Clinical Characteristics And Prognosis Of 51 Cases Of Intravenous Leiomyomatosis

Objective:To investigate the clinical features and prognosis of intravenous leiomyomatosis(intravenous leiomyomatosis,IVL).Methods: 51 patients with intravenous leiomyomatosis who received surgical operation in Shengjing Hospital of China Medical University from June 2012 to November 2020 were selected.The disease characteristics,diagnosis and treatment were retrospectively analyzed,followed up and prognosis were analyzed,and different surgical methods and patients’ postoperative recovery were compared.Results: The mean age of these 51 patients was 43.92±7.50 years old,41.2%(21/51)of them had a history of uterine fibroids,and 11.8%(6/51)had undergone hysteromyoma nucleation.33.3%(17/51)saw the doctor with abnormal menstrual changes as the main symptom,and 96.1(49/51)received specialist examination suggesting irregular enlargement of uterus.The diagnosis of IVL depends on imaging examination.In this study,the preoperative diagnosis rate was 5.9%(3/51),ultrasound diagnosis accounted for5.9%(3/51),and computed tomography(CT)showed that IVL only accounted for 10.0%(1/10).The preoperative CA125 level of 20.0%(7/35)patients was higher than normal;All patients received surgical treatment.Total bilateral adnexectomy accounted for 29.4%(15/51),while only hysterectomy accounted for 23.5%(12/51),and intraoperative diagnosis of IVL reached 47.1%(24/51).Follow-up period ranged from 3 months to 9 years.Three of the 45 patients had recurrence,with a recurrence rate of 6.7%,and the remaining patients had no recurrence.Compared with laparoscopic total hysterectomy group,patients with total abdominal hysterectomy were younger,lesion size,amount of blood loss,postoperative catheter retention time were all higher than those of laparoscopic total hysterectomy group(P < 0.05).Conclusion: The clinical manifestations of IVL lack specificity.Preoperative imaging examination has a low diagnostic accuracy.Patients with a history of uterine fibroids,such as parauterine mass,irregular shape and degeneration,should be alert to the possibility of IVL;All patients with high suspicion of IVL should undergo intraoperative cryopathology;Compared with transabdominal surgery,laparoscopic surgery has a smaller incision,which can significantly shorten the operation time and reduce the amount of surgical bleeding.However,the operation is more difficult and requires skilled and experienced doctors to implement it.IVL is easy to relapse,and long-term follow-up is needed.