Clinical Analysis Of 86 Cases Of Uterine Borderline Leiomyoma

Objective: Study the related pathogenesis,clinical features,pathological features,diagnosis and treatment methods and prognosis of uterine borderline leiomyoma.Methods: The clinical and pathological data of 86 uterine borderline leiomyoma patients admitted to Dalian Maternal and Child Health Hospital from June 1,2009 to June 30,2019 were retrospectively analyzed,and the characteristics of the cases were summarized.Summarize the characteristics of the case,study the postoperative pathology and diagnosis and treatment,and follow up the postoperative period to observe the prognosis.Results:From June 1,2009 to June 30,2019,86 patients with uterine borderline leiomyoma were admitted to Dalian maternal and child health hospital,including 53IVL(intravascular leiomyomatosis,IVL)patients,30 STUMP(smooth muscle tumor of uncertain malignant potential,STUMP)and 3 DUL(diffuse uterine leiomyomatosis,DUL)patients.Factors related to the incidence of uterine borderline leiomyoma include age,fertility history,menopause,family history,history of surgery,etc.Among them,the study found that age is a risk factor for IVL.For every unit of surgery age,the probability of IVL is 1.307 times that of the original.The family history of uterine fibroids is a risk factor for STUMP.Patients with family history have STUMP.The probability is 7.602 times that of patients without family history.Patients with uterine borderline leiomyoma have different disease durations,and their clinical manifestations are similar to those of benign uterine leiomyoma,including symptoms such as pelvic mass,increased menstrual flow,and prolonged menstrual periods.Gynecological examination often finds that the uterus is irregularly enlarged or touches clear boundary pelvic masses of various sizes.Auxiliary examinations include ultrasound,CT,MRI,etc.Most patients have a solid hypoechoic mass,similar to benign uterine leiomyoma,lacking features,difficult preoperative diagnosis,and the main diagnosis depends on postoperative pathology.The gross and microscopic pathological characteristics of different types of uterine borderline leiomyomas are different.Some IVL patients show intravascular fibroids or cord-like objects,and some STUMP patients have fibroids that are crunchy and rotten.Jelly-like substance,fibroids diffused and normal myometrium disappeared in some patients with DUL.At present,the main treatment of uterine borderline leiomyomas is surgery.The surgical methods vary according to the individual patient's situation,including uterine fibroids enucleation,total uterus and bilateral salpingectomy,total uterus and bilateral attachment Resection and so on.Ten patients with uterine borderline leiomyoma were lost to follow-up,with a follow-up rate of88.4%.The longest follow-up time was 105 months and the shortest follow-up time was3 months.Most patients had good prognosis,only 2 cases recurred,and the recurrence rate was low.Conclusion:At present,the pathogenesis of borderline leiomyoma of uterus is not clear,which may be related to hormone level,genetic factors,abnormal gene expression,etc.the related factors include age,family history,operation history,etc.Due to the lack of characteristics of clinical manifestations,clinical aspects should be combined with the patient's medical history,auxiliary examination and the presence of disease-related factors to be aware of the occurrence of such diseases,to avoid misdiagnosis.Frozen pathological examination should be carried out in time during the operation to determine the further operation mode,and the diagnosis mainly depends on the postoperative pathology.In addition,the choice of surgical methods and the effect of adjuvant drug treatment for this kind of disease need to be discussed.At present,the treatment method is mainly surgery.The choice of surgical methods needs to be combined with the patient's age and fertility requirements.During the operation,the focus should be completely removed as much as possible,and the circumcision device should be used carefully to avoid the spread of myoma.Most of the patients with uterine borderline leiomyoma have a good prognosis and less recurrence,but there is still a long-term risk of malignant change,which needs long-term close follow-up.