目的:探讨不同类型静脉内血管平滑肌瘤(IVL)患者的临床特征及诊治情况,提高对该病的认识.方法:回顾分析在北京大学人民医院诊治的12例IVL患者的临床情况,依照肿物主要延伸部位的不同,分为Ⅰ、Ⅱ、Ⅲ三种类型.比较三种类型IVL患者临床特征、诊治及复发情况.结果:12例患者平均发病年龄44.33岁,Ⅰ型3例,Ⅱ型4例,Ⅲ型5例.术前确诊5例,其中Ⅰ型3例,Ⅱ型0例,Ⅲ型2例.平均随访34.00±17.26个月.9例患者既往有子宫肌瘤相关手术史.12例患者均接受手术治疗,Ⅰ型IVL平均出血量6066.67±1900.88 ml,Ⅱ型950.00±1135.78 ml,Ⅲ型8060.00±12393.87 ml(P＞0.05).2例复发,均为Ⅲ型患者.结论:将IVL依照肿物延伸部位分为三种类型,其中延伸至髂内静脉丛的Ⅲ型手术治疗较困难,较易复发；而局限于局部的Ⅱ型易误诊.应提高对不同类型IVL的认识.%Objectives:To analyze the clinical features and treatments of different types of Intravenous leiomyomatosis (IVL). Methods:The clinical data of twelve cases of Intravenous leiomyomatosis surgically treated in Peking university people's hospital from July 2006 to November 2011 were reviewed retrospectively. According to relative sizes and locations of intracardiac leiomyoma,The 12 cases were classified into three types:type Ⅰ, Ⅱ, Ⅲ. The IVL history,clinical manifestations,preoperative proper diagnosis rates,auxiliary rnexaminations,surgeries and recurrences were compared. Results:Of the 12 cases under study,there were 3 type Ⅰ ,4 type Ⅱ,5 type Ⅲ. The average age of the patients of the 12 cases was 44.33. Mean follow-up time was 34.00 ±17.26 months. Nine cases had history of uterine surgeries in other hospitals(75.00%,9/12). The diagnosis rate preoperatively was 5 cases. There were significant differences in the diagnosis rates pre-operatively among the three types of IVL,Type I was 3 cases,type Ⅱ was 0,and type Ⅲ was 2 cases. All 12 cases were treated with surgey,and the average blood losses of typeⅠ,type Ⅱ and type Ⅲ were 6066. 67 ±1900.88ml,950.00 ±1135.78ml, 8060 ±12393.87ml respectively(P>0.05).2 recurrent cases were both in type Ⅲ. Conclusions:In this study,the IVL is divided into three types according to their relative sizes and locations. The surgery of type Ⅲ is more difficult because of the tumor extending to internal iliac venous plexus. The type Ⅱ limiting in the local is easy to misdiagnosed. We should improve our understanding about the different types of IVL.
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