有少数患红细胞增多症的妇女合并子宫肌瘤。协和医院1956~1977年共诊治红细胞增多症65例,其中女性18例,合并子宫肌瘤者5例。国外文献报道13例女性患者,她们除了子宫肌瘤外,找不到足以引起红细胞增多的原因。瘤体一般较大,可如足月妊娠。有的将子宫肌瘤切除后,血红蛋白、红细胞及其他血象恢复正常,追踪数年未见复发;而有的子宫肌瘤复发后,红细胞增多症也跟着出现。这虽不是普遍现象,但说明红细胞增多症与子宫肌瘤两者有一定关系。早期文献曾报道有关子宫肌瘤引起红细胞增多的几种假设,但未得公认,故确切机制尚待进一步研究。
手术切除子宫肌瘤。但这类患者因血液浓缩黏滞,容易发生血栓,耐受手术的能力低于一般患者,加之术后红细胞迅速下降,会引起相对贫血,也可使患者难于适应。原有心血管系统异常者,则术后可能出现并发症。有的因血红蛋白迅速下降,可引起末梢神经相对营养不良和缺氧,发生多发性神经炎。因而术前多次少量放血,或给予α-干扰素治疗,将红细胞和血红蛋白控制在一定水平后再行手术,有利于减少并发症。
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