子宫血管内平滑肌瘤病例报道及临床分析

Cases report and clinical analysis of uterine intravascular leiomyoma

目的:通过分析子宫血管内平滑肌瘤病[亦称静脉内平滑肌瘤病(intravascular leiomyoma,IVL)]的临床病例资料,洞悉该病的核心特点以指导临床。方法:以短期内发现的2例IVL为重点,回顾性分析该院确诊为IVL的12例患者资料,结合相关国内外文献对该罕见疾病进行综合的分析探讨。结果:包括重点介绍的2例患者,该院共收治IVL患者12例,年龄介于42~55岁之间。从患者高发人群、临床症状、影像学检查、手术情况、术后病理、预后及随访等各方面分析结果。结论:IVL好发于绝经前女性,均合并子宫肌瘤,术前明确诊断困难。血管内瘤栓沿着血管分支蔓延,并不依赖于静脉回流方向。手术是最直接有效的治疗方式。IVL术后复发与残留病灶密切相关。保留卵巢的年轻患者,内分泌治疗是一种选择,但是内分泌治疗的适应人群、治疗维持时间、疗效仍然存在争议。

Objective:By analyzing the clinical data of endovascular leiomyoma[also called intravenous leiomyoma(IVL)],we can understand the core characteristics of this disease to guide the clinic.Methods:Focus on the 2 cases identified in a short period of time,we retrospectively analyzed 12 patients diagnosed with IVL in our hospital.We combined the relevant literature,the incidence,age of onset,high-risk population,diagnosis,treatment,prognosis and follow-up of this rare disease were comprehensively analyzed and discussed.Results:Including the two cases,a total of 12 patients with IVL were admitted to our hospital,aged from 42 to 55 years.We combined the high-risk population,clinical symptoms,imaging examinations,surgical conditions,prognosis and follow-up of this rare disease were comprehensively analyzed and discussed.Conclusion:IVL mainly occurs in premenopausal women,and all of them are complicated with hysteromyoma.It is difficult to make a definite diagnosis before operation.Intravascular tumor thrombus spread along the branches of the blood vessels,independent of the direction of venous return.Surgery is the most direct and effective treatment for IVL.The recurrence of IVL is closely related to whether there is residual disease after surgery.For patients with ovarian preservation,endocrine therapy is an option,but the suitable population,duration of treatment,and efficacy of endocrine therapy are still controversial.