伴有心脏受累的血管内平滑肌瘤病一例临床分析

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1、新医学2013年l2月第44卷第12期86l综合病例报告伴有心脏受累的血管内平滑肌瘤病一例临床分析夏梦陈艳刘军秀王晶何勉【摘要】伴有心脏受累的血管内平滑肌瘤病(ICL)较罕见，术前诊断率低。该文报道了1例52岁ICL患者。其全身PET—CT检查提示子宫体部见多发低密度灶，形态欠规则，边界欠清，以子宫体左侧壁范围最大，约4．0CIYI×2．0emx3．2em，病变延子宫阔韧带累及左侧附件；左卵巢静脉、左肾静脉管腔及下腔静脉增粗，其内见低密度影，考虑子宫平滑肌瘤病并通过左卵巢静脉、左肾静脉延伸至下腔静脉，达右心房平面，

2、诊断为ICL。予体外循环腔静脉转流下腔静脉、左肾静脉平滑肌瘤切除、全子宫、双侧附件切除术治疗。患者手术顺利，术后恢复良好，出院后定期随访，无肿瘤复发表现。ICL需与子宫恶性肿瘤，深静脉血栓相鉴别。手术是治疗的主要方法，完整切除肿瘤是成功治疗的关键，术前要全面评估肿瘤范围。ICL预后好，有复发可能，需要长期随诊。【关键词】血管内平滑肌瘤病；伴有心脏受累；诊断；治疗Intravenousleiomyomatosiswithintracardiacinvolvement：acasereportXIAMeng，ChenYa

3、n，LIUJun—xiu，WangJing，HEMiaruDepartmentofGynaecology&Obstetrics，thefAffiliatedHospitalofSUNYat—senUniversity，Guangzhou510080，ChinaCorrespondingauthor，HEMian，E—mail：gz87335487@vip．tonkcoin【Abstract】Intravenousleiomyomatosiswithintracardiacinvolvementisararedise

4、asewithlowdiag—nosticratebeforeoperation．Thearticlereporteda52year—oldpatientsufferingfromintravenousleiomyomatosiswithintracardiacinvolvementenrolledintheFirstAfiliatedHospitalofSUNYat—senUniversityon9May2009．GeneralPET—CTscanningshowedmultiplelowdensityfocus

5、withirregularshapeandundefinedmarginonuterinebody，mainlylocatedontheleftsidewall(4．0cm×2．0am×3．2em)，andlowdensitylesioninleftovarianvein，leftrenalveinandinferiorvenacava．Thepatientwasdiagnosedasintravenousleiomyomato—siswithintracardiacinvolvement．Thepatientun

6、derwentmyomateetomy(1eftrenalveinandinferiorvenaea—va)，hysterectomy，bilateralsalping—oophenrectomyunderthecardiopulmonarybypass．Successfuloperationwasperformed．Thepatientrecoveredwellafteroperationandreceivedregularfollow—up．Noepisodeoftumorrecurrencewasobserv

7、edduringthefollow—up．Thedifferentialdiagnosisincludesmalignanttumoranddeepveinthrombosis．Operationisthemaintherapyandcompleteresectionisthekey．Totalassessmentfortumorextentisrequiredbeforeoperation．Mostpatientshavegoodprognosisbutpossiblerecurrence，SOthelong-t

8、ermfollow—upisneeded．【Keywords】Intravenousleiomyomatosis；Intracardiacinvolvement；Diagnosis；Treatment血管内平滑肌瘤病(IVL)是一种少见的子宫恶性肿瘤的生长方式，并且约有10％一30％IVL患中胚叶良性肿瘤。主要临床特点是平滑肌瘤细胞超者的肿瘤可以累及下腔静脉