腹腔镜切除小肠系膜平滑肌瘤1例并文献复习

Laparoscopic Resection of a Small Bowel Mesenteric Leiomyoma: A Case Report and Literature Review

摘要: 目的：探讨小肠系膜平滑肌瘤的临床特点、诊断方法及治疗策略，并结合文献复习提高对该罕见疾病的认识。方法：报道扬州大学附属医院收治的1例小肠系膜平滑肌瘤患者的临床资料，包括症状表现、影像学检查、手术治疗及病理结果。同时检索PubMed、Medline及Embase数据库相关文献，对已报道病例进行总结分析。结果：患者女性，25岁，因“进食时上腹部疼痛不适1周”入院。增强CT提示左上腹小肠旁约1.6 cm结节，术前考虑小肠间质瘤可能。患者接受腹腔镜肠系膜病灶切除术，术中发现肿瘤位于近端小肠系膜内，大小约2.0 cm，边界清晰，包膜完整。病理检查示梭形细胞肿瘤；免疫组织化学结果显示SMA阳性，CD117阴性，DOG-1阴性，CD34仅血管阳性，最终诊断为小肠系膜平滑肌瘤。患者术后恢复顺利，无明显并发症。文献复习显示，小肠系膜平滑肌瘤极为罕见，临床表现缺乏特异性，术前常被误诊为胃肠间质瘤或其他间叶源性肿瘤。结论：小肠系膜平滑肌瘤是一种罕见良性肿瘤，临床及影像学表现缺乏特异性，术前诊断困难。病理学及免疫组织化学检查是确诊的关键。腹腔镜完整切除安全有效，患者预后良好。

Abstract: Objective: To investigate the clinical characteristics, diagnostic approaches, and treatment strategies of small bowel mesenteric leiomyoma and to improve awareness of this rare disease through literature review. Methods: The clinical data of a patient with small bowel mesenteric leiomyoma treated at the Affiliated Hospital of Yangzhou University were retrospectively analyzed, including clinical presentation, imaging findings, surgical management, and pathological results. Meanwhile, relevant literature was reviewed through searches of PubMed, Medline, and Embase databases, and the reported cases were summarized and analyzed. Results: A 25-year-old woman presented with “postprandial upper abdominal pain and discomfort for one week”. Contrast-enhanced computed tomography revealed a 1.6-cm enhancing nodule adjacent to the small intestine in the left upper abdomen, and a gastrointestinal stromal tumor (GIST) was initially suspected. Laparoscopic mesenteric tumor resection was performed. Intraoperatively, a well-circumscribed encapsulated tumor measuring approximately 2.0 cm was identified within the proximal small bowel mesentery. Histopathological examination demonstrated a spindle-cell tumor. Immunohistochemistry showed positivity for smooth muscle actin (SMA) and negativity for CD117 and DOG-1, while CD34 staining was limited to vascular structures. The final diagnosis was mesenteric leiomyoma. The patient recovered uneventfully without postoperative complications. Literature review revealed that mesenteric leiomyoma is extremely rare and is frequently misdiagnosed preoperatively as GIST or other mesenchymal tumors because of its nonspecific clinical and radiological features. Conclusion: Small bowel mesenteric leiomyoma is a rare benign tumor with nonspecific clinical manifestations and imaging findings, making preoperative diagnosis challenging. Histopathological and immunohistochemical examinations remain essential for definitive diagnosis. Complete laparoscopic excision is a safe and effective treatment option with an excellent prognosis.