| Backround:Uterine leiomyoma is the most common benign tumor in the growth period,and it is the common and frequently occurring disease which affects the health of women.Leiomyoma mainly occurred in women with 30-50 years old,and it is one of the most common causes of gynecological surgery.Morphology of uterine leiomyoma is diversity.Diagnosis of typical leiomyoma and leiomyosarcoma is relatively easy.However,there are quite a lot of differences in some microscopic histological or clinical findings of biological behavior of myoma compared with common type of uterine leiomyoma,which are special types of uterine leiomyoma,and the most common one is cellular leiomyoma.Cellular leiomyoma is benign,and the clinical manifestation is similar to that of common uterine leiomyoma,while the ultrasound examination,intraoperativegross and microscopic appearance is unlike with ordinary ones,especially under a microscope,the cells arranged densely with little cytoplasm.Clinically found that some patients in this group tend to late recurrence,so understanding cell type characteristics of uterine fibroids,help to avoid excessive or insufficient treatment.Uterine leiomyoma are the main indications of hysterectomy in the United States,Germany,France,the United Kingdom and other countries,estimated at the age of childbearing women accounted for 20-30%[30-31].At present,the clinical operation use of hysterectomy or uterine fibroids removed.Patients with hysterectomy will suffer loss of fertility and menstruation or the imperfection of the pelvic floor structure,and some patients will appear ovarian failure or psychological barriers.In reproductive age young or has not been fertility of patients,with the change of China’s family planning policy,fertility two-child policy is open,the doctor in the treatment of uterine fibroids operation choice also should pay more attention to the patient’s fertility requirements and the desire of the uterus.In guarantee under the premise of women’s health,the uterus continues to play a reproductive function,make the treatment of uterine fibroids more humanization,individualization and standardization.With the development of minimally invasive techniques,improvement and perfection of endoscopic suturing techniques,laparoscopic surgery has become more and more important.Laparoscopic resection of uterine fibroids has been one of the main operations.The risk factors of laparoscopic surgery of uterine myoma are the recurrence and the crushing device in the pelvic cavity caused metastasis and residual implantation.Cellular uterine leiomyoma,which is similar to that of uterine malignant tumor on the cell morphology,is more likely to be benign in biological behavior.In this study,we retrospectively analyzed the clinical and pathological features of cellular leiomyoma of uterus according to their biological behavior and clinical outcomes.Found all types of operation choices for cellular leiomyoma under laparoscopy,especially the feasibility of laparoscopic myomectomy.Objective:Based on 148 cases,we investigated the clinical character,pathological features of cellular leiomyoma of uterus(CUL),discussed its biological behavior,clinical outcomes and the factors with recurrence,which guided we choose specific laparoscopic surgical means,especially the feasibility of laparoscopic myomectomy.Methods:Retrospectively analyzed 148 cases of patients with cellular leiomyoma between January 2012 and December 2014 in lishui Hospital and The Second affiliated Hospital of Zhejiang University.The clinical symptoms,signs and surgical methods,surgical findings and pathological results of CUL and other aspects have been statistical analyzed,and the follow-up.To investigate the postoperative recurrence,postoperative relapse or recurrence of 2 to 4 years follow-up after operation by using the grinder lathe cutting specimens.Results:Compared with ordinary leiomyoma,the cellular leiomyoma showed no significant differences in the age of onset,clinical symptoms and signs,ultrasound examination.66 cases of laparoscopic myomectomy;laparoscopic hysterectomy in 20 cases;laparoscopic hysterectomy in 30 cases;15 cases treated by abdominal hysterectomy;abdominal hysterectomy in 6 cases;11 cases of abdominal myomectomy,including cases with cervical carcinoma underwent radical hysterectomy to exclude.Another laparoscopic removal of uterine fibroids and uterine incision were taken to remove the specimen.Analysis showed that there are adverse consequences of the rotary cutting device:the small debris generated from the plant in the abdominal cavity,resulting in parasitic tumor growth and metastatic spread of malignant tumor,tissue damage to the pathological diagnosis.The risk factors of recurrence were age,the number of myoma,the location of myoma and the follow-up time.After 2-4 years follow-up,96 cases of comminuted had no parasitic myoma growth and metastasis of malignant tumors;four patients in 77 cases of patients with myomectomy had relapsed,those which preoperative were multiple myoma.And three cases had laparoscopic myomectomy while one case had abdominal myomectomy.Conclusions:Cellular uterine leiomyoma is a special type of uterine leiomyoma,which is a benign tumor of the uterine leiomyoma.The literature reported the possibility of late recurrence and metastasis.The cutting technique of laparoscopic uterine surgery is clear,and laparoscopic myomectomy is feasible.The grinder lathe cutting method did not increase the risk of surgery,surgical complications and recurrence or metastasis,planting,but this kind of patients should strengthen follow-up after operation. |
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