本文選題：靜脈內(nèi)平滑肌瘤病　切入點：心臟內(nèi)平滑肌瘤病　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討靜脈內(nèi)平滑肌瘤病(intravenous leiomyomatosis,IVL)發(fā)病特點、臨床表現(xiàn)、術前及術后診斷、治療方案的選擇以及預后效果。方法:采用回顧性方法分析,搜集2012年9月至2015年8月由吉林大學第二醫(yī)院收治的20例IVL患者的臨床、病理資料。所有統(tǒng)計數(shù)據(jù)錄入Excel表格。分別對本組患者的術前檢查、術前診斷、治療方案、病理診斷進行統(tǒng)計分析。所有診斷均為2名有經(jīng)驗的病理醫(yī)師明確診斷。該20例患者均就診于吉大二院并行手術治療。結果:(1)本組患者90%為絕經(jīng)前女性,平均年齡為45歲。多因為子宮肌瘤或者子宮腺肌癥等入院行手術治療。所有患者術前均未明確IVL的診斷,均術中及術后明確診斷。(2)本組IVL患者術前檢查均無明顯特異性。6例(30%)見肌瘤樣組織凸向兩側(cè)闊韌帶;3例(15%)宮頸部近峽部肌瘤;8例(40%)子宮肌壁間有蚯蚓樣腫物從脈管內(nèi)凸出;2例(10%)附件區(qū)見從脈管內(nèi)突出的條索樣腫物。(3)1例有生育要求,僅行病灶切除術;7例行子宮切除術;6例行子宮切除術+雙附件切除術;5例行子宮切除術+雙側(cè)輸卵管切除術;1例行子宮切除術+患側(cè)附件切除術+健側(cè)輸卵管切除術。術后均未行激素治療。結論:(1)IVL起病隱匿,多為絕經(jīng)前女性。IVL早期多無明顯特異性陽性體征及檢查結果,常因子宮肌瘤及子宮肌腺癥或者盆腔包塊行手術治療,多為術中及術后明確診斷。(2)術前懷疑IVL的患者建議行婦科彩超、心臟彩超及胸腹盆腔聯(lián)合平掃,必要時行CTA檢查,對于有陽性表現(xiàn)者,積極充分術前準備。(3)對于術前發(fā)現(xiàn)子宮肌瘤位于宮頸峽部、宮角、闊韌帶等血供豐富區(qū)或者術中發(fā)現(xiàn)子宮肌瘤呈串珠樣及條索狀時,建議術中行快速病理,提高術中診斷率,降低漏診率。(4)對于IVL腫瘤僅限于子宮內(nèi)的,無生育要求年輕女性,建議行子宮全切除術;有生育要求的,可行病灶切除術,術后嚴密觀察病情,定期隨診,及時發(fā)現(xiàn)血管內(nèi)病灶并清除。對于大于45歲或發(fā)現(xiàn)子宮外脈管受累及者,建議行全子宮切除術+雙附件切除術+宮外病灶切除術。對于年輕女性伴有附件區(qū)病灶者,是否保留健側(cè)卵巢輸卵管,目前尚缺乏大量臨床資料。保留健側(cè)卵巢或者健側(cè)卵巢輸卵管對預后的影響,需更多的臨床研究來闡述。IVL累及下腔靜脈、心臟者,需婦產(chǎn)科、心臟外科、血管外科協(xié)同決定手術方案。依患者病情及狀況,選擇治療方案,手術方案可選擇一期手術或者分期手術治療。對于在術中及術后病理明確診斷為IVL患者,術后建議行盆腹部血管彩超或者盆腹部CTA檢查,排除其他殘留病灶,協(xié)助術后治療方案選擇。
[Abstract]:Objective: to investigate the clinical features, clinical manifestations, preoperative and postoperative diagnosis, treatment options and prognosis of intravenous leiomyoidosis IVL (IVL). The clinical and pathological data of 20 patients with IVL were collected from September 2012 to August 2015 in the second Hospital of Jilin University. All statistical data were recorded in Excel tables. All the diagnoses were confirmed by two experienced pathologists. All the 20 patients were treated with surgical treatment in the second Hospital of Jilin University. Results 90% of the patients were premenopausal women. The average age was 45 years. Most of the patients were admitted to the hospital for surgical treatment such as hysteromyoma or adenomyosis. All the patients had no definite diagnosis of IVL before operation. All patients with IVL were diagnosed intraoperatively and postoperatively. (there was no significant specificity in preoperative examination in all patients with IVL.) there were 30 cases of myomatous tissue protruding to bilateral broad ligaments in 3 cases and 15 cases); 8 cases of proximal isthmus myoma of uterine neck and 8 cases of myoma of proximal isthmus of uterus were treated with earthwormlike masses from the wall of uterus muscle. In the adnexal region, there was a protruding strip-like mass from the vessel in 1 case with fertility requirements. Focus resection only 7 cases hysterectomy 6 cases double appendage hysterectomy 5 cases hysterectomy bilateral salpingotomy 1 case hysterectomy 1 patient side appendage resection healthy side salpingotomy. No hormone therapy was performed after the operation. Conclusion the onset of IVL is occult. Most of them were premenopausal women. Most of them had no specific positive signs and examination results at the early stage of menopausal women. They were often treated with surgery because of uterine leiomyoma, myometriosis or pelvic mass. Most of the patients suspected of IVL were diagnosed intraoperatively and postoperatively. Patients suspected of IVL were advised to perform gynecological color Doppler ultrasonography, echocardiography and combined plain scan of chest, abdomen and pelvic cavity, and CTA examination if necessary. To find uterine leiomyoma in cervical isthmus, uterine horn, broad ligament and other areas of blood supply before operation, or to find uterine fibroids in the shape of bead and stripe, it is recommended to make rapid pathology during operation and improve the diagnostic rate during operation. To reduce the rate of missed diagnosis. (4) for the IVL tumor limited to the uterus, young women without fertility requirements, total hysterectomy is recommended; if there is fertility requirement, feasible focus resection, close observation of the state of the disease after surgery, regular follow-up, For those over 45 years of age or with extrauterine vascular involvement, it is recommended that total hysterectomy be performed with double appendage resection of extrauterine lesions. For young women with adnexal lesions, Whether or not to preserve the oviduct is still lack of a lot of clinical data. The effect of preserving the healthy ovary or the oviduct on the prognosis needs more clinical research to explain that IVL involving inferior vena cava, heart, gynecology and obstetrics. According to the patient's condition and condition, choose the treatment plan, the operation plan may choose the one stage operation or the stage operation treatment. For the intraoperative and postoperative pathological diagnosis of patients with IVL, It is suggested that color Doppler ultrasound or CTA should be performed to remove other residual lesions and to assist in the selection of postoperative treatment.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

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