静脉内平滑肌瘤病长入右心1例并文献复习

Intravenous Leiomyomatosis Growing into the Right Heart: A Case Report and Literature Review

目的:通过分析静脉内平滑肌瘤病(intravenous leiomyomatosis, IVL)的临床特点、临床表现、诊断及治疗与预后,同时阅读最新文献,总结最新诊疗方法,以提高该疾病的诊疗水平。方法:分析青岛大学附属医院收治的1例静脉内平滑肌瘤病长入右心的诊治经过,并复习国内外文献。结果:患者吕某,因“胸闷、憋气20天”入院,入院后完善相关辅助检查,排除禁忌后行手术,术后病理:血管内平滑肌瘤。结论:静脉内平滑肌瘤病是一种罕见的、组织学表现为良性的子宫肿瘤,特征是平滑肌细胞在血管内增生,起源于子宫肌层,以其最广泛的形式,可以通过盆腔静脉和下腔静脉到达心脏,造成血液动力学并发症。子宫平滑肌瘤侵入血管长入右心室极少,病情严重,早发现、早诊断、早治疗尤为重要。

Objective: To analyze the clinical features, diagnosis, treatment and prognosis of intravenous leio-myomatosis, read the latest literature, and summarize the latest diagnosis and treatment methods in order to improve the diagnosis and treatment of the disease. Methods: The diagnosis and treat-ment of 1 case of intravenous leiomyomatosis growing to the right heart treated in the Affiliated Hospital of Qingdao University were analyzed, and the literature at home and abroad was reviewed. Results: The patient, Lv, was admitted to the hospital because of “chest tightness and breath hold-ing for 20 days”. After admission, he improved relevant auxiliary examinations and performed sur-gery after excluding contraindications. The postoperative pathology was intravascular leiomyoma. Conclusion: Intravenous leiomyomatosis is a rare and histologically benign uterine tumor, charac-terized by the proliferation of smooth muscle cells in blood vessels, which originated from the my-ometrium of uterus. In its most extensive form, it can reach the heart through pelvic vein and infe-rior vena cava, resulting in hemodynamic complications. Uterine leiomyoma rarely invades blood vessels and grows into the right ventricle, and its condition is serious. Early detection, diagnosis and treatment are particularly important.