病灶局限在盆腔的静脉平滑肌瘤病81例临床分析

目的:探讨病灶局限在盆腔的静脉内平滑肌瘤病（IVL）的临床特征、治疗方法，并分析IVL术后复发的影响因素。方法:收集2014年1月至2021年3月在浙江大学医学院附属妇产科医院接受手术治疗且术后病理检查证实病灶局限在盆腔的81例IVL患者的临床病理资料及随访资料，回顾性分析IVL患者的临床特征、治疗方法，并探讨IVL术...

Clinical analysis of 81 cases of intravenous leiomyomatosis confined to pelvic cavity

Objective To investigate the clinical features,treatment and recurrence factors of intravenous leiomyomatosis(IVL)confined to the pelvic cavity after the operation.Methods The clinical data of 81 patients who underwent surgery and were pathologically diagnosed with IVL at Women′s Hospital,School of Medicine,Zhejiang University from January 2014 to March 2021,were analyzed retrospectively to explore the influencing factors of postoperative recurrence of IVL,including age,gravidity and parity,surgical methods,intraoperative conditions and so on.Results(1)Clinical features:the age of 81 IVL patients was(43.9±8.1)years old;increased menstrual volume in 26 cases(32%,26/81),prolonged menstrual period in 31 cases(38%,31/81),frequency and urgency to urinate in 4 cases(5%,4/81),abdominal pain and abdominal distension in 8 cases(10%,8/81),and pelvic masses in 34 cases(42%,34/81).IVL was diagnosed right in 4 of 72 patients(6%,4/72)underwent preoperative ultrasound,right in 11 of 51 patients(22%,11/51)underwent magnetic resonance imaging(MRI),and right in 4 of 19 patients(4/19)underwent CT.(2)Treatment:all patients with IVL underwent surgical treatment.Surgical procedure:myomectomy in 37 cases,total hysterectomy and bilateral salpingectomy in 19 cases,total hysterectomy and bilateral salpingo-ophorectomy in 25 cases.Surgical approach:hysteroscopic operation in 6 cases,transabdominal operation in 52 cases,laparoscopic operation in 23 cases.Fifty-three cases underwent rapid intraoperative pathological examination,17 cases(32%,17/53)of them were diagnosed right as IVL.(3)Influencing factors of IVL postoperative recurrence:among 81 patients with IVL,3 cases were lost to follow-up,and 8 cases(10%,8/78)had recurrence during follow-up.Age<35 years,number of pregnancies<2,number of births<2,number of fibroids≥10,abnormal appearance of fibroids(long,vermicular,beadlike,cystic,etc.)and IVL invasion into adjacent vessels were all the risk factors influencing postoperative recurrence of IVL(all P<0.05).Methods of operation,ovariectomy or not,IVL invasion or not,maximum diameter of IVL,abundant blood vessels near uterine fibroids were not associated with postoperative recurrence of IVL(all P>0.05).Conclusions The clinical manifestations and preoperative auxiliary examination of IVL are lack of specificity.Doctors need to pay attention to young patients with uterine fibroids,and choose the appropriate surgical scope when the characteristic manifestations of IVL be found during the operation,or the right diagnoses of IVL in the surgery′s rapid intraoperative pathology be examined,and should remove the IVL lesions to reduce the recurrence as far as possible.