背景:血管平滑肌瘤,由平滑肌细胞和厚壁血管组成的良性肿瘤,预计在女性生殖道中非常罕见。本研究旨在描述女性生殖道血管平滑肌瘤的临床病理特征和治疗结果。
方法:回顾性分析2008年7月至2023年10月在中南大学湘雅三医院治疗的89例生殖道血管平滑肌瘤患者。症状缓解率是该研究的主要结果。
结果:血管平滑肌瘤占女性生殖道平滑肌瘤的0.6%。89名妇女的平均年龄为41.8±8.7岁。70名妇女(78.7%)有子宫手术史,其中两名患者通过腹腔镜子宫肌瘤切除术切除了子宫血管肌瘤。61例(68.5%)女性血管平滑肌瘤位于子宫体,17(19.1%)在阔韧带,宫颈10(11.2%),阴道仅1(1.1%)。异常子宫出血是位于子宫体或子宫颈的血管平滑肌瘤的主要临床表现,而宽韧带血管平滑肌瘤的主要临床表现是盆腔肿块。89名女性中,59人接受了保留子宫的手术,30例接受了全子宫切除术或次全子宫切除术。6名妇女的术中失血量超过500ml(700-4,500ml)。术后症状缓解率为100%。在59名子宫保留的妇女中,8在随访期间显示多发性子宫平滑肌瘤,但是很难确定它们是否是血管平滑肌瘤。一名接受全子宫切除术的妇女血管平滑肌瘤复发。
结论:血管平滑肌瘤在女性生殖道罕见,患者可能会出现不同的症状,这与肿瘤的位置有关。子宫切除术和子宫肌瘤切除术都是有效的治疗方法,但是对于多发病变和直径较大的病变,应认识到术中出血的风险.一些患者可能出现复发。
BACKGROUND: Angioleiomyoma, a benign tumour composed of smooth muscle cells and thick-walled vessels, is expected to be very rare in the female genital tract. This study aimed to describe the clinicopathological features and treatment outcomes of
angioleiomyoma in the female genital tract.
METHODS: We retrospectively reviewed 89 women with
angioleiomyoma in the genital tract who were treated at Third Xiangya Hospital of Central South University between July 2008 and October 2023. Symptom remission rate was the primary outcome of the study.
RESULTS: Angioleiomyomas accounted for 0.6% of leiomyomas of the female genital tract. The average age of the 89 women was 41.8 ± 8.7 years. Seventy women (78.7%) had a history of uterine surgery, of whom two patients had removed uterine
angioleiomyoma by laparoscopic myomectomy. The angioleiomyomas of 61 (68.5%) women were located in the uterine corpus, 17 (19.1%) in the broad ligament, 10 (11.2%) in the cervix and only 1 (1.1%) in the vagina. Abnormal uterine bleeding was the main clinical manifestation of angioleiomyomas located in the uterine corpus or cervix, whereas the main clinical manifestation of angioleiomyomas in the broad ligaments was pelvic mass. Of the 89 women, 59 underwent surgery to preserve the uterus, and 30 underwent total hysterectomy or subtotal hysterectomy. The intraoperative blood loss was more than 500 ml (700-4,500 ml) in six women. The symptom remission rate was 100% after surgery. Among the 59 women with preserved uterus, 8 showed multiple uterine leiomyomas during follow-up, but it was difficult to determine whether they were angioleiomyomas. Angioleiomyomas recurred in one women who underwent total hysterectomy.
CONCLUSIONS: Angioleiomyoma is rare in the female reproductive tract, and patients may present with diverse symptoms, which are related to the location of the tumour. Hysterectomy and myomectomy are both effective treatment methods, but the risk of intraoperative bleeding should be recognised for multiple lesions and those with large diameters. Relapse may occur in some patients.