Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Disease, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Obstetrics and Gynecology, Anhui Province Maternity & Child Health Hospital, Hefei, Anhui, China.
Int J Gynaecol Obstet. 2023 Oct;163(1):51-57. doi: 10.1002/ijgo.14769. Epub 2023 Apr 4.
To provide perspectives on preoperative diagnosis and conservative treatment for diffuse uterine leiomyomatosis (DUL).
The clinical characteristics, management, and outcome of the five cases diagnosed with DUL receiving surgical treatment at Peking Union Medical College Hospital between January 2010 and December 2021 were retrospectively analyzed.
DUL is a diagnosis based on histopathology. It is a subtype of uterine leiomyoma, characterized by innumerable, poorly circumscribed hypercellular nodules of bland smooth muscle cells with no cytologic atypia diffusely involving the myometrium. Clinical manifestations, including menorrhagia, anemia, and infertility, are similar to those of typical uterine leiomyomas, making a definitive preoperative diagnosis difficult. Magnetic resonance imaging plays an important role in the pre-treatment mapping. Conservative surgery can reduce the uterine volume and improve the contour of the uterine cavity, thereby relieving symptoms of menorrhagia and improving the chance of conception. Gonadotropin-releasing hormone (GnRH) agonist therapy is of great significance for controlling vaginal bleeding, reducing uterine volume, and delaying postoperative recurrence, and can be used alone or as postoperative adjuvant therapy for conservative surgery.
The treatment goal for DUL patients with fertility-sparing request should not aim at complete fibroid removal. A successful pregnancy can be achieved following conservative surgery and/or GnRH agonist therapy.
为弥漫性子宫平滑肌瘤（DUL）提供术前诊断和保守治疗的思路。
回顾性分析 2010 年 1 月至 2021 年 12 月期间，北京协和医院接受手术治疗的 5 例 DUL 患者的临床特点、治疗方法及结局。
DUL 是基于组织病理学的诊断，是子宫平滑肌瘤的一种亚型，其特征为无数边界不清的高细胞性、良性平滑肌细胞结节弥漫性累及子宫肌层，无细胞学异型性。临床表现包括月经过多、贫血和不孕等，与典型的子宫平滑肌瘤相似，因此术前明确诊断较为困难。磁共振成像在术前评估中具有重要作用。保守手术可缩小子宫体积，改善宫腔形态，从而缓解月经过多症状，提高受孕机会。促性腺激素释放激素（GnRH）激动剂治疗对控制阴道出血、缩小子宫体积和延缓术后复发具有重要意义，可单独使用或作为保守手术的术后辅助治疗。
对于有生育要求的 DUL 患者，治疗目标不应是完全去除肌瘤，通过保守手术和/或 GnRH 激动剂治疗可实现妊娠成功。
