盆腔腹膜后平滑肌瘤一例

doi:10.12280/gjszjk.20260199

摘要/Abstract

摘要：

腹膜后平滑肌瘤（retroperitoneal leiomyoma，RL）较为罕见，因其生长位置深在、解剖关系复杂，术前影像学诊断困难，确诊往往依赖于手术探查及术后病理。报告1例38岁女性，因发现盆腔肿物1年余，外院曾行2次手术，最终在梅州市人民医院手术探查发现肿物位于腹膜后，病理诊断为RL。对于发生在子宫外特殊部位的平滑肌瘤，症状、体征、辅助检查缺乏特异性，术前易被漏诊，术中易忽略对腹膜后的全面探查而导致误治。对此，妇科医师应跳出平滑肌瘤即存在于盆腔的固有思维，对术中未探及的盆腔肿物，应考虑进行腹膜后探查，以降低漏诊率，提高RL诊疗的意识。

关键词: 腹膜后肿瘤, 平滑肌瘤, 子宫, 漏诊, 病例报告

Abstract:

Retroperitoneal leiomyoma (RL) is a rare disease. Because RL grows deep inside and has a complex anatomical relationship with the surrounding tissue, it's hard to diagnose RL by imaging before surgery. The confirmation of RL diagnosis usually depends on surgical exploration and postoperative pathology. This article reports a case of a 38-year-old woman who was found to have a pelvic mass one year earlier and underwent two previous surgeries at another hospital. Finally, during surgical exploration at our hospital, the mass was found to be located in the retroperitoneum, and the pathological diagnosis was RL. For leiomyomas occurring in unusual extra-uterine location, symptoms, signs, and auxiliary examinations lack specificity, making them frequently misdiagnosed before operation. This article discusses the diagnosis and treatment of retroperitoneal uterine leiomyoma, so as to enhance clinicians' understanding of this condition, and to reduce the rate of misdiagnosis through retroperitoneal exploration for those pelvic masses that were not explored during the operation.

Key words: Retroperitoneal neoplasms, Leiomyoma, Uterus, Missed diagnosis, Case reports

梁惠, 陈紫均, 罗意红, 雷南香. 盆腔腹膜后平滑肌瘤一例[J]. 国际生殖健康/计划生育杂志, 2026, 45(5): 390-394.

LIANG Hui, CHEN Zi-jun, LUO Yi-hong, LEI Nan-xiang. A Case of Pelvic Retroperitoneal Leiomyoma[J]. Journal of International Reproductive Health/Family Planning, 2026, 45(5): 390-394.

图/表 4

图1 经阴道超声图注：宫颈后方见一不规则实性肿物，局部与宫颈后壁分界不清，CDFI见少量血流信号。

图2 盆腔MRI图注：A 矢状面，B 水平面；子宫体中下段-宫颈后壁肌壁间/浆膜下见团块状影。

图3 术中所见注：腹膜后肿物，包膜完整，血管丰富。

图4 腹膜后肿物病理图注：见梭形平滑肌细胞，符合平滑肌瘤；HE染色×100，标尺=100 μm。

参考文献 19

[1]	Zhang Z, Shi F, She J. Robot-assisted tumorectomy for an unusual pelvic retroperitoneal leiomyoma: A case report[J]. Medicine(Baltimore), 2022, 101(31):e29650. doi: 10.1097/MD.0000000000029650.
[2]	von Mehren M, Kane JM, Armstrong SA, et al. NCCN Guidelines® Insights: Soft Tissue Sarcoma, Version 1.2025[J]. J Natl Compr Canc Netw, 2025, 23(12):498-506. doi: 10.6004/jnccn.2025.0058.
[3]	Smolle MA, van de Sande M, Hayes A, et al. Comparison of the 7th and 8th version of the AJCC classification system for soft tissue sarcomas of extremities and trunk in patients with localised, intermediate or high-grade disease treated at European tertiary sarcoma centres[J]. Eur J Surg Oncol, 2021, 47(8):2182-2188. doi: 10.1016/j.ejso.2021.03.252. pmid: 33865657
[4]	Trans-Atlantic RPS Working Group. Management of Recurrent Retroperitoneal Sarcoma (RPS) in the Adult: A Consensus Approach from the Trans-Atlantic RPS Working Group[J]. Ann Surg Oncol, 2016, 23(11):3531-3540. doi: 10.1245/s10434-016-5336-7. pmid: 27480354
[5]	赵丽红, 尹承勇. 盆腔腹膜后肿瘤误诊为子宫肌瘤2例[J]. 中国实用医药, 2018, 13(19):128-129. doi: 10.14163/j.cnki.11-5547/r.2018.19.073.
[6]	Poliquin V, Victory R, Vilos GA. Epidemiology, presentation, and management of retroperitoneal leiomyomata: systematic literature review and case report[J]. J Minim Invasive Gynecol, 2008, 15(2):152-160. doi: 10.1016/j.jmig.2007.12.009.
[7]	汤倩倩, 柳丽阳, 程广英, 等. 子宫及腹膜外平滑肌瘤一例误诊并文献复习[J]. 临床误诊误治, 2012, 25(12):8-9. doi: 10.3969/j.issn.1002-3429.2012.12.004.
[8]	Karray O, Boulma R, Abdi A, et al. Management of a giant retroperitoneal leiomyoma: a case report[J]. J Med Case Rep, 2018, 12(1):81. doi: 10.1186/s13256-018-1617-z.
[9]	Di Giuseppe J, Natalini L, Bordini M, et al. Diagnosis, treatment and clinical outcomes of extrauterine sites of leiomyomatosis: a systematic review[J]. Ann Med, 2025, 57(1):2546681. doi: 10.1080/07853890.2025.2546681.
[10]	Fukamachi N, Togami S, Iwamoto I, et al. Retroperitoneal uterine leiomyoma occurring 5 years after hysterectomy for fibroids[J]. J Obstet Gynaecol Res, 2007, 33(6):878-881. doi: 10.1111/j.1447-0756.2007.00672.x. pmid: 18001458
[11]	Panesar H, Dhaliwal HS. Iatrogenic Parasitic Leiomyomas: A Late and Uncommon Complication After Laparoscopic Morcellation[J]. Cureus, 2022, 14(5):e24718. doi: 10.7759/cureus.24718.
[12]	Chen JH, Yue CT, Lai CW. Vague abdominal discomfort for 5 years and a large upper abdominal mass in a 45-year-old woman[J]. Gastroenterology, 2012, 142(2):e12-13. doi: 10.1053/j.gastro.2011.02.070.
[13]	Billings SD, Folpe AL, Weiss SW. Do leiomyomas of deep soft tissue exist? An analysis of highly differentiated smooth muscle tumors of deep soft tissue supporting two distinct subtypes[J]. Am J Surg Pathol, 2001, 25(9):1134-1142. doi: 10.1097/00000478-200109000-00003. pmid: 11688572
[14]	Li J, Zhu-Ge YY, Lin KQ. Torsed retroperitoneal leiomyomas: A case report and review of literature[J]. World J Clin Cases, 2024, 12(21):4762-4769. doi: 10.12998/wjcc.v12.i21.4762. pmid: 39070816
[15]	Paal E, Miettinen M. Retroperitoneal leiomyomas: a clinicopathologic and immunohistochemical study of 56 cases with a comparison to retroperitoneal leiomyosarcomas[J]. Am J Surg Pathol, 2001, 25(11):1355-1363. doi: 10.1097/00000478-200111000-00002. pmid: 11684951
[16]	Lin HW, Su WC, Tsai MS, et al. Pelvic retroperitoneal leiomyoma[J]. Am J Surg, 2010, 199(4):e36-e38. doi: 10.1016/j.amjsurg.2009.05.039.
[17]	Yüksel D, Kilic C, Kodal B, et al. A rare case of a retroperitoneal leiomyomatosis[J]. J Gynecol Obstet Hum Reprod, 2021, 50(6):101760. doi: 10.1016/j.jogoh.2020.101760.
[18]	杨帆. 腹膜后肿瘤的影像诊断、手术及术后并发症的回顾性研究[D]. 广州: 南方医科大学, 2020. doi: 10.27003/d.cnki.gojyu.2019.000133.
[19]	刘雪琰, 赵孟玲, 付翰林, 等. 原发盆腔腹膜后肿瘤机器人辅助腹腔镜与传统腹腔镜手术并发症的比较及危险因素分析[J]. 现代妇产科进展, 2023, 32(2):108-112. doi:10.13283/j.cnki.xdfckjz.2023.02.005.