腹腔镜术后腹膜播散性平滑肌瘤病及文献复习  

Disseminated peritoneal leiomyomatosis after laparoscopic surgery and literatures review

作　　者：黄晓晖[1] 曾俐琴[1] 金文艳[1] 

机构地区：[1]广东省妇幼保健院妇科,广州510010

出　　处：《中华妇幼临床医学杂志（电子版）》2017年第2期183-188,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：广东省科技厅科技支撑计划项目(2014A020212553)~~

摘　　要：目的探讨腹腔镜术后腹膜播散性平滑肌瘤病(DPL)的预防和诊治。方法回顾性分析广东省妇幼保健院3例腹腔镜术后DPL患者的临床病历资料,并结合文献检索获得的14篇国内外关于腹腔镜术后DPL的相关文献报道,进行文献复习,总结腹腔镜术后DPL的临床特点、预防及诊治方法。结果 (1)采集纳入本研究的3例腹腔镜术后DPL患者病历资料结果为:均有腹腔镜子宫肌瘤剔除(LM)史,并采用子宫旋切器取出肌瘤;均无明显症状及体征,常规体检发现盆腔包块;术前诊断均为子宫平滑肌瘤,术中发现DPL并予以手术切除,术后恢复良好。(2)14篇国内外腹腔镜术后DPL相关文献及本研究DPL患者临床特点分析:14篇文献及本研究共计24例腹腔镜术后DPL患者,病理学检查结果均为子宫平滑肌瘤,均有LM史或腹腔镜次全子宫切除术(LSH)史,并使用子宫旋切器取出肌瘤病史。所有患者均为育龄期妇女,20.8%(5/24)患者未孕、未育;8.3%(2/24)患者曾服用雌激素或孕激素治疗;58.3%(14/24)患者无特殊症状和体征,仅常规体检发现盆腔包块或子宫肿物;25.0%(6/24)患者因"腹痛"就诊,其余患者症状为腹胀、腹部不适和月经量增多;33.3%(8/24)患者此前有≥2次子宫部位手术史。结论对子宫平滑肌瘤患者,应慎重选择其腹部手术方式和子宫旋切器的使用,同时应采取措施防止肌瘤碎片组织在盆、腹腔播散。针对DPL患者应采取个体化治疗方案。ObjectiveTo explore the prevention, diagnosis and treatment of disseminated peritoneal leiomyomatosis （DPL） after laparoscopic surgery.MethodsRetrospectively analyzed the clinical data of 3 cases of DPL patients after laparoscopic surgery in Guangdong Women and Children′s Hospital, and reviewed 14 domestic and foreign literatures about the DPL after laparoscopic surgery by literature retrieval.And summarized the clinical characteristics, prevention, diagnosis and treatment of DPL after laparoscopic surgery.Results① The cases histories data of 3 patients with DPL after laparoscopic surgery were as following： all cases had laparoscopic myomectomy（LM） histories, and used uterine shredder to remove fibroids; no obvious symptoms and signs were shown, just found pelvic mass by routine health examination; preoperative diagnosises were uterine leiomyoma, and intraoperative DPL was found and took surgical resection with good postoperative recovery. ② Clinical characteristics of DPL patients in 14 domestic and foreign literatures and this paper were analyzed. There were 24 DPL patients after laparoscopic surgery, pathological results were leiomyoma, all had LM or laparoscopic subtotal hysterectomy （LSH） histories, and the histories of removing the fibroids by uterine shredder. All patients were women of childbearing age, 20.8%（5/24） patients were not yet pregnant and childbearing; 8.3%（2/24） patients had taken estrogen or progesterone treatment; 58.3%（14/24） patients had no special symptoms and signs, only found pelvic or uterine mass by routine health examination, 25.0%（6/24） patients with the symptom of abdominal pain, others had abdominal distensions and discomforts, or menstrual flow increased; 33.3%（8/24） patients had twice or more histories of uterine surgery.ConclusionsPatients with uterine leiomyoma should be carefully selected for their abdominal surgery mode and the use of uterine shredder, and should take measures to prevent fragment tissues of fibroids disseminating in pe

关 键 词：子宫肿瘤 平滑肌瘤病 腹腔镜检查 腹膜肿瘤 粉碎术 妇女 

分 类 号：R737.33[医药卫生—肿瘤]