子宫平滑肌肉瘤超声诊断及误诊分析  

Ultrasonic diagnosis and causes of misdiagnosis of uterine leiomyosarcoma

作　　者：刘勤[1] 王岳 兰月 汪龙霞[1] 罗渝昆[1] Liu Qin;Wang Yue;Lan Yue;Wang Longxia;Luo Yukun(Departmentof Ultrasound,Chinese People's Liberation Army General Hospital,Beijing 100853,China;Department of Gynaecology and Obstetrics,First Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心超声科,北京100853 [2]解放军总医院第一医学中心妇产科,北京100853

出　　处：《中华医学超声杂志（电子版）》2021年第5期457-461,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：首都特色—超声新技术在剖宫产术后切口瘢痕妊娠诊断及早期治疗中的应用(Z171100001017141)。

摘　　要：目的探讨子宫平滑肌肉瘤超声图像特征、分析术前超声误诊原因。方法选取于2013年6月至2018年12月经解放军总医院第一医学中心手术病理证实为子宫平滑肌肉瘤16例患者的术前临床影像检查资料进行研究分析。结果16例患者术前超声显示子宫内多发病灶7例,单发病灶9例;子宫肌壁间12例,黏膜下3例,宫颈部1例;形态规则9例,不规则7例;边界清晰6例,边界不清10例;病灶内部呈不均匀高回声9例,囊实混合回声4例(内有液化坏死区),低回声3例。16例中9例病灶内部或子宫黏膜下偏后方衰减不明显,后方回声略增强,彩色多普勒示病灶内血流较丰富;2例为晚期肿瘤病灶,形态不规则,内有坏死区,呈囊实混合回声改变,侵犯浆膜层向子宫外膨胀性生长,见髂血管旁淋巴结转移及盆腹腔静脉瘤栓形成。结论超声诊断子宫平滑肌肉瘤有难度和局限性,但对于子宫肌层内单发病灶,呈稍高回声或不均质回声,且边界不清,内部回声不均匀,血供丰富,病灶质地柔软,探头加压变形时可能为恶性病变,待病理诊断确诊。Objective To investigate the ultrasonographic features of uterine leiomyosarcoma and analyze the causes of misdiagnosis.Methods Preoperative clinical imaging data of 16 patients with uterine leiomyosarcoma confirmed by surgery and pathology at the First Medical Center of PLA General Hospital from June 2013 to December 2018 were selected for analysis.Results Preoperative ultrasound showed multiple intrauterine lesions in six cases and single lesions in nine cases.Among the 16 cases included,12 were intramural,3 were submucosal,and 1 was cervical.The morphology of lesions was regular in 9 cases and irregular in 7 cases.The boundary was clear in 6 cases and unclear in 10 cases.Inhomogeneous hyperechogenicity was found in 9 cases,mixed echogenicity found in 4(with liquefactive necrotic areas),and hypoechogenicity in 3.In 9 of the 16 cases,there was no significant attenuation in the inner or submucosal posterior lesions,and the posterior echo was slightly enhanced.When the shape of the lesion was irregular,there were necrotic areas in the lesion,which showed mixed echogenic cystic and solid changes,and the serosal layer was involved in the extrauterine expansion growth.At the late stage,metastases of adjacent iliac vessels lymph nodes and the formation of tumor thrombolytic in the pelvic and abdominal veins were observed.Conclusion Utrasound diagnosis of uterine leiomyosarcoma has some limitations,but for a single lesion in the myometrium,it is slightly hyperechoic or has heterogeneous echo,with unclear boundary,uneven internal echo,rich blood supply,and soft lesion texture.It is necessary to be on alert for possible malignant lesions when the probe is deformed under pressure,and in this case,confirmation by pathological diagnosis is recommended.

关 键 词：超声检查 平滑肌肉瘤 子宫 误诊 

分 类 号：R737.33[医药卫生—肿瘤]