Disseminated peritoneal leiomyomatosis after laparoscopic surgery and literatures review

Abstract

Objective To explore the prevention, diagnosis and treatment of disseminated peritoneal leiomyomatosis (DPL) after laparoscopic surgery. Methods Retrospectively analyzed the clinical data of 3 cases of DPL patients after laparoscopic surgery in Guangdong Women and Children′s Hospital, and reviewed 14 domestic and foreign literatures about the DPL after laparoscopic surgery by literature retrieval.And summarized the clinical characteristics, prevention, diagnosis and treatment of DPL after laparoscopic surgery. Results ① The cases histories data of 3 patients with DPL after laparoscopic surgery were as following: all cases had laparoscopic myomectomy(LM) histories, and used uterine shredder to remove fibroids; no obvious symptoms and signs were shown, just found pelvic mass by routine health examination; preoperative diagnosises were uterine leiomyoma, and intraoperative DPL was found and took surgical resection with good postoperative recovery. ② Clinical characteristics of DPL patients in 14 domestic and foreign literatures and this paper were analyzed. There were 24 DPL patients after laparoscopic surgery, pathological results were leiomyoma, all had LM or laparoscopic subtotal hysterectomy (LSH) histories, and the histories of removing the fibroids by uterine shredder. All patients were women of childbearing age, 20.8%(5/24) patients were not yet pregnant and childbearing; 8.3%(2/24) patients had taken estrogen or progesterone treatment; 58.3%(14/24) patients had no special symptoms and signs, only found pelvic or uterine mass by routine health examination, 25.0%(6/24) patients with the symptom of abdominal pain, others had abdominal distensions and discomforts, or menstrual flow increased; 33.3%(8/24) patients had twice or more histories of uterine surgery. Conclusions Patients with uterine leiomyoma should be carefully selected for their abdominal surgery mode and the use of uterine shredder, and should take measures to prevent fragment tissues of fibroids disseminating in pelvic and abdominal cavity. Individualized treatment should be taken for DPL patients. Key words: Uterine neoplasms; Leiomyomatosis; Laparoscopy; Peritoneal neoplasms; Morcellation; Women