48例Ⅰ期子宫静脉内平滑肌瘤病临床分析

Clinical data analysis of 48 patients with stage I uterine intravenous leiomyomatosis

目的 研究Ⅰ期子宫静脉内平滑肌瘤病(IVL)病例临床特征,为其治疗及预后的临床管理提供理论依据。方法 回顾性分析2013年12月至2021年12月于本院经手术治疗且病理确诊的48例IVL患者临床资料,对临床治疗结果进行统计分析。结果 患者平均年龄为(46.68±7.45)岁,7例(14.58%)有子宫肌瘤切除史,13例(27.08%)有剖宫产史,临床表现及辅助检查缺乏特异性。45例患者术中行冰冻病理检查,32例提示IVL,5例提示子宫良性病变。获得随访的病例有40例,随访中位时间为48个月,3例复发,复发率7.5%。单因素分析显示手术方式的选择对IVL复发有显著影响(P=0.012);不同手术方式及术后应用GnRH激动剂(GnRH-a)对复发率影响的Kaplan-Meier生存曲线分析结果显示,子宫肌瘤切除术患者较子宫切除术、子宫及附件切除术患者IVL复发率显著升高(P=0.009),术后是否应用GnRH-a对复发无显著性影响(P=0.243)。结论 IVL治疗主要以手术为主,手术方式影响Ⅰ期IVL患者的复发率,而术后是否应用GnRH-a对疾病复发率无明显影响。

Objective:To analyze the clinical characteristics of the patients with stage I uterine intravenous leiomyomatosis(IVL),in order to provide a theoretical basis for the clinical management of their treatment and prognosis.Methods:The clinical data of 40 IVL patients with surgical treatment and pathological diagnosis in our hospital from December 2013 to December 2021 were retrospectively analyzed, and the clinical examination results were statistically analyzed.Results:The average age of the patients was(46.68±7.45) years. Seven patients(14.5%) had a history of hysteromyomectomy, 13 patients(27.08%) had a history of cesarean section, and the clinical manifestations and auxiliary examinations were not specific. Forty-five patients underwent frozen pathological examination during operation, 32 patients showed IVL,and 5 patients showed benign uterine lesions. Forty patients were followed up, and the median follow-up time was 48 months. Three patients recurred and the recurrence rate was 7.5%. Univariate analysis showed that the operation mode was related to the recurrence of IVL(P=0.012).The results of Kaplan-Meier survival curve analysis of different operation mode and postoperative effect of GnRH agonist(GnRH-a) on recurrence rate showed that patients with myomectomy had a higher recurrence rate of IVL than patients with hysterectomy and adnexectomy(P=0.009),and whether GnRH-a is applied after operation had no significant effect on recurrence(P=0.243) Conclusions:IVL treatment was mainly based on surgery. The operation mode affects the recurrence rate of patients with stage I IVL,while whether GnRH-a is taken after operation has no significant effect on the recurrence rate.