子宫静脉血管平滑肌瘤病的超声特征分析  

Diagnosis and differential diagnosis of uterine intravenous leiomyomatosis on sonography

作　　者：刘爽[1] 吴青青[1] 詹阳[2] 许阡 陈照娟 

机构地区：[1]首都医科大学附属北京妇产医院超声科,100026 [2]首都医科大学附属北京妇产医院病理科,100026 [3]首都医科大学附属北京妇产医院微创中心,100026 [4]首都医科大学附属北京妇产医院妇科,100026

出　　处：《中华医学超声杂志（电子版）》2017年第8期630-635,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：北京市医院管理局"登峰"计划专项经费资助(DFL20151302);首都卫生发展科研专项(首发2014-2-2113)

摘　　要：目的总结子宫静脉血管平滑肌瘤病(IVL)的超声影像学特征及鉴别诊断要点。方法对2014年1月至2016年12月在首都医科大学附属北京妇产医院超声检查并经临床手术及病理免疫组化染色证实为IVL患者的超声声像图特征及超声鉴别诊断要点进行总结分析。结果 6例IVL患者中,3例为实体型IVL,表现为宫颈及子宫旁区域的实性肿物,内部见不规则裂隙状血管回声,彩色多普勒可探及静脉血流信号;3例为静脉型IVL,表现为沿子宫静脉走行的串珠状中等回声肿物附着于扩张的静脉管腔内壁。其中1例术前超声及血管超声显示髂静脉内瘤栓正确提示为子宫IVL,术中超声心动图显示下腔静脉血管及下腔静脉近心段同时伴发活动性瘤栓型IVL。其余5例术前超声误诊为阔韧带肌瘤2例、宫颈肌瘤2例、卵巢实性肿物1例,手术病理检查证实均为子宫IVL。结论子宫IVL表现为分布于宫颈及子宫旁区域沿子宫静脉走行的实性肿物,部分IVL沿静脉管腔内部蔓延性生长至髂静脉及下腔静脉。实体型IVL易误诊为子宫平滑肌瘤或卵巢实性肿物,实性肿物内部呈现多发裂隙状无回声为超声诊断IVL的重要依据。经阴道超声联合下腔静脉血管超声及超声心动图检查对IVL的诊断有更明显的优势。Objective Uterine intravenous leiomyomatosiswas a rare type of uterus tumors. Because ofthe lack of knowledge about the ultrasonic patterns of this kind of disease, misdiagnosis frequently happens. Reviewing the cases and relevant researcheswas helpful to understand the disease and figure it out inultrasonic images. Methods Six cases of patients with uterine intravenous leiomyomatosis were reviewed which werehospitalized in Beijing Obstetrics and Gynecology Hospital during 2014 to 2016. All of the patients underwentultrasound examinations before surgery. The ultrasound findings,clinical presentations and pathological features of the 6 patients were evaluated. Results In 6 patients with uterine intravenous leiomyomatosis, 3 cases were solid tumors, located in the cervix region and para uterine region, withirregular veinvascular inside; 3 cases performance as multiple tumorlocated in dilated uterine vein, active tumor embolus were found in inferior vena cavain one of the 3 cases. Conclusions Uterine intravenous leiomyomatosisis found to be a solid mass located in the cervix region and para uterine region. The internal fissure of solid tumor is an important feature. Tumor extending to the iliac vein and inferior vena cava in some cases. Thusit is hard to be diagnosed before surgery by ultrasonography. Moreover, transvaginal ultrasound combined with inferior vena cava ultrasonography and echocardiography has a more obvious advantage in the diagnosis of the uterine intravenous leiomyomatosis.

关 键 词：超声检查 静脉平滑肌瘤病 子宫 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]