腹膜播散性平滑肌瘤病(leiomyomatosis peritonealis disseminate, LPD)是一种极罕见的发生在盆腹腔的良性肿瘤,大多数表现为平滑肌瘤结节弥散分布、种植于盆腹腔腹膜、输卵管系膜、肠系膜、大网膜、肠管、直肠子宫陷凹、卵巢及腹腔镜Tr...腹膜播散性平滑肌瘤病(leiomyomatosis peritonealis disseminate, LPD)是一种极罕见的发生在盆腹腔的良性肿瘤,大多数表现为平滑肌瘤结节弥散分布、种植于盆腹腔腹膜、输卵管系膜、肠系膜、大网膜、肠管、直肠子宫陷凹、卵巢及腹腔镜Trocar口。LPD多见于育龄期女性,发病机制尚不明确,主要有医源性学说、腹膜下间充质干细胞化生学说、性激素学说和遗传学说。患者大多缺乏典型的临床表现和体征,常在影像学检查或术中探查偶然发现,临床误诊率较高,且易与恶性肿瘤相混淆,导致临床过度治疗。国内外多为个案报道,且大多与医源性腹腔镜下肌瘤粉碎术后,肌瘤碎片播散有关,而非腹腔镜下子宫肌瘤剔除术后腹膜播散性平滑肌瘤病合并子宫内膜异位症鲜有报道。因此,该文报道一例非腹腔镜下子宫肌瘤剔除术后LPD合并子宫内膜异位症的病例,通过探讨患者的诊疗过程,总结诊疗经验,加深临床医生对该病的认识。Leiomyomatosis peritonealis disseminate (LPD) is an extremely rare benign tumor occurring in the pelvic cavity. The most common manifestations were diffuse distribution of leiomyoma nodules, and implantation in peritoneum, mesosalpinx, mesentery, omentum, bowel, rectum, excavatio rectouterina, ovaries, and laparoscopic Trocars. LPD tends to occur in fertile women, and its pathogenesis is still unclear, mainly including iatrogenic theory, subperitoneal mesenchymal stem cell metaplasia theory, sex hormone theory and genetic theory. Most of the patients lack specific clinical manifestations and signs, which are often accidentally found in imaging examinations or intraoperative exploration, and the clinical misdiagnosis rate is high, and it is easy to be confused with malignant tumors, leading to clinical overtreatment. Most cases have been reported at home and abroad, and most of them are related to the spread of fibroid fragments after iatrogenic laparoscopic uterine myomectomy, while there are few reports of peritoneal disseminated leiomyomatosis complicated with endometriosis after non-laparoscopic surgery. Therefore, this article reports a case of LPD complicated with endometriosis after non-laparoscopic surgery. By discussing the diagnosis and treatment process of the patient, summarizing the diagnosis and treatment experience, and deepening the clinician's understanding of the disease.展开更多
文摘腹膜播散性平滑肌瘤病(leiomyomatosis peritonealis disseminate, LPD)是一种极罕见的发生在盆腹腔的良性肿瘤,大多数表现为平滑肌瘤结节弥散分布、种植于盆腹腔腹膜、输卵管系膜、肠系膜、大网膜、肠管、直肠子宫陷凹、卵巢及腹腔镜Trocar口。LPD多见于育龄期女性,发病机制尚不明确,主要有医源性学说、腹膜下间充质干细胞化生学说、性激素学说和遗传学说。患者大多缺乏典型的临床表现和体征,常在影像学检查或术中探查偶然发现,临床误诊率较高,且易与恶性肿瘤相混淆,导致临床过度治疗。国内外多为个案报道,且大多与医源性腹腔镜下肌瘤粉碎术后,肌瘤碎片播散有关,而非腹腔镜下子宫肌瘤剔除术后腹膜播散性平滑肌瘤病合并子宫内膜异位症鲜有报道。因此,该文报道一例非腹腔镜下子宫肌瘤剔除术后LPD合并子宫内膜异位症的病例,通过探讨患者的诊疗过程,总结诊疗经验,加深临床医生对该病的认识。Leiomyomatosis peritonealis disseminate (LPD) is an extremely rare benign tumor occurring in the pelvic cavity. The most common manifestations were diffuse distribution of leiomyoma nodules, and implantation in peritoneum, mesosalpinx, mesentery, omentum, bowel, rectum, excavatio rectouterina, ovaries, and laparoscopic Trocars. LPD tends to occur in fertile women, and its pathogenesis is still unclear, mainly including iatrogenic theory, subperitoneal mesenchymal stem cell metaplasia theory, sex hormone theory and genetic theory. Most of the patients lack specific clinical manifestations and signs, which are often accidentally found in imaging examinations or intraoperative exploration, and the clinical misdiagnosis rate is high, and it is easy to be confused with malignant tumors, leading to clinical overtreatment. Most cases have been reported at home and abroad, and most of them are related to the spread of fibroid fragments after iatrogenic laparoscopic uterine myomectomy, while there are few reports of peritoneal disseminated leiomyomatosis complicated with endometriosis after non-laparoscopic surgery. Therefore, this article reports a case of LPD complicated with endometriosis after non-laparoscopic surgery. By discussing the diagnosis and treatment process of the patient, summarizing the diagnosis and treatment experience, and deepening the clinician's understanding of the disease.
