静脉平滑肌瘤病临床分析

发布时间：2018-03-20 02:29

本文选题：静脉内平滑肌瘤病　切入点：心脏内平滑肌瘤病　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨静脉内平滑肌瘤病(intravenous leiomyomatosis,IVL)发病特点、临床表现、术前及术后诊断、治疗方案的选择以及预后效果。方法:采用回顾性方法分析,搜集2012年9月至2015年8月由吉林大学第二医院收治的20例IVL患者的临床、病理资料。所有统计数据录入Excel表格。分别对本组患者的术前检查、术前诊断、治疗方案、病理诊断进行统计分析。所有诊断均为2名有经验的病理医师明确诊断。该20例患者均就诊于吉大二院并行手术治疗。结果:(1)本组患者90%为绝经前女性,平均年龄为45岁。多因为子宫肌瘤或者子宫腺肌症等入院行手术治疗。所有患者术前均未明确IVL的诊断,均术中及术后明确诊断。(2)本组IVL患者术前检查均无明显特异性。6例(30%)见肌瘤样组织凸向两侧阔韧带;3例(15%)宫颈部近峡部肌瘤;8例(40%)子宫肌壁间有蚯蚓样肿物从脉管内凸出;2例(10%)附件区见从脉管内突出的条索样肿物。(3)1例有生育要求,仅行病灶切除术;7例行子宫切除术;6例行子宫切除术+双附件切除术;5例行子宫切除术+双侧输卵管切除术;1例行子宫切除术+患侧附件切除术+健侧输卵管切除术。术后均未行激素治疗。结论:(1)IVL起病隐匿,多为绝经前女性。IVL早期多无明显特异性阳性体征及检查结果,常因子宫肌瘤及子宫肌腺症或者盆腔包块行手术治疗,多为术中及术后明确诊断。(2)术前怀疑IVL的患者建议行妇科彩超、心脏彩超及胸腹盆腔联合平扫,必要时行CTA检查,对于有阳性表现者,积极充分术前准备。(3)对于术前发现子宫肌瘤位于宫颈峡部、宫角、阔韧带等血供丰富区或者术中发现子宫肌瘤呈串珠样及条索状时,建议术中行快速病理,提高术中诊断率,降低漏诊率。(4)对于IVL肿瘤仅限于子宫内的,无生育要求年轻女性,建议行子宫全切除术;有生育要求的,可行病灶切除术,术后严密观察病情,定期随诊,及时发现血管内病灶并清除。对于大于45岁或发现子宫外脉管受累及者,建议行全子宫切除术+双附件切除术+宫外病灶切除术。对于年轻女性伴有附件区病灶者,是否保留健侧卵巢输卵管,目前尚缺乏大量临床资料。保留健侧卵巢或者健侧卵巢输卵管对预后的影响,需更多的临床研究来阐述。IVL累及下腔静脉、心脏者,需妇产科、心脏外科、血管外科协同决定手术方案。依患者病情及状况,选择治疗方案,手术方案可选择一期手术或者分期手术治疗。对于在术中及术后病理明确诊断为IVL患者,术后建议行盆腹部血管彩超或者盆腹部CTA检查,排除其他残留病灶,协助术后治疗方案选择。
[Abstract]:Objective: to investigate the clinical features, clinical manifestations, preoperative and postoperative diagnosis, treatment options and prognosis of intravenous leiomyoidosis IVL (IVL). The clinical and pathological data of 20 patients with IVL were collected from September 2012 to August 2015 in the second Hospital of Jilin University. All statistical data were recorded in Excel tables. All the diagnoses were confirmed by two experienced pathologists. All the 20 patients were treated with surgical treatment in the second Hospital of Jilin University. Results 90% of the patients were premenopausal women. The average age was 45 years. Most of the patients were admitted to the hospital for surgical treatment such as hysteromyoma or adenomyosis. All the patients had no definite diagnosis of IVL before operation. All patients with IVL were diagnosed intraoperatively and postoperatively. (there was no significant specificity in preoperative examination in all patients with IVL.) there were 30 cases of myomatous tissue protruding to bilateral broad ligaments in 3 cases and 15 cases); 8 cases of proximal isthmus myoma of uterine neck and 8 cases of myoma of proximal isthmus of uterus were treated with earthwormlike masses from the wall of uterus muscle. In the adnexal region, there was a protruding strip-like mass from the vessel in 1 case with fertility requirements. Focus resection only 7 cases hysterectomy 6 cases double appendage hysterectomy 5 cases hysterectomy bilateral salpingotomy 1 case hysterectomy 1 patient side appendage resection healthy side salpingotomy. No hormone therapy was performed after the operation. Conclusion the onset of IVL is occult. Most of them were premenopausal women. Most of them had no specific positive signs and examination results at the early stage of menopausal women. They were often treated with surgery because of uterine leiomyoma, myometriosis or pelvic mass. Most of the patients suspected of IVL were diagnosed intraoperatively and postoperatively. Patients suspected of IVL were advised to perform gynecological color Doppler ultrasonography, echocardiography and combined plain scan of chest, abdomen and pelvic cavity, and CTA examination if necessary. To find uterine leiomyoma in cervical isthmus, uterine horn, broad ligament and other areas of blood supply before operation, or to find uterine fibroids in the shape of bead and stripe, it is recommended to make rapid pathology during operation and improve the diagnostic rate during operation. To reduce the rate of missed diagnosis. (4) for the IVL tumor limited to the uterus, young women without fertility requirements, total hysterectomy is recommended; if there is fertility requirement, feasible focus resection, close observation of the state of the disease after surgery, regular follow-up, For those over 45 years of age or with extrauterine vascular involvement, it is recommended that total hysterectomy be performed with double appendage resection of extrauterine lesions. For young women with adnexal lesions, Whether or not to preserve the oviduct is still lack of a lot of clinical data. The effect of preserving the healthy ovary or the oviduct on the prognosis needs more clinical research to explain that IVL involving inferior vena cava, heart, gynecology and obstetrics. According to the patient's condition and condition, choose the treatment plan, the operation plan may choose the one stage operation or the stage operation treatment. For the intraoperative and postoperative pathological diagnosis of patients with IVL, It is suggested that color Doppler ultrasound or CTA should be performed to remove other residual lesions and to assist in the selection of postoperative treatment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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