子宫脉管内平滑肌瘤的临床诊治分析

目的 探讨子宫脉管内平滑肌瘤的临床和病理特征、诊治要点及其预后,期望能更好的了解其生物学行为,指导临床。方法 回顾性分析2010年8月至2016年8月在福建省妇幼保健院手术并经病理证实的21例子宫脉管内平滑肌瘤患者的临床及病理资料。结果 14例(66.7%)以月经改变为主要临床表现,其次为下腹痛、下腹部包块。妇科检查均有子宫增大表现,≥3个月妊娠子宫10例(47.6%),出现贫血7例(33.3%)。超声提示子宫肌瘤或子宫腺肌病18例(76.2%),2例不除外肌瘤恶性病变可能,1例提示性质不明的宫旁实性肿物,术前无一例诊断为子宫脉管内平滑肌瘤。术中冰冻病理诊断符合率58.8%(10/17),术后根据石蜡病理切片及免疫组化确诊。手术治疗行子宫切除和(或)附件切除者共17例(81.0%),单纯肌瘤剔除者4例(19.0%),在随访的病例中只有1例单纯肌瘤剔除者复发,再行彻底的手术切除治疗。结论 子宫脉管内平滑肌瘤术前误诊率高,具有侵袭、复发、转移等不良生物学行为,临床处理以彻底的手术切除病灶为主；及时正确诊断,规范手术治疗,可改善预后。

Clinical analysis in the diagnosis and treatment of uterine intravenous leiomyoma

Objective To study the clinical and pathological characteristics,diagnosis and treatment and prognosis of uterine intravenous leiomyoma,and to better understand its biological behavior and guide clinical treatment.Methods The clinical and pathological data of 21 patients of uterine intravenous leiomyoma proved by operation and pathology were analyzed retrospectively.Results Menstrual change was the main clinical manifestation(14/21,66.7%),followed by lower abdominal pain and lower abdominal mass.Gynecological examination revealed enlargement of the uterus,10 cases(47.6%) had enlarged uterus which was over three months pregnant uterus,Anemia occurred in 7 patients(33.3%).Ultrasound indicated 18 cases(76.2%) of myoma of uterus or adenomyosis,2 cases showed malignant change of suspicious myoma,and 1 cases of solid tumors of the uterus,which were of unknown nature.No uterine intravenous leiomyoma was diagnosed before operation.The accuracy rate of intraoperative frozen pathological diagnosis was 58.8%(10/17),the diagnosis was confirmed by pathological examination and immunohistochemistry.There were 17 cases(81%) who underwent hysterectomy,and 4 cases(19%) chosed myomectomy,In the follow-up case,only a single case of recurrence occurred in one case of myomectomy,and then radical resection was performed.Conclusion Uterine intravenous leiomyoma had high preoperative misdiagnosis rate,with poor biological behavior of invasion,recurrence and metastasis.The clinical treatment was mainly surgical resection,Timely and correct diagnosis and standard operation treatment can improve the prognosis.