不同手术方式治疗延伸至心脏的静脉内平滑肌瘤病

Different surgical methods for the treatment of intravenous leiomyomatosis with intracardiac extension

摘要:

目的： 探讨延伸至心脏的静脉内平滑肌瘤病发病机制、临床特点、手术治疗方式；提高对延伸至心脏的静脉内平滑肌瘤病的认识。方法： 回顾性分析兰州大学第一医院收治的3例延伸至心脏内的静脉内平滑肌瘤病患者临床资料、诊治过程，并复习相关文献。结果： 3例患者均成功行手术治疗，其中2例一期一站式经胸腹联合切口行“子宫、附件、盆腔肿物切除+心脏、下腔静脉肿物取出术”，另1例患者手术分2期进行，一期先行“右心房肿物切除+三尖瓣成形术”，术后1周二期行“全子宫切除+双侧附件切除+下腔静脉肿物取出+右侧输尿管支架植入术”。3例患者均手术成功，术后康复出院。结论： 延伸至心脏的静脉内平滑肌瘤病临床少见，彻底切除瘤体是治疗本病的关键。手术需多学科联合，可一期一站式完成，也可分期分站式完成，2种手术方式临床治疗效果满意。

Abstract:

Objective: To investigate the pathogenesis, clinical features, and surgical treatment of intravenous leiomyomatosis with intracardiac extension, and to improve the understanding of this disease. Methods: We retrospectively analyzed the clinical data, diagnosis and treatment of 3 patients with intravenous leiomyomatosis with intracardiac extension in The First Hospital of Lanzhou University, and reviewed relevant literature. Results: All the 3 patients were successfully treated with surgery. Among them, 2 patients underwent thoracoabdominal incision with one-stop surgery of "uterine, accessory, pelvic mass resection and removal of intracardiac and inferior vena cava tumors". Another patient's surgery was performed in two phases. During the first phase, "right atrial mass resection+tricuspid valvuloplasty" was performed firstly. After 1 week, we performed a second surgery "full hysterectomy+bilateral adnexectomy+removal of inferior vena cava tumor+right ureteral stent implantation". All 3 patients were successfully operated and recovered and discharged after the surgery. Conclusion: Intravenous leiomyomatosis with intracardiac extension is rarely seen in clinic. Thorough resection of the tumor is the key to the treatment of this disease. The surgery requires multiple disciplines to be combined, which can be completed in one-phase one-stop, or can be completed in stages by stages. Two kinds of surgical methods both can achieve satisfactory therapeutic effect in clinic.