Clinical Analysis Of Intravenous Leiomyomatosis

Purpose: Objective to investigate the clinical features,clinical manifestations,preoperative and postoperative diagnosis,treatment options and prognosis of in patients with intravenous leiomyomatosis(IVL).Method: Methods the clinical and pathological data of 20 patients with admitted to The second hospital of Jilin University from September 2012 to August 2015 were retrospectively analyzed.The clinical data of the patients with IVL were collected and analyzed retrospectively.All statistical data are entered in Excel form.The preoperative examination,preoperative diagnosis,treatment and pathological diagnosis were analyzed statistically.All diagnoses were confirmed by 2 experienced pathologists.The 20 patients were admitted to hospital and underwent surgery.Result:(1)In this group of patients,the average age of the patients was 90% years old.The average age of the patients was about 45 years old.Patients admitted to surgery because of uterine fibroids or adenomyosis.All of the patients had no definite diagnosis of IVL before operation,all of them were diagnosed during and after operation.(2)There was no significant difference in preoperative examination of IVL patients.6 cases(30%)have myomatous tissues protruding to the both sides of the broad ligament;3 cases(15%)of cervical myoma near the isthmus(40%);8 cases of uterine intramural tumor vasculature from earthworms like bulge;2 cases(10%)cordlike protruding from the intravascular mass in the area of the attachment. (3)1 cases of childbearing,only underwent lesion resection;7 cases underwent hysterectomy;6 cases underwent hysterectomy and double appendix resection;5 cases underwent hysterectomy with bilateral tubal resection;1 cases underwent hysterectomy and salpingo resection and resection of the contralateral fallopian tube.All the patients were not treated with anti hormone therapy.Conclusion:(1)The onset of IVL was hidden,mostly come to premenopausal women.There were no obvious positive signs and examination results in the early stage of IVL,often because of uterine fibroids and adenomyosis or pelvic mass surgery,intraoperative and postoperative help clear diagnosis.(2)Preoperative suspected IVL patients for gynecological ultrasound,echocardiography and chest abdominal pelvic joint scan,if necessary for CTA examination,positive,active and full preoperative preparation.(3)For the preoperative detection of uterine fibroids in cervical isthmus,uterine horn,broad ligament etc.the rich blood supply area or intraoperative findings of uterine leiomyoma was beaded and cords,suggest rapid intraoperative pathological diagnosis,improve the rate of operation,reduce the rate of misdiagnosis.(4)For IVL tumor only located in utero,no fertility requirements of young women that underwent hysterectomy;as for fertility requirements of young womenthere are feasible lesion resection and postoperative close observation for timely detection of intravascular lesions and clear.45 years old or found outside the uterine vascular involvement,it is recommended that total hysterectomy and double accessory resection + ectopic lesion resection.For young women with adnexal lesions,whether or not to keep the contralateral fallopian tube,there is still a lack of a large number of clinical data.It is necessary to study the influence of the preservation of the contralateral ovary or the contralateral fallopian tube on the prognosis.the blood vessel surgery cooperation decides the surgery plan for IVL involves the inferior vena cava and the heart,and it needs the help of gynecology?obstetrics the and heart surgery department.According to the patient's condition,we can choose the treatment plan for one stage operation or staged operation.For patients with definite IVL in the operation and postoperative pathology,it is suggested that the CTA should be performed in the pelvic or abdominal cavity,and other residual lesions should be excluded.