静脉内平滑肌瘤病25例临床分析  

Clinical analysis of 25 cases with intravenous leiomyomatosis

作　　者：房臻[1] 雷蕾[1] 包照亮[1] FANG Zhen;LEI Lei;BAO Zhaoliang(Department of Obstetrics and Gynecology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Hearte,Lung and Blood Veases Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所妇产科,100029

出　　处：《心肺血管病杂志》2025年第3期288-292,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家重大疾病多学科合作诊疗能力建设项目。

摘　　要：目的:探讨静脉内平滑肌瘤病(intravennous leiomyomatosis,IVL)的临床特点及诊疗方案。方法:回顾性分析2016年6月至2024年8月北京安贞医院收治的25例IVL的临床资料。结果:患者年龄35~61岁,平均(45.4±6.3)岁,均为经产妇,19例(76%)患者未绝经,4例(16%)患者有子宫平滑肌瘤剔除术史,6例(24%)患者因子宫平滑肌瘤已切除子宫。临床分期Ⅰ期9例,Ⅱ期4例,Ⅲ期10例,Ⅳ期2例。术前辅助检查提示IVL者15例(60%)。所有患者均手术治疗,20例患者手术一期完成,5例患者接受了二次手术。20例根治手术均顺利完成,5例有残余肿瘤,其中1例术后复发再次手术,其余4例随访至今,无明显血流动力学障碍。结论:IVL常见于生育年龄及围绝经期女性,临床表现多样,治疗以手术为主。术前充分评估,多学科协作,彻底切除病灶是改善预后的关键因素。术后应长期随访。Objective:To investigate the clinical characteristics,diagnosis and treatment of intravennous leiomyomatosis(IVL).Methods:A retrospective analysis was performed on 25 IVL cases admitted to Beijing Anzhen Hospital from June 2016 to August 2024.Results:Patients aged 35-61 years old,with an average age of(45.4±6.3)years old,were all menpara,19 patients(76%)were premenopausal,4 patients(16%)had a history of myomectomy,and 6 patients(24%)had a history of hysterectomy due to myoma.The clinical stages were stageⅠ(9 cases),stageⅡ(4 cases),stageⅢ(10 cases)and stage IV(2 cases).Preoperative imaging examination showed IVL in 15 cases(60%).Total of 25 patients underwent surgical treatment,of which 5 underwent secondary surgery and 20 underwent primary surgery.Twenty cases underwent radical surgery successfully,5 cases had residual tumors,of which 1 case recurred 2 years after surgery and was treated again,and the other 4 cases had no obvious hemodynamic disturbance after follow-up.Conclusions:IVL tends to occur in fertile and perimenopausal women,and its clinical manifestations are lack of specificity.Surgery is the main treatment method.Adequate preoperative evaluation,multidisciplinary collaboration,complete resection of the lesion are the key factors to improve prognosis,and regular review should be strengthened after surgery.

关 键 词：静脉内平滑肌瘤病 子宫肿瘤 血管内肿瘤 多学科诊疗 

分 类 号：R54[医药卫生—心血管疾病]