Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2016, Vol. 38 ›› Issue (4): 438-443.doi: 10.3881/j.issn.1000-503X.2016.04.013

• Orginal Article • Previous Articles     Next Articles

Surgical Treatment Strategies of Intravenous Leiomyomatosis with Right Cardiac Cavities Extension

Guo-tao MA1, Qi MIAO1(), Xing-rong LIU1, Chao-ji ZHANG1, Yue-hong ZHENG2, Jiang SHAO2, Ning-hai CHENG3, Shun-da DU4, Jian-zhou LIU1, Chao JIANG5   

  1. 1Department of Cardiac Surgery, PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    2Department of Vascular Surgery, PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    3Department of Obstetrics and Gynecology, PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    4Department of Hepatic Surgery, PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    5Department of Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2015-06-11 Online:2016-08-20 Published:2016-08-20

Abstract:

Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis(IVL)extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015.The following variables were studied: age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,origins of IVL,blood loss,duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence. Results Thirteen of 30 patients reported double lower limb edema. The cardiopulmonary bypass was applied in 27 cases,and the average duration of cardiopulmonary bypass was(106.9±53.7)min. Then,21 patients were treated with the deep hypothermic circulatory arrest,and the mean time was(28.2±11.6) min. The tumors originated from the genital veins in 9 cases,the iliac vein in 13 cases,and both veins in 8 cases. The average intra-operative blood loss volume was (2060.5±2012.3)ml,and 21 patients received blood transfusion. The average hospitalization time was(18.9±8.3)days and the average hospitalization expenses was (80 840.4±28 264.2)RMB yuan. While 14 patients had postoperative complications,there was no serious postoperative complication or death.All patients have shown a favorable outcome. Conclusions Tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected in patients with multiple hysteromyoma. Successful therapy for IVL with right cardiac cavities extension is dependent on reasonable surgical treatment strategies. Surgical removal of the ovaries is vital to avoid IVL re-grow or recurrence.

Key words: intravenous leiomyomatosis, right cardiac cavities, surgical treatment strategies

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