Clinical Characteristics And Postoperative Recurrence Of Cellular Uterine Leiomyoma

Uterine leiomyoma is the most common benign tumor of female reproductive organs.Surgery is still the main treatment for women with severe symptoms.Follow-up of postoperative pathology,cellular uterine leiomyoma has attracted our attention.It is the most common subtype of special uterine leiomyoma,accounting for 95.45%of special uterine leiomyoma.Clinical symptoms are similar to those of ordinary uterine leiomyoma,which can lead to abnormal menstruation,abdominal mass,abdominal pain,abortion and other symptoms,causing great trouble to women.Long-term follow-up showed that the postoperative recurrence rate of uterine leiomyoma was close to 50%.About 1/3 patients eventually needed reoperation,while CUL was more likely to relapse.CUL is a borderline tumor with malignant potential and easy recurrence and metastasis after operation.Because its clinical manifestation is difficult to distinguish from ordinary uterine leiomyoma,clinicians lack of understanding of it,clinical treatment often ignores the nature of its borderline tumor,and treats it as ordinary uterine leiomyoma,resulting in rapid recurrence and even malignant transformation of CUL.ObjectiveA retrospective study was conducted to explore the clinical characteristics of CUL,the risk factors of postoperative recurrence and the efficacy of mifepristone and Gosserrelin acetate in preventing recurrence after operation,so as to enhance clinicians’ understanding of CUL,and provide reference for the use of drugs after operation.Methods1.The clinical data of 349 patients with CUL who underwent surgery in Zhujiang Hospital of Southern Medical University,the third affiliated Hospital of Guangzhou Medical University and Guangdong Maternal and Child Health Hospital from January 1,2010 to December 30,2019 were retrospectively analyzed.In addition,432 patients with common uterine leiomyoma(Ordinary uterine leiomyoma,OUL)and 31 patients with uterine leiomyosarcoma(Uterine leiomyosarcoma,ULMS)were collected.To analyze the clinical characteristics of patients with CUL,such as age composition,clinical manifestation,preoperative anemia and choice of operation methods,and compare the clinical characteristics of CUL,OUL and ULMS:2.From January 1,2010 to September 30,2019,127patients with CUL who underwent myomectomy in the above three hospitals and excluded the residual myoma were collected.The recurrence of leiomyoma in patients with CUL was followed up by telephone,Wechat and outpatient reexamination.the difference of clinical characteristics between recurrent group and non-recurrent group and the risk factors of postoperative recurrence were analyzed.3.75 patients with CUL who underwent myomectomy in Zhujiang Hospital of Southern Medical University from January 1,2010 to April 20,2018 were divided into three groups according to different postoperative treatment methods to explore the efficacy of mifepristone and Gosserrelin acetate in preventing recurrence of CUL.Conclusions1.The incidence of CUL was high in childbearing age,and the incidence decreased after menopause,and the incidence of CUL was the highest in 40-49 years old.Abnormal menstruation is the most common clinical symptom of CUL,followed by myoma in asymptomatic physical examination.More than 1/3 CUL patients developed preoperative anemia,of which severe anemia accounted for 56.6%of anemia.Myomectomy is the main surgical treatment of CUL patients,and laparoscopic surgery is the most common choice.2.Compared with the clinical features of CUL and OUL,the average age of onset in CUL was younger than that in OUL,but the maximum diameter of leiomyoma in CUL was larger than that in OUL.There is no significant difference in the number of pregnancy and delivery,the history of cesarean section,myoma degeneration,the number of leiomyoma,preoperative anemia and other characteristics,it is difficult to distinguish between the two through the general clinical features.3.Compared with the clinical characteristics of CUL and ULMS,the average age of onset in CUL is younger than that in ULMS.In addition,the proportion of patients with multiple parturition and multiple pregnancies in ULMS was higher,and there were more patients with abnormal increase of serum CA-125 before operation.Most patients with CUL have no obvious clinical manifestations and tumors are found by physical examination,but most ULMS patients see a doctor because of various symptoms,of which ULMS is more likely to have symptoms of postmenopausal vaginal bleeding.There was no significant difference between the two groups in the history of cesarean section,the maximum diameter of tumors,preoperative anemia and so on.4.The proportion of patients with multiple myomas and the largest diameter of myoma larger than 50mm in the recurrent group after CUL was higher than that in the non-recurrent group,and the difference was statistically significant.There was no significant difference between the two groups in age,pregnancy and delivery,myoma degeneration,preoperative anemia,mode of operation and so on.The number of fibroid was an independent risk factor for CUL recurrence.The more the number of leiomyomas,the easier it is to relapse after CUL.5.From the observation of short-term and long-term efficacy,the use of mifepristone and Gosserrelin acetate after CUL can not reduce the probability of myoma recurrence,and the use of drugs has some side effects.Therefore,mifepristone and Gosserrelin acetate are not recommended to prevent the recurrence of leiomyoma after operation.