| Leiomyoma of uterus(Uterine smooth muscle tumors,USMT)is the most common tumor in the female reproductive system,the incidence rate is about 60%-80%,most of which are benign,reported the canceration rate is about 0.3%-2.02%(Uterine,leiomyosarcoma,ULMS of uterine leiomyosarcoma)the high degree of malignancy,the preoperative diagnosis rate is low.The prognosis is bad.Is that between benign and malignant uterine fibroids are an atypical leiomyoma(Uterine atypical,leiomyoma,UAL),including a cell type(Cellular leiomyoma,CL),mitotic activity,cell type,type of singular uncertain malignant potential of uterine fibroids,the cellular leiomyoma is the most common subtype.The clinical manifestations and common type of leiomyoma similar with benign process,but the histological diagnosis standard of performance which is different from the common leiomyoma cells did not reach malignant cells,recurrent malignant potential,the preoperative diagnosis rate is low,the pathological diagnosis depends on postoperative.In this study,through the collection of2010.01-2015.12 in 3534 cases of primary diagnosis of uterine leiomyoma and hospitalized in First Affiliated Hospital of Hebei North University(comprehensive three hospitals),surgically treated patients with clinical data,establish a database,using the retrospective analysis method and the control group,USMT,CL,ULMS three groups of age of onset,clinical manifestations,preoperative examination,surgical procedure selection and effect of comparative study,and on the understanding of the application of the fibroids crushing,in order to improve the early diagnosis of the disease,choose the suitable operation mode,make the treatment moreindividualized,standardized.The study showed that the average age of the patients in group USMT was 46.72 + 7.13 years and the median age was 43 years.The average age of the patients in group CL was 47.95 + 7.45 years,with a median age of47.The average age of patients in group ULMS was 53.43 + 9.37 years,and the median age was 53 years old.The average age of onset in group ULMS was later than that in the other two groups.The difference was statistically significant(P<0.05).The clinical manifestations of the three groups were similar.There was a significant difference between the ULMS group and the other two groups(P <0.05).There was no significant difference in menstrual change,postmenopausal bleeding,abdominal mass and other clinical manifestations(P>0.05).The preoperative B type ultrasound examination was similar in the three groups of USMT,CL and ULMS,and the specific diagnostic index of the special type of uterine myoma was lacking.Studies have shown that when the observation index is resistance to blood flow(RI),RI <0.4 can be used as a threshold to indicate the malignant transformation of uterine leiomyoma,which can provide help for correct diagnosis before operation.In group USMT,CL and ULMS,there were 51.1%,67.7% and 76.5% of patients who underwent curettage because of abnormal vaginal bleeding before operation.The positive rate of postoperative pathological results was low,and the missed diagnosis rate was 84.6%.Preoperative diagnostic curettage did not improve the preoperative diagnosis rate of specific uterine leiomyoma.In group USMT,57.2% of the total hysterectomy patients and38.1% of the women who retained the uterus accounted for 63.7% of the total hysterectomy in group CL,and the proportion of those who retained the uterus was 30.7%.There was no significant difference between the two groups in group USMT and group CL(P>0.05).Group ULMS is based on total hysterectomy to determine the scope of operation based on the specific conditions and the prognosis is poor.The proportion of minimallyinvasive surgery in group USMT increased from 33.8% of2010.01-2012.12 to 56.8% of 2013.01-2015.12,indicating that the proportion of micro invasive surgery has increased.The advantages and disadvantages of intraoperative application of fibroid smashing device are still controversial. |
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