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目的探讨静脉内平滑肌瘤病的临床病理特点和治疗策略。方法回顾性分析北京大学人民医院收治的18例静脉内平滑肌瘤病患者临床病理资料。结果 18例患者中,12例就诊于妇科,6例就诊于血管外科;中位数年龄为45岁,主诉以月经改变、腹痛及运动后黑朦为主。术前影像学检查如彩色超声、MRI、CT、血管造影等检查可初步提示该疾病,8例术前提示此诊断。18例患者均接受手术治疗,在血管外科就诊的患者中2例行盆腔肿物切除术,4例行下腔静脉(心房)病变切除术,妇科手术范围包括7例行全子宫双侧输卵管卵巢切除术,7例行全子宫切除术,2例既往曾行全子宫切除术的患者,术中切除子宫外病灶后切除双侧输卵管卵巢,1例行子宫肌瘤切除术。术中均尽可能切除肿瘤组织,术后经病理明确诊断。术后均未药物治疗,平均随访34.7个月,一例患者术后1年复发,再次手术切除复发病灶并切除双侧输卵管卵巢后随访无复发。结论静脉内平滑肌瘤病术前诊断较困难,影像学检查有辅助诊断价值。手术为主要治疗方式,无生育要求者建议切除全子宫及双侧附件。
Objective To investigate the clinicopathological characteristics and treatment strategies of intravenous leiomyomata. Methods The clinical and pathological data of 18 patients with venous leiomyoma treated by Peking University People’s Hospital were retrospectively analyzed. Results Of the 18 patients, 12 were treated in gynecology and 6 were treated in vascular surgery. The median age was 45 years. The chief complaint was menstrual change, abdominal pain and post-exercise blackness. Preoperative imaging examination such as color ultrasound, MRI, CT, angiography and other tests can be initially prompted the disease, 8 cases of preoperative prompt diagnosis. Eighteen patients underwent surgical treatment. Two patients who underwent endovascular surgery received resection of pelvic masses and four patients underwent resection of the inferior vena cava (atrium). The scope of gynecologic surgery included seven cases of total hysteroporosis Resection, 7 cases of hysterectomy, 2 cases of patients who had undergone hysterectomy in the past, removal of bilateral uterine tubercle oviduct after surgery, 1 case of myomectomy. Intraoperative resection of tumor tissue as much as possible, postoperative diagnosis by pathology. No postoperative drug treatment, with an average follow-up of 34.7 months, one patient relapsed one year after surgery, resection of the lesion again surgery and removal of bilateral ovarian ovaries after follow-up without recurrence. Conclusions Preoperative diagnosis of venous leiomyoma is difficult and the imaging diagnosis is of value in diagnosis. Surgery as the main treatment, no fertility requirements are recommended to remove the whole uterus and bilateral attachment.