The Clinical Analysis Of 798 Cases With Uterine Leiomyomas

The uterine leiomyoma is the most common benign tumor in the female reproductive organs, also is one of most common benign tumors in the human body.Statistics have indicated, the disease incidence rate reaches as high as 25%~30%.The majority of patients demonstrate clinically significant symptoms, including abnormal uterine bleeding, Sequential anemia, sensations of pressure in the pelvic cavity, pain and the reproductive disability,ect. The prevalence has severely affected women's healthy conditions.At present, there're not effective medicines can eradicate the uterine leiomyoma. For the uterine leiomyoma with clinical symptoms, the surgery is still the most important method of treatment. The surgery scope including myomectomy, subtotal-hysterectomy and total hysterectomy.The way of surgery may pass through the abdomen or the vagina ,as well as under the laparoscopy or the hysteroscope which developed in recent years.This article has analyzed the clinical characteristic of the uterine leiomyoma and the degenerate leiomyoma.Through the analysis , this article has discussed the relationship of surgical approach with the patient's age, the location and size of the leiomymomas, the pathologic type.The objective is summarizing the experience with diagnosis and treatment .Method: The clinical data and pathological result of the medical records of 798 surgically treated patients from September 2006 to September 2007 were retrospectively reviewed. And the distribution of patient's age, the clinical symptoms, the diagnostic method, the choice of surgical approach and the pathologic type have been discussed. Setting up the database base on the EXCEL software, carring on the statistical analysis with the SPSS software, the counting data uses theχ2 examination to test.We got the results as follow: Among the 798 patients with uterine leiomyoma, the age concentrates in 30~50 years old women who are being in childbearing years,which occupies the total sample 84. 46%. In 798 cases,656 cases had clinical symptoms(82.20%),206 cases had no evident clinical symptoms(25.82%).In front of the surgery,784 cases(98.24%)were diagnosed as hysteromyoma with ultrasound , the error diagnostic rate is 1.38%.The main surgical method is myomectomy (50.25%).The surgical approach has statistic difference in different age section.The younger patient is,the bigger myomectomy accounting for the proportion is.In the group of 20~30 years, myomectomy accounts for 96.97%.The odder patient is,the bigger hysterectomy accounting for the proportion is, In the group of≥50 years , hysterectomy account for 69.23%.The uterine leiomyoma with different characteristic uses different surgical approach, The main surgical approach of the multiple leiomyoma is hysterectomy, occupies 36.92%(151/409). The main surgical approach of the single leiomyoma is myomectomy, approximately occupies 55%~70%.There is no obvious difference in the choice of surgical approach between intermural myoma and subserous myoma. All submucous myomas which diameter <5cm all use hysteroscopic myomectom as treatment,but the submucous myoma which diameter >5cm uses hysterectomy or subtotal-hysterectomy through the abdomen.The mini-trauma technology is suitable for the small myoma. The degenerate leiomyoma has 68 cases, accounts for 8.52%, the age distribution of normal uterine leiomyoma is similar to degenerate uterine leiomyoma. The clinical symptom is also similar. The degenerate leiomyoma which diameter is bigger than 4cm is 62 cases (91.1%).In this group of cases,the uterine leiomyomas which incorporate with cervical intraepithelial neoplasia(CIN) have 11 cases(1.38%),in which CINIII have 5 cases.There are 2 cases which make the TCT examination before operations,the resule is hight-grade squamous intraepithelial lesions. There are 4 cases which make the biopsy before operations diagnosed definitely as CINIII. There is one case which have not be diagnosed before operations, the pathological result after hysterectomy is hight-grade squamous intraepithelial lesions (CINIII),implicates the gland partially. Among the 798 patients with uterine leiomyoma,simple hyperplasia of uterine endometrium have 25 cases (3.13%),polypus of uterine endometrium have 22 cases (2.76%),endometrial carcinoma 3 cases (0.37%).Among the 3 cases,there are 2 cases which make fractional curettage before operations diagnosed definitely as endometrial carcinoma, there is one case which make fast pathology in operation,the resule is complex hyperplasia,the canceration partially.We obtain the conclusion as follow: 1.The morbidity of uterine leiomyoma has the central tendency with age, most patients are between 30-50 year old; 2. The main symptom of uterine leiomyoma is the menstrual change, the vaginal bleeding, the pain, the hypogastric lump, sensations of pressure in the pelvic cavity and sequential anemia, but there are many patients without evident clinical symptoms.The physical examination which is very important for the woman at childbearing age, is the effective method to discover uterine leiomyoma early;3. The ultrasound is the most important diagnostic method of the uterine leiomyoma.We should pay attention to distinguishing uterine leiomyoma from adenomyoma, as well as ovarian tumor. Hysteroscopy is suitable for the examination of submucous myomas,as well as the treatment of submucous myomas; 4. Surgery is still the best therapy for uterine leiomyoma with clinical symptoms. The following factors should be considered when choosing to surgical appobache for uterine leromyomas:the age,reproductive requre,the location and size of the leiomymomas and so on.The main surgical appobache to treat uterine leiomyoma is myomectomy. The mini-trauma technology will be popularized in the application to treatment of uterine leiomyoma; 5. The bigger uterine leiomyoma is,the easier the degeneration is.And the benign degeneration has no special clinical manifestations.It is difficulty to diagnose degeneration of uterine leiomyomas befor operation;6. The patient who wants to retain the uterus or the cervix should be making TCT conventionally before operation.If the result has some suspicions, the patient should be making the cervical biopsy to obviate the cervical intraepithelial neoplasia or the early invasive carcinoma of cervix. The patient whose age is slightly big ,and whose vagina has bleeding irregularly, should be making fractional curettage conventionally to obviate the malignant pathological change of endometrium before operation.