| Purpose:In order to explore the influence of uterine leiomyomas on the reproductive health of nulliparous young women,this paper conducts a statistical analysis on the incidence,pathogenic factors and clinical characteristics of uterine leiomyomas in nulliparous young women,changes in surgical methods,and postoperative recurrence factors to provide clinical research data for the prevention of uterine leiomyomas,early diagnosis,individualized and standardized management,and fertility protection for young women without childbearing.Method:This study collected 3,777 patients with uterine leiomyomas admitted to the hospital for uterine fibroids from January 2017 to December 2020 in the First Hospital of Jilin University,who were surgically treated and diagnosed with uterine leiomyomas by pathology.There were 582 patients with uterine leiomyomas aged 35 and younger,306 young nulliparous patients and 276 patients who had given birth.And 183 cases of nulliparous uterine fibroids were successfully followed up.Casecontrol method was used to analyze the incidence trend of nulliparous uterine fibroids aged 35 and below,the clinical characteristics of nulliparous uterine fibroids,fibroid degeneration and influencing factors,histopathological characteristics and clinical characteristics of special types of uterine fibroids,treatment and the clinical characteristics and risk factors of recurrence after myomectomy.Result:1.From January 2017 to December 2020,there were 3195 patients with uterine fibroids aged >35 years old,and 582 patients with uterine fibroids aged ≤35 years old,accounting for 15.4%（582/3777）,of which 306 cases were nulliparous patients,accounting for 52.6%（306/582）,and 276 cases of fertile patients,accounting for47.4%（276/582）.During the 4-year period,the incidence rate of nulliparous uterine fibroids patients aged ≤35 years showed a slow upward trend year by year,accounting for 8.1%（306/3777）of the total incidence of uterine fibroids during this period.2.The age of 306 young nulliparous patients ranged from 16 to 35 years old,with an average age of（29.55±3.74）years old,and the 276 young fertile patients ranged from 22 to 35 years old,with an average age of（32.31±2.43）years old.In young patients with uterine fibroids,the number of cases of nulliparous patients gradually increased with age,peaked at the age of 30,and then stabilized.There were46 cases with the treatment age ≤25 years old;the number of cases of fertile patients increased rapidly after the age of 28,there were only 4 cases with the age of treatment less than or equal to 25 years old.There was a significant difference in the age distribution of the two groups of patients（P<0.05）.Patients with nulliparous uterine fibroids are younger and have an earlier age of onset.3.Among the 306 cases of nulliparous patients,165 cases of uterine fibroids were found by physical examination,accounting for 51.4%.In the fertile group,115 cases were found by physical examination,accounting for 41.7%.The proportion of patients found by physical examination in the nulliparous group was significantly higher than that in the fertile group.In addition,in nulliparous patients,fibroids growing is the main symptom,followed by abnormal uterine bleeding,and in the fertile group,abnormal uterine bleeding is the main symptom.There was a statistically significant difference in clinical manifestations between the nulliparous group and the fertile group（P<0.05）.38.3%（75/196）of nulliparous but married patients with uterine fibroids were infertile.4.Among the 582 young patients,there was a statistically significant difference between the location distribution of uterine fibroids during nulliparous and fertile group（P<0.05）,but intramural fibroids were the most common,accounting for 50.0%and 55.0%.In the nulliparous group,there were 46 patients aged 16-25 years,including 10 patients with giant uterine fibroids（fibroids diameter ≥ 10 cm）;260patients aged 26-35 years,including 24 patients with giant uterine fibroids.The difference between groups was statistically significant（P<0.05）.5.Among the 306 cases of nulliparous uterine fibroids,34 cases were degenerated uterine fibroids,accounting for 11.1%,and the incidence of degeneration in patients with fibroids aged 16-25 years was significantly higher than that in patients aged 26-35 years（P<0.05）.The incidence of degenerated uterine fibroids with a diameter of ≥5cm was significantly increased（P<0.05）.Degeneration fibroids were mainly intramural fibroids,followed by subserosal fibroids,while submucosal fibroids basically did not degenerate（P<0.05）,but had nothing to do with the number of fibroids（P> 0.05）.6.The most common type of special uterine fibroids aged 35 and below is cellular leiomyoma,accounting for 73.4%.Among the nulliparous patients with uterine fibroids,there were 23 patients with cellular leiomyomas.Most of the cellular leiomyomas were multiple（P<0.05）,regardless of the size of the uterine fibroids.And in cellular leiomyomas,ultrasonography mostly suggested that the internal echo was uneven（P<0.05）.Uterine fibroids with uncertain malignant potential were mainly seen in the nulliparous group,accounting for 6.9%,and angioleiomyomas were mainly found in the fertile group,accounting for 16.1%.7.The proportion of patients with endometrial lesions and adenomyosis in the nulliparous group was not significantly different from that in the fertile group,while the incidence of endometriosis and tubo-ovarian tumors was higher than that in the fertile group,and the incidence of pelvic inflammatory disease was significantly lower than that of the fertile group,and there was a statistically significant difference between the two groups of patients with gynecological diseases（P<0.05）.8.Among the 306 nulliparous patients collected in this study,only one patient with uterine fibroids combined with primordial uterus underwent total hysterectomy;the remaining 305 patients were selected for myomectomy.Among the 276 fertile patients,5 patients underwent subtotal hysterectomy;5 patients underwent total hysterectomy（3 patients had intravenous leiomyomatosis）;and 266 patients opted for myomectomy.The choice of surgical methods between the two groups was statistically significant difference（P<0.05）.9.Among the 183 cases of uterine fibroids in nulliparous women who were successfully followed up,51 cases recurred after surgery,accounting for 27.9%.The time of recurrence fluctuated from 7 to 43 months,with an average of（21.08±9.927）months.The median time to recurrence was 21 months.Among the 51 patients with postoperative recurrence of uterine fibroids,there was no significant difference in postoperative delivery between the two groups（P>0.05）.There were significant differences in family history,preoperative Gn RH-a treatment,postoperative exogenous hormone intake,special types of uterine fibroids,multiple uterine fibroids,and previous history of fibroid surgery between the recurrence group and the nonrecurrence group（P<0.05）.The multivariate analysis showed that family history,preoperative Gn RH-a treatment,previous history of fibroids surgery,and postoperative exogenous hormone intake were independent risk factors for postoperative recurrence of uterine fibroids（P<0.05）.Conclusion:1.The incidence rate of uterine fibroids in young nulliparous women shows a slow upward trend,and they are younger.It can be seen that some patients with uterine fibroids have constituted an influencing factor of infertility.2.Most of young nulliparous women with uterine fibroids have no clinical symptoms,finding by physical examination,they are prone to large uterine fibroids,easy to edema and degeneration,and more cellular leiomyoma,showing uncertain malignant potential tumor.Early detection,early diagnosis and early prevention are particularly important.3.Conservative surgery is the main method for uterine fibroids in young nulliparous women,but it is easy to recur after surgery.Strictly grasp the surgical indications before surgery,reduce preoperative intervention,encourage early completion of childbirth,and strengthen psychological counseling and management. |
PDF Full Text Request