腹膜播散性平滑肌瘤病7例诊治分析  

Clinical Analysis of 7 Cases of Leiomyomatosis Peritonealis Disseminate

作　　者：许阡 柳鑫 王金娟[1] XU Qian;LIU Xin;WANG Jin-juan(Gynecology Minimally Invasive Center,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院妇科微创中心,北京100006

出　　处：《国际妇产科学杂志》2022年第2期228-232,共5页Journal of International Obstetrics and Gynecology

摘　　要：目的:提高对腹膜播散性平滑肌瘤病(leiomyomatosis peritonealis disseminate,LPD)的诊断及治疗水平。方法:回顾性分析2018年6月—2021年7月首都医科大学附属北京妇产医院收治的7例经手术、病理确诊的LPD患者的病例资料,分析其临床特点、诊治方法、术后病理诊断及术后复发情况。结果:7例患者的平均发病年龄为41.6岁(33~48岁),均有腹腔镜子宫肌瘤剔除术史,本次LPD发病距既往最近腹腔镜子宫肌瘤剔除术时间为6~132个月,平均(60.1±44.6)个月。4例(57.1%)患者无明显临床症状,以体检发现盆腹腔包块为主诉就诊。影像学主要表现为盆腹腔多发实性肿块,磁共振成像(magnetic resonance imaging,MRI)和CT的诊断率分别为28.6%和25.0%。7例患者均接受了手术治疗,术中结节广泛分布在肠系膜(4例)、腹膜(3例)、大网膜(2例)和子宫直肠陷凹(2例)等处,结节大小0.4~10 cm。1例行腹腔镜全子宫+双附件切除术+LPD结节切除术,余6例均行腹腔镜或开腹LPD结节切除术,术后均经石蜡病理及免疫组织化学检查证实为LPD,其中1例为富于细胞型平滑肌瘤。结论:LPD是一种罕见的良性肿瘤,缺乏特异性临床症状和影像学表现,诊断主要依靠手术探查、术后病理及免疫组织化学,首选的治疗方法是手术治疗,术后需严密随访。Objective:Improve the diagnosis and treatment of leiomyomatosis peritonealis disseminate(LPD).Methods:7 cases of LPD admitted between June 2018 and July 2021 in the Beijing Obstetrics and Gynecology Hospital of Capital Medical University were analyzed retrospectively,including their clinical characteristics,diagnosis and treatment methods,pathological diagnosis and recurrence.Results:The average age of onset of the 7 patients was 41.6 years(33-48 years).All 7 cases had a history of laparoscopic uterine myomectomy with an average of(60.1±44.6)months(range 6 to 132 months).57.1%of patients were asymptomatic,and they presented with the main complaint of masses in the pelvic and abdominal cavity found on physical examination.Imaging mainly showed multiple solid nodules in the pelvic and abdominal cavity.The diagnostic rates of MRI and CT were 28.6%and 25.0%,respectively.All 7 patients underwent surgical treatment.Nodules extensively involved the colon mesentery(4 cases),the surface of the peritoneum(3 cases),the omentum(2 cases),Douglas pouch(2 cases),ranging from 0.4 to 10 cm in diameters.One case underwent laparoscopic total hysterectomy,double adnexectomy and resected all LPD nodules,and the remaining 6 cases done laparoscopic or laparotomy LPD nodule resection.All cases were definitive diagnosed as LPD by histopathology and immunohistochemical examination,of which 1 case was cellular uterine leiomyomas.Conclusions:LPD is a rare benign tumor,lacking specific clinical symptoms and imaging.The diagnosis mainly depends on surgery,histopathology and immunohistochemistry.The preferred treatment is surgical resection if possible,and close follow-up is required after surgery.

关 键 词：腹膜肿瘤 平滑肌瘤病 诊断 治疗 预后 

分 类 号：R735.5[医药卫生—肿瘤]