33例弥漫性子宫平滑肌瘤病临床分析

Clinical Analysis of 33 Cases of Diffuse Uterine Leiomyomatosis

目的:提高对弥漫性子宫平滑肌瘤病(diffuse uterine leiomyomatosis,DUL)的诊断及治疗水平。方法:回顾性分析2009年1月—2022年10月首都医科大学附属北京妇产医院收治的33例确诊DUL患者的病例资料,分析其临床特点、诊治方法及术后妊娠情况。结果:33例患者的平均发病年龄为(38.4±6.9)岁(24~52岁)。19例(57.6%)表现为月经量增多,7例(21.2%)表现为尿频或下腹胀痛,余7例(21.2%)无明显临床症状,仅为查体发现子宫肌瘤逐渐增大就诊。33例患者均行超声检查,15例(45.5%)患者提示子宫肌层布满或弥漫性分布的低回声结节。7例患者行盆腔磁共振成像(magnetic resonance imaging,MRI)检查,3例提示子宫肌层弥漫分布大小不等的类圆形结节或团块。33例患者均行手术治疗,19例行开腹/腹腔镜全子宫切除术,另14例有生育要求患者,其中11例行经腹子宫肌瘤剔除术,3例行宫腔镜子宫肌瘤切除术。术后病理及免疫组织化学检查均提示平滑肌瘤。14例有生育要求患者(2例失访)术后平均随访时间(67.8±36.3)个月,3例患者自然妊娠,2例顺利分娩(其中1例分娩2次),另1例为宫角妊娠行清宫术。结论:DUL是一种罕见的良性平滑肌肿瘤,好发于育龄女性。临床最主要表现为月经量明显增多和不孕,若超声提示子宫肌壁间布满肌瘤且患者表现为月经量明显增多或除外其他原因的不孕时,需加查MRI,有助于早期识别该病。手术是主要的治疗方法,无生育要求的患者推荐行全子宫切除术,保留生育能力的治疗方式的选择尚需进一步的研究。

Objective:To improve the diagnosis and treatment of diffuse uterine leiomyomatosis(DUL).Methods:33 cases of DUL admitted between January 2009 and October 2022 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University were analyzed retrospectively,including their clinical characteristics,diagnosis and treatment methods and postoperative pregnancy.Results:The average age of onset of the 33 patients was(38.4±6.9)years(24-52 years).Nineteen patients(57.6%)presented with menorrhagia,7 patients(21.2%)presented with frequent urination or lower abdominal distension,and the remaining 7 patients(21.2%)were asymptomatic and the examination revealed the uterine leiomyoma was progressively enlarged.Ultrasound examination was performed in 33 patients,and 15 patients(45.5%)showed myometrium was full of hypoechoic nodules.7 patients underwent magnetic resonance imaging(MRI),and 3 cases showed diffuse distribution of round nodules or masses of variable sizes in the myometrium.All 33 patients underwent surgical treatment,19 underwent transabdominal or laparoscopic hysterectomy,the other 14 with fertility requirements,11 of them underwent transabdominal myomectomy and 3 underwent hysteroscopic myomectomy.Postoperative pathology and immunohistochemistry were all suggestive of leiomyoma.The average follow-up time after surgery was(67.8±36.3)months in 14 patients with fertility requirements(2 patients lost).Three patients had natural pregnancies,two had successful deliveries(one of which had two deliveries),and the other had cornual pregnancy that was cleared.Conclusions:DUL is a rare benign smooth muscle tumor that occurs in women of reproductive age.The most common clinical symptoms were menorrhagia and infertility.If ultrasound shows myometrium was full of myoma nodules and the patient presents with menorrhagia or infertility except for other reasons,MRI is indicated to help identify the disease early stage.Surgery is the main treatment.Hysterectomy is recommended for patients without fertility requirements,and the choice of fertility-preserving treatment requires further research.