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目的:探讨医源性寄生子宫肌瘤的临床特点、预防和治疗。方法:回顾分析2012年9月至2014年12月北京大学第一医院收治的4例医源性寄生子宫肌瘤病例,总结其临床特点,结合国内外相关文献,分析其病因及防治。结果:4例患者有腹腔镜子宫肌瘤剔除术史或腹腔镜子宫次全切除术史,术中均应用粉碎器,病理均为子宫平滑肌瘤,术后42~69个月复发。1例表现为腹痛、腹胀,1例表现为腹部包块,2例无症状为常规体检发现。再次手术方式为开腹探查术或腹腔镜探查术,切除病灶,其中1例行乙状结肠切除术,术后病理回报为平滑肌瘤及腺肌瘤,结局良好。结论:应用粉碎器的腹腔镜子宫肌瘤剔除手术或子宫切除手术会增加寄生性子宫肌瘤的发病风险。操作中避免组织残留,术后结合其他相关治疗,将最大限度地减少寄生性子宫肌瘤发生。
Objective: To investigate the clinical features, prevention and treatment of iatrogenic myoma of uterus. Methods: Four cases of iatrogenic myoma of uterine leiomyoma from September 2012 to December 2014 in Peking University First Hospital were retrospectively analyzed. The clinical features were summarized. The etiology and prevention and treatment were analyzed according to relevant literature at home and abroad. Results: Four patients had a history of laparoscopic myomectomy or laparoscopic subtotal hysterectomy. Pulverizers were used during operation. The pathology was all uterine leiomyomas. The recurrence occurred 42-69 months after operation. 1 case showed abdominal pain, bloating, 1 case showed abdominal mass, 2 cases of asymptomatic findings for the routine examination. Reoperation for laparotomy or laparoscopic exploration, removal of lesions, including 1 case of sigmoid colon resection, postoperative pathological findings of leiomyoma and adenomyoma, with good outcome. CONCLUSIONS: Laparoscopic myomectomy or hysterectomy using pulverizers increases the risk of parasitic uterine fibroids. Operation to avoid residual tissue, combined with other related postoperative treatment, will minimize the occurrence of parasitic uterine fibroids.