The Clinical Analysis Of922Cases With Uterine Leiomyomas

objective：The uterine leiomyoma is the most common benign tumor in the femalereproductive organs, See more at30to50years old woman.Statistics haveindicated, the disease incidence rate reaches as high as25%to30%. Mostpatients with uterine leiomyomas have obvious clinical symptoms，includingmenstrual changes, irregular vaginal bleeding，abdominal mass，sensations ofpressure in the pelvic cavity, sequential anemia, waist abdominal pain and thereproductive disability,ect. The uterine leiomyomas have caused seriousinfluence to the women’s health.The uterine leiomyoma always occurs in growth period women， atpresent, there’re not effective medicines can eradicate the uterine leiomyoma.For the uterine leiomyoma with clinical symptoms, the surgery is still the mostimportant method of treatment. The surgery scope including totalhysterectomy，myomectomy, and subtotal-hysterectomy.The way of surgerymay pass through the abdomen or the vagina,as well as under the laparoscopyor the hysteroscope which developed in recent years.This article has analyzed the clinical characteristic of the uterineleiomyoma and the degenerate leiomyoma.Through the analysis, this articlehas discussed the relationship of surgical approach with the patient’s age,clinical symptoms，the location and the size of the leiomyomas，the pathologictype and merger disease.The objective is summarizing the experience withdiagnosis and treatment. Make the surgical treatment of uterine leiomyomasmore standardized，humanized and personalized.Method:The clinical data and pathological result of the medical records of922surgically treated patients from October2009to October2010were retrospectively reviewed. And the distribution of patient’s age, the clinicalsymptoms, the diagnostic method, the choice of surgical approach and thepathologic type have been discussed. Setting up the database base on theEXCEL software, carrying on the statistical analysis with the SPSS16.0software. The comparison of the measurement data (such as blood loss,operation time, etc) application variance analysis, and comparisons betweentwo variables were based on LSD（Least Significant Difference Test）and SNK（Student Newman Kuels Test）,the counting data (such as previous pelvicsurgery material, etc) uses the χ2examination to test.Result：We got the results as follow: Among the922patients with uterineleiomyoma, the age concentrates in30to50years old women who are being inchildbearing years,which occupies the total sample83.19%. The age of30to40years old294cases, the age of40to50years old473cases. One of the mostcommon symptoms is menstrual changes,a total of398cases(43.17%)，In922cases,740cases had clinical symptoms(80.26%)，182cases had no evidentclinical symptoms(19.74%).In front of the surgery，913cases(99.02%)werediagnosed as hysteromyoma with ultrasound, the error diagnostic rate is0.98%.The main surgical method is myomectomy (48.16%).The surgicalapproach has statistic difference in different age section.The younger patientis,the bigger myomectomy accounting for the proportion is.In the group of17to30years, myomectomy accounts for100.00%.The odder patient is，thebigger hysterectomy accounting for the proportion is, In the group of≥50years，hysterectomy account for76.52%.The uterine leiomyoma with differentcharacteristic uses different surgical approach, The main surgical approach ofthe multiple leiomyoma is hysterectomy, occupies33.07%(209/632). The mainsurgical approach of the single leiomyoma is myomectomy.There is no obviousdifference in the choice of surgical approach between intermural myoma andsubserous myoma. All submucous myomas which diameter <5cm all use hysteroscopic myomectom as treatment, but the submucous myoma whichdiameter>5cm uses hysterectomy or subtotal-hysterectomy through theabdomen or vagina.The mini-trauma technology is suitable for the smallmyoma. The degenerate leiomyoma has186cases, accounts for20.17%. The40to50years old group is the list of fibroids degeneration age，two groups wasstatistically significant differences(P﹤0.05), fibroids degeneration wasage-related，perimenopausal women’s uterine fibroids produces denaturationratio is higher （44.09％），in which abound cell type have47cases. Thedegenerate leiomyoma which diameter is bigger than5cm is139cases(74.73%).In this group of cases,the uterine leiomyomas which incorporatewith chronic cervicitis most have159cases(17.25%), which incorporate withcervical polyp27cases(2.93%), which incorporate with cervical intraepithelialneoplasia(CIN) have10cases(1.08%)，in which CINI to CINII have4cases，there are2cases which make the biopsy before operations diagnosed definitelyas CINI to CINII； in which CINIII have6cases，there are1cases which makethe TCT examination before operations，the result is equivocal not typicalsquamous epithetlial（ASCUS）. There are2cases which make the biopsybefore operations diagnosed definitely as CINIII，implicates the glands. Amongthe922patients with uterine leiomyoma， simple hyperplasia of uterineendometrium have17cases(1.84%)； complex hyperplasia of uterineendometrium have2cases (0.22%)；polypus of uterine endometrium have53cases (5.75%)，cervical cancer have1case (0.11%). Endometriosis have161cases(17.46%)，adenomyosis have115cases，adenomyoma have5cases，endometrioid tumor have26cases，abdominal wall endometriosis1case，pelvicand other part endometriosis14cases. Ovarian benign tumor have101cases(10.95%)，in which parovarian cysts have8cases，endometrioid tumorhave26cases，ovarian maturity teratoma have10cases，simple ovarian cysts have13cases. Ovarian serous cystadenoma have10cases，in which ovarianborderline serous cystadenoma have2cases. Ovarian mucinous cystadenomahave3cases，in which ovarian borderline mucinous cystadenoma have2cases.Ovarian corpus luteum cysts have5cases，ovarian corpus luteum hematomahave4cases，ovarian follicles cysts have12cases，theca cell tumor have2cases，ovarian fibroma have3cases，ovarian inclusion cysts have2cases，ovarian encapsulated effusion have1case，ovarian serous adenofibroma have1case，ovarian leiomyoma have1case. Chronic salpingitis have19cases(2.06%)，hydrosalpinx have12cases (1.30%)，fallopian tube pyometra have4cases (0.43%). The chronic pelvic inflammation have10cases (1.08%).Chronic appendicitis have5cases (0.54%). Mild anemia have54cases(5.86%)，moderate anemia have107cases (11.61%)，severe anemia have15cases (1.63%).Conclusion：We obtain the conclusion as follow:1.The morbidity of uterineleiomyoma has the central tendency with age, most patients are between30-50year old;2. The main symptom of uterine leiomyoma is themenstrual change, the vaginal bleeding, the pain, the hypogastric lump,sensations of pressure in the pelvic cavity and sequential anemia, but thereare many patients without evident clinical symptoms.The physicalexamination which is very important for the woman at childbearing age, is theeffective method to discover uterine leiomyoma early;3. The ultrasound is themost important diagnostic method of the uterine leiomyoma.We should payattention to distinguishing uterine leiomyoma from adenomyoma, as well asovarian tumor. Hysteroscopy is suitable for the examination of submucousmyomas,as well as the treatment of submucous myomas;4. Surgery is still thebest therapy for uterine leiomyoma with clinical symptoms. The followingfactors should be considered when choosing to surgical appobache for uterineleromyomas:the age,reproductive requre,the location and size of the leiomymomas and so on.The main surgical appobache to treat uterineleiomyoma is myomectomy. The mini-trauma technology will be popularizedin the application to treatment of uterine leiomyoma;5. The bigger uterineleiomyoma is,the easier the degeneration is.The surgical treatment of aboundcell type degeneration fibroids should choose hysterectomy，and do the need toclose follow-up after hysteromyoma resection;6.The patient who wants toretain the uterus or the cervix should be making TCT conventionally beforeoperation.If the result has some suspicions, the patient should be making thecervical biopsy to obviate the cervical intraepithelial neoplasia or the earlyinvasive carcinoma of cervix. The patient whose age is slightly big,and whosevagina has bleeding irregularly, should be making fractional curettageconventionally to obviate the malignant pathological change of endometriumbefore operation.