Kho Kimberly A, Nezhat Ceana
From the Atlanta Center for Special Minimally Invasive Surgery & Reproductive Medicine, Atlanta, Georgia.
Obstet Gynecol. 2009 Sep;114(3):611-615. doi: 10.1097/AOG.0b013e3181b2b09a.
To report a large case series of parasitic myomas and to examine their causes, associations, and risk factors.
Retrospective chart review was performed on 12 patients found to have parasitic myomas between August 2000 and April 2008. The following data were systematically collected: surgery date; indications for surgery; number, dates, and types of prior surgeries; prior use of morcellation; and locations of parasitic myomas. Pathologic confirmation of all specimens was obtained.
Laparoscopic evaluation confirmed the presence of intraperitoneal and retroperitoneal myomas distinct from the uterus in 12 patients. Ten of the 12 patients had prior abdominal surgery. Eight patients had prior morcellation procedures; six performed laparoscopically, two performed by laparotomy. Three patients had multiple parasitic myomas, all of whom had a history of laparoscopic myomectomy with morcellation. The majority (14 of 15) of myomas were found in the pelvis, including two retroperitoneal myomas, one of which was embedded in the bladder. Six of 15 myomas were found along the gastrointestinal tract, and 1 of 15 was found in the upper abdomen.
Parasitic myomas may occur spontaneously as pedunculated subserosal myomas lose their uterine blood supply and parasitize to other organs. More parasitic myomas may be iatrogenically created after surgery, particularly surgery using morcellation techniques. With increasing rates of laparoscopic procedures, surgeons should be aware of the potential for iatrogenic parasitic myoma formation, their likely increasing frequency, and intraoperative precautions to minimize occurrence.
III.
报告大量寄生性肌瘤病例系列，并研究其病因、关联因素和风险因素。
对2000年8月至2008年4月间发现患有寄生性肌瘤的12例患者进行回顾性病历审查。系统收集以下数据：手术日期；手术指征；既往手术的次数、日期和类型；既往是否使用肌瘤粉碎术；以及寄生性肌瘤的位置。所有标本均获得病理证实。
腹腔镜评估证实12例患者腹腔内和腹膜后存在与子宫不同的肌瘤。12例患者中有10例曾接受过腹部手术。8例患者曾接受过肌瘤粉碎术；6例为腹腔镜下进行，2例为开腹进行。3例患者有多个寄生性肌瘤，均有腹腔镜下肌瘤切除术并使用肌瘤粉碎术的病史。大多数（15个中的14个）肌瘤位于盆腔，包括2个腹膜后肌瘤，其中1个嵌入膀胱。15个肌瘤中有6个位于胃肠道沿线，15个中有1个位于上腹部。
随着有蒂浆膜下肌瘤失去其子宫血供并寄生到其他器官，寄生性肌瘤可能会自发出现。手术后，尤其是使用肌瘤粉碎术的手术，可能会医源性地产生更多寄生性肌瘤。随着腹腔镜手术率的增加，外科医生应意识到医源性寄生性肌瘤形成的可能性、其可能增加的频率以及术中预防措施以尽量减少其发生。
III级。
