子宫血管性平滑肌瘤26例临床病理分析

目的 探讨子宫血管性平滑肌瘤的临床病理特征,以提高临床医师对这种少见肌瘤的认识.方法 回顾性分析我院1998年至2004年10月间行手术,并经病理检查证实为子宫血管性平滑肌瘤的26例患者的临床病理资料,并随访其预后.结果 作为一种少见的特殊类型的平滑肌瘤,近年来其发生率呈上升趋势;临床表现以月经改变为最多,可伴贫血;B超检查多数难与普通肌瘤区别,彩超在辅助诊断上有一定的优势.此类肌瘤的手术方式与普通子宫平滑肌瘤相同,两者病理改变不相同.结论 鉴于其富于血管的特点,对于B超检查可疑血管性平滑肌瘤者,应积极行彩超检查,进一步明确诊断.根据患者主要表现为月经改变导致的出血,进而可能发展为贫血,临床应积极治疗,加之术中出血常较普通肌瘤多,因此应做好充分的术前准备.对于肌瘤较大者,需充分估计手术困难度,必要时合血备血.

Clinical pathologic analysis of 26 cases of uterine vascular leiomyoma

Objective To investigate the clinicopathological features of the uterine vascular leiomyoma and to improve the understanding of clinical gynecologists for it. Methods We retrospectively analysed the clinical and pathological data of 26 cases of uterine vascular leiomyoma from 1998 to 2004,of which all patients were treated by operations and all specimens were confirmed by pathologic examination. Also the cases were followed up postoperation. Results Being a type of rare, special leiomyoma, the prevalence of uterine vascular leiomyoma had been increasing recently. Menstruation changes presented the most common clinical features accompanying with anemia. It was difficult to distinguish vascular leiomyoma from common myoma of uterus by B Ultrasound in most situations. Color Doppler Ultrasound had certain advantages in adjuvant diagnosis. This type of leiomyoma had the similar operation pattern with common ones but the pathologic changes are different. Conclusions Considering that it is rich in vessels, further diagnosis should be prompted by Color Doppler Ultrasound when the vascular leiomyoma is suspected by B Ultrasound. We should treat it positively because its main clinical feature is bleeding caused by menstruation changes which can lead to anemia. Careful preparation is needed before operation because hemorrhage is severer in vascular leiomyoma than in the common ones during operation. As for the big vascular leiomyoma, we should get ourselves ready for possible difficult surgery. If needed, blood should be prepared for operation use.