and number of myomas,and the patient's general condition,the best plan was selected,and hysteromyomectomy was performed by laparotomy(n=13)or laparoscopy(n=8)respectively,total hysterectomy were performed laparoscopically(n=4)or laparoscopically(n=5).During the surgery,giant fibroids were found to be located under the serosa in 22 cases,between the muscle walls in 5 cases,and in the broad ligament in 1 case.A total of 8 cases underwent adhesiolysis due to pelvic and abdominal adhesions during surgery.There was no residual tumour or recurrence in the operated area at postoperative imaging follow-up from 6 months to 5 years.Conclusion For giant uterine fibroids,careful clinical and imaging examination before surgery,optimization of surgical plan,and regular postoperative imaging follow-up are of great significance for patients to obtain a good prognosis.